title: Facilitators and barriers of medication adherence in pediatric liver and kidney transplant recipients: a mixed-methods study.
abstract: OBJECTIVE
  Many young transplant patients (≤11 years old) struggle to take their immunosuppressive and co-medications correctly, yet it remains unclear which factors positively or negatively affect medication adherence. Research studies on determinants in this age group are scarce, have methodological flaws, and focus exclusively on immunosuppressants or on barriers rather than on facilitators.
  
  
  METHODS
  This study used a consecutive mixed-methods (qualitative + quantitative) design. Semistructured interviews with parents of 10 pediatric liver or kidney transplant recipients 2 to 11 years old on adherence facilitators and barriers were conducted, complemented by quantification of adherence to the immunosuppressants and co-medications, and completion of the "immunosuppressive medication adherence barriers" self-report instrument.
  
  
  RESULTS
  A median of 19 (range, 10-29) barriers was reported: the most commonly encountered were forgetfulness (70%), vomiting (70%), bad taste (60%), and interruptions in routine (60%). Parents reported a median of 15 facilitators (range, 6-26), including using practical aids (100%), having medication with you at all times (100%), having to take fewer medications (80%), and experiencing fewer regimen changes over time (80%). No clear distinction between immunosuppressants or co-medications was made.
  
  
  CONCLUSIONS
  This study provides several new insights based on peer experience to support future patients and their parents in medication adherence.
authors.affiliation: University of Leuven, Leuven, Belgium.
authors.forename: Anouck
authors.initials: A
authors.lastname: Claes
authors.affiliation: University Hospitals of Leuven, Leuven, Belgium.
authors.forename: Anneloes
authors.initials: A
authors.lastname: Decorte
authors.affiliation: University Hospitals of Leuven, Leuven, Belgium.
authors.forename: Elena
authors.initials: E
authors.lastname: Levtchenko
authors.affiliation: University of Leuven, Leuven, Belgium University Hospitals of Leuven, Leuven, Belgium.
authors.forename: Noel
authors.initials: N
authors.lastname: Knops
authors.affiliation: University of Leuven, Leuven, Belgium.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Dobbels
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007223:Infant; D007407:Interviews as Topic; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008297:Male; D055118:Medication Adherence; D010290:Parents / Q000523:psychology*; D066027:Transplant Recipients
chemical_list: D007166:Immunosuppressive Agents