title: Can You Teach a Teen New Tricks? Problem Solving Skills Training Improves Oral Medication Adherence in Pediatric Patients with Inflammatory Bowel Disease Participating in a Randomized Trial.
abstract: BACKGROUND
  Medication nonadherence is associated with higher disease activity, greater health care utilization, and lower health-related quality of life in pediatric inflammatory bowel diseases (IBD). Problem solving skills training (PSST) is a useful tool to improve adherence in patients with chronic diseases but has not been fully investigated in IBD. This study assessed feasibility, acceptability, and preliminary efficacy of PSST in pediatric IBD.
  
  
  METHODS
  Recruitment occurred during outpatient clinic appointments. After completion of baseline questionnaires, families were randomized to a treatment group or wait-list comparison group. The treatment group received either 2 or 4 PSST sessions. Youth health-related quality of life was assessed at 3 time points, and electronic monitoring of oral medication adherence occurred for the study duration.
  
  
  RESULTS
  Seventy-six youth (ages 11-18 years) on an oral IBD maintenance medication participated. High retention (86%) and treatment fidelity rates (95%) supported feasibility. High satisfaction ratings (mean values ≥4.2 on 1-5 scale) supported intervention acceptability. Modest increases in adherence occurred after 2 PSST sessions among those with imperfect baseline adherence (d = 0.41, P < 0.10). Significant increases in adherence after 2 PSST sessions were documented for participants aged 16 to 18 years (d = 0.95, P < 0.05). Improvements in health-related quality of life occurred after 2 PSST sessions. No added benefit of 4 sessions on adherence was documented (d = 0.05, P > 0.05).
  
  
  CONCLUSIONS
  Phone-delivered PSST was feasible and acceptable. Efficacy estimates were similar to those of lengthier interventions conducted in other chronic illness populations. Older adolescents benefited more from the intervention than their younger counterparts.
authors.affiliation: *Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois; †Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; ‡Department of Pediatrics, The University of Chicago, Chicago, Illinois; and §Department of Pediatrics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Rachel N
authors.initials: RN
authors.lastname: Greenley
authors.forename: Amitha P
authors.initials: AP
authors.lastname: Gumidyala
authors.forename: Eve
authors.initials: E
authors.lastname: Nguyen
authors.forename: Jill M
authors.initials: JM
authors.lastname: Plevinsky
authors.forename: Natasha
authors.initials: N
authors.lastname: Poulopoulos
authors.forename: Molly M
authors.initials: MM
authors.lastname: Thomason
authors.forename: Jennifer G
authors.initials: JG
authors.lastname: Walter
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Wojtowicz
authors.forename: Ellen
authors.initials: E
authors.lastname: Blank
authors.forename: Ranjana
authors.initials: R
authors.lastname: Gokhale
authors.forename: Barbara S
authors.initials: BS
authors.lastname: Kirschner
authors.forename: Adrian
authors.initials: A
authors.lastname: Miranda
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Noe
authors.forename: Michael C
authors.initials: MC
authors.lastname: Stephens
authors.forename: Steven
authors.initials: S
authors.lastname: Werlin
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Kahn
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D011340:Problem Solving; D011788:Quality of Life; D011795:Surveys and Questionnaires