Evaluation of a group-based behavioral intervention to promote adherence in adolescents with inflammatory bowel disease
Open accessAbstract
OBJECTIVE: To pilot test the feasibility and acceptability of a family-based group behavioral intervention and to improve medication adherence in adolescents diagnosed with inflammatory bowel disease. METHODS: Participants were 40 adolescents aged 11-18 years diagnosed with inflammatory bowel disease and their primary caregivers, who were randomized to either a four-session Family-Based Group Behavioral Treatment or Usual Care over a 6-week period. Adherence was measured using a multi-method, multi-informant assessment involving caregiver-report and patient-report, pill count data, and electronic monitoring. RESULTS: Adherence rates ranged from 66 to 89% for 6-mercaptopurine/azathioprine and 51 to 93% for mesalamine across assessment methods. The intervention was feasible, as evidenced by the 99% treatment session attendance rate, and acceptable based on patient and caregiver report. Repeated measures analysis of variance tests revealed nonsignificant differences between the conditions from baseline to post-treatment assessments for pill count, electronic monitor, and primary caregiver-reported adherence (P's>0.05). There was a statistically significant improvement in patient-reported mesalamine adherence represented by a significant main effect for Condition (F=22.24, P<0.01; δ=0.79) and Condition×Time interaction (F=13.32, P<0.05; δ=0.69). CONCLUSION: Findings suggest potential for use of behavioral intervention to improve medication adherence in this population. This intervention may be more effective with more complex regimens (e.g. multiple doses per day) such as those prescribed with mesalamine. Further research is needed to examine this type of intervention in more diverse samples with more active disease. Use of alternative adherence measurement approaches, including electronic pill boxes and/or real-time self-report (e.g. by text messaging, electronic diaries, etc.) is also recommended.
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Parents gave higher ratings than adolescents for two interventions by Hommel et al. to promote medication adherence.
“and parents gave higher ratings than adolescents for two interventions by Hommel et al. to promote medication adherence 26, 27 .”
From A Systematic review of self-management interventions for children and adolescents with inflammatory bowel disease (2019) · cites this paper as [26]
The Introduction and Methods > Measures describe a medication-adherence intervention rated by patients and caregivers. Results > Descriptive Data and the Discussion say both groups rated it highly acceptable, but the retrieved passages do not establish that parents rated it higher than adolescents. This paper evaluates one intervention; the sentence cites two Hommel studies collectively. (LLM, conf=0.83)
Experimental — accuracy not yet measuredAdolescents rated the convenience of attending the sessions lower (4.95) compared to their parents' acceptability mean (5.88).
“Adolescents rated the convenience of attending the sessions lower (4.95) compared to their parents acceptability mean range of (5.88).”
From A Systematic review of self-management interventions for children and adolescents with inflammatory bowel disease (2019) · cites this paper as Hommel et al (2012)
The Methods > Measures section says adolescents and caregivers rated convenience of attendance on the Feasibility and Acceptability Questionnaire. Results > Descriptive Data says their ratings are summarized in Table 3, but the available passages do not give the 4.95 and 5.88 means or establish the claimed comparison. (LLM, conf=0.78)
Experimental — accuracy not yet measuredBoth parents (5.41) and adolescents (5.25) highly rated the intervention for helping to improve adherence.
“Both parents (5.41) and adolescents (5.25) highly rated the intervention for helping to improve adherence.”
From A Systematic review of self-management interventions for children and adolescents with inflammatory bowel disease (2019) · cites this paper as Hommel et al (2012)
The Discussion (page not provided) says patients and caregivers rated the intervention highly acceptable, including its perceived impact on treatment adherence. The Methods > Measures section confirms that both groups rated adherence-related impact on a seven-point scale, but the passages in our copy do not substantiate the specific parent and adolescent scores of 5.41 and 5.25. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThree interventions used skills training to improve medication adherence.
“Three interventions used skills training to improve medication adherence 25,26, 27 .”
From A Systematic review of self-management interventions for children and adolescents with inflammatory bowel disease (2019) · cites this paper as [26]
Treatment satisfaction and acceptability was measured in four trials and ratings were mostly positive.
“Treatment satisfaction and acceptability was measured in four trials (.,Hommel et al. 2012., Hommel et al. 2011, Reigada et al.) 25-28 and ratings were mostly positive.”
From A Systematic review of self-management interventions for children and adolescents with inflammatory bowel disease (2019) · cites this paper as [26]
Three trials assessed medication adherence but findings were inconsistent.
“Three trials assessed medication adherence 25-27 but findings were inconsistent.”
From A Systematic review of self-management interventions for children and adolescents with inflammatory bowel disease (2019) · cites this paper as [26]
Hommel et al. 2012 found a beneficial effect on one of the assessed medications, but only for patient-reported adherence whereas other measures of adherence - pill count, electronic monitor and parent-report - were not significant.
“Hommel et al. 2012found a beneficial effect on one of the assessed medications, but only for patient-reported adherence whereas other measures of adherence - pill count, electronic monitor and parent-report - were not significant 26 .”
From A Systematic review of self-management interventions for children and adolescents with inflammatory bowel disease (2019) · cites this paper as [26]
The structure of the intervention (information, number of sessions, length and commitment time) had similar ideal ranges of high acceptability mean ratings between parents and adolescents.
“The structure of the intervention (information, no. sessions, length and commitment time) had similar ideal ranges of high acceptability mean ratings between parents and adolescents.”
From A Systematic review of self-management interventions for children and adolescents with inflammatory bowel disease (2019) · cites this paper as Hommel et al (2012)
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- Authors
- Hommel, K. A., Hente, E. A., Odell, S., Herzer, M., Ingerski, L. M., Guilfoyle, S. M., & Denson, L. A.
- Affiliations
- Cincinnati Children's Hospital Medical Center (US)
- Cleveland Clinic (US)
- Children's Mercy Hospital (US)
- St. Jude Children's Research Hospital (US)
- Corresponding author
- Hommel, Kevin A.
- Venue
- European Journal of Gastroenterology & Hepatology
- Published
- 2012-01
- Volume
- 24
- Issue
- 1
- Pages
- 64-69
- ISSN
- 0954-691X (ISSN-L)
- PMC
- PMC3233635
- OpenAlex
- W2047596123
- Cited by
- 55
- References
- 27
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 2 · 2023: 6 · 2022: 2 · 2021: 2 · 2020: 5 · 2019: 3 · 2018: 5 · 2017: 7 · 2016: 1 · 2015: 7 · 2014: 6 · 2013: 4 · 2012: 1
- FWCI
- 3.24
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- European Journal of Gastroenterology & Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5ul1rr026314-03)
- U.S. Public Health Service
- National Institute of Diabetes and Digestive and Kidney Diseases (K23DK079037, P30DK078392)
- National Center for Research Resources (UL1-RR026314)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Health Professions › Speech and Hearing › Adolescent and Pediatric Healthcare
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Keywords
- inflammatory bowel disease, medication adherence, adolescents, 5-aminosalicylic acid, 6-mercaptopurine, azathioprine, feasibility and acceptability, patient-reported adherence
- MeSH terms
- Assessment of Medication Adherence, Adolescent, Adolescent Behavior, Adult, Anti-Inflammatory Agents, Non-Steroidal, Azathioprine, Behavior Therapy, Child, Drug Administration Schedule, Drug Combinations, Epidemiologic Methods, Family Therapy, Female, Humans, Immunosuppressive Agents, Male, Middle Aged, Self Administration, United States, Mercaptopurine, Inflammatory Bowel Diseases, Drug Monitoring, Caregivers, Mesalamine, Medication Adherence
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