ADHD Medication Adherence: A Parent-Provider Intervention Modeled From HIV

ADHD 药物依从性：以 HIV 为模型的家长干预措施

• 批准号: 7163097
• 负责人: ELIZABETH A PAPPADOPULOS
• 金额: $ 20.93万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-26 至 2009-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7163097
• 关键词: AIDS therapy; attention deficit disorder; audiotape; behavior therapy; behavioral /social science research tag; caregivers; clinical research; clinical trials; educational resource design /development; emotions; expectancy; focus groups; health care service availability; human subject; mental disorder chemotherapy; middle childhood (6-11); parent offspring interaction; parents; patient oriented research; questionnaires; self concept; therapy compliance; therapy design /development

DESCRIPTION (provided by applicant): This R34 application develops a provider-administered intervention to improve medication adherence and persistence in caregivers and their children with Attention Deficit Hyperactivity Disorder (ADHD). Utilizing the Theory of Planned Behavior (TPB) (Fishbein & Ajzen, 1975; Ajjzen & Fishbein, 1980) and Communication Theory (CT), we propose a conceptual framework and intervention modeled from HIV research. Although inadequate adherence and persistence prevents children with ADHD from realizing the full therapeutic benefits of stimulant pharmacotherapy and contributes to poor long-term outcomes, stimulant noncompliance rates range from 20-65% (Swanson et al., 2003); moreover, compliance tends to decline over time and treatments are often maintained for only a few months. Although efforts to adequately address this clinical problem are limited, major theoretical and methodological advances in the development of HIV behavior change interventions could potentially improve treatment outcomes in children with mental health problems. The present approach will build on adaptations of TPB and CT, identifying parents and providers as key change agents (Jaccard & Dittus, 2003; Jammot et al., 2003). During Phase I of the proposed study (6 months), which involves focus groups with 10 psychiatrists and 90 parents of children (6-11 years) with ADHD, we identify specific attitudes, beliefs, subjective norms, and barriers that underlie adherence to medication treatments. In Phase II (6-12 months), we utilize this information to develop and administer surveys to a cross-sectional sample of 120 parents. In Phase III (12-36 months), we use survey results to create a clinician-initiated intervention that is tailored to needs of children with ADHD and their parents. The study addresses 2 specific aims: AIM 1: To identify factors associated with medication adherence and persistence using constructs from the Theory of Planned Behavior (i.e., attitudes, expectancies, subjective norms, self-efficacy, and barriers) and classic communication theory (what is said, how it is said, who says it to whom, when it is said) in a survey of 120 parents of children with ADHD who have been diagnosed within an 18 month period and identified from open and closed medical records. AIM 2: To use information from Aim 1 to develop and pilot an ADHD medication adherence intervention and parent educational toolkit in a 6-month RCT of 40 parents of medication naive children with ADHD.

描述（由申请人提供）：此R34应用程序开发了一种提供者的管理干预措施，以改善护理人员及其患有注意力缺陷多动障碍（ADHD）的儿童的药物依从性和持久性。利用计划行为理论（TPB）（Fishbein＆Ajzen，1975； Ajjzen＆Fishbein，1980）和通信理论（CT），我们提出了一种根据HIV研究建模的概念框架和干预措施。尽管依从性不足和持久性使患有多动症儿童无法实现刺激药物治疗的全部治疗益处，并导致长期不良的结果，但兴奋剂的不合规率范围为20-65％（Swanson等人，2003年）；此外，合规性往往会随着时间的流逝而下降，而治疗通常仅几个月。尽管为充分解决这个临床问题的努力是有限的，但艾滋病毒行为改变干预措施发展的主要理论和方法论进步可能会改善心理健康问题儿童的治疗结果。目前的方法将基于TPB和CT的改编，将父母和提供者识别为关键变更代理（Jaccard＆Dittus，2003; Jammot等，2003）。在拟议的研究的第一阶段（6个月）期间，涉及有10位精神科医生和90名儿童父母（6-11岁）的焦点小组，我们确定了遵守药物治疗基础的特定态度，信念，主观规范和障碍。在第二阶段（6-12个月）中，我们利用此信息来开发和管理调查，以对120个父母的横断面样本进行调查。在第三阶段（12-36个月）中，我们使用调查结果来创建临床医生发起的干预措施，该干预措施是根据多动症儿童及其父母的需求量身定制的。该研究解决了2个具体目的：目标1：目的1：确定与药物依从性和持久性相关的因素，使用计划的行为理论（即态度，期望，预期，主观规范，自我效能和障碍）和经典沟通理论（态度，期望，主观规范，自我效能和障碍）和经典沟通理论（何时对谁说，何时诊断，何时介绍了一个人，何时介绍了一个人，何时介绍了一名父母，该父母及时享受了一名父母，该父母及其及时及时。封闭的病历。 AIM 2：使用AIM 1的信息来开发和试行多动症药物依从性干预措施和父母教育工具包，其中6个月的40名药物父母幼稚的儿童患有多动症。