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: 7475697
• 负责人: VIVIAN KAFANTARIS
• 金额: $ 29.21万
• 依托单位: FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH
• 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 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7475697
• 关键词: Address; Adherence; Adolescent; Age; Antiviral Agents; Attention deficit hyperactivity disorder; Attitude; Behavior; Belief; Caregivers; Child; Clinical; Combined Modality Therapy; Communication; Development; Diagnosis; Disease model; Dose; Emotions; Ensure; Expectancy; Focus Groups; Goals; HIV; Health behavior change; Intervention; Link; Medical Records; Mental Health; Mental disorders; Methods; Modeling; National Institute of Mental Health; Outcome; Parenting behavior; Parents; Persuasive Communication; Pharmaceutical Preparations; Pharmacotherapy; Phase; Physicians; Planning Theory; Provider; Psychiatrist; Range; Rate; Research; Risk-Taking; Sampling; Self Concept; Self Efficacy; Surveys; Symptoms; Therapeutic; Time; Treatment Protocols; Treatment outcome; base; behavior change; communication theory; condoms; cooperative study; improved; innovation; medication compliance; prevent; programs; provider intervention; social skills; theories; therapy development; treatment planning

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 申请开发了一种由提供者管理的干预措施，以提高患有注意力缺陷多动障碍 (ADHD) 的护理人员及其孩子的药物依从性和持久性。利用计划行为理论 (TPB)（Fishbein 和 Ajzen，1975；Ajjzen 和 Fishbein，1980）和沟通理论 (CT)，我们提出了一个以艾滋病毒研究为模型的概念框架和干预措施。尽管依从性和持久性不足会阻碍 ADHD 儿童充分发挥兴奋剂药物治疗的疗效，并导致长期结果不佳，但兴奋剂不依从率在 20-65% 之间（Swanson 等人，2003 年）；此外，随着时间的推移，依从性往往会下降，治疗往往只能维持几个月。尽管充分解决这一临床问题的努力有限，但艾滋病毒行为改变干预措施发展方面的重大理论和方法进展可能会改善患有心理健康问题的儿童的治疗结果。目前的方法将建立在 TPB 和 CT 的基础上，将父母和提供者确定为关键的变革推动者（Jaccard & Dittus，2003；Jammot 等，2003）。在拟议研究的第一阶段（6 个月）期间，包括由 10 名精神科医生和 90 名 ADHD 儿童（6-11 岁）家长组成的焦点小组，我们确定了依从药物治疗的具体态度、信念、主观规范和障碍治疗。在第二阶段（6-12 个月），我们利用这些信息对 120 名家长进行横断面抽样调查并进行调查。在第三阶段（12-36 个月），我们利用调查结果来制定临床医生发起的干预措施，以满足多动症儿童及其父母的需求。该研究有 2 个具体目标： 目标 1：使用计划行为理论（即态度、期望、主观规范、自我效能和障碍）和经典沟通理论（什么是这样说的、怎么说的、谁对谁说的、何时说的），这是一项针对 120 名多动症儿童家长的调查，这些儿童在 18 个月内被诊断出来，并从公开和封闭的角度进行了识别医疗记录。目标 2：利用目标 1 的信息，在 40 名未接受药物治疗的 ADHD 儿童家长进行的为期 6 个月的随机对照试验中，开发和试点 ADHD 药物依从性干预和家长教育工具包。