Non-adherence to immunosuppressant medications is common among adolescent liver transplant recipients, and is a leading cause of chronic rejection and graft loss, particularly following the transfer from pediatric to adult-centered transplant care. There is a critical need to promote medication adherence in this high risk group. The objective of this project is to design and evaluate a tailored intervention delivered using web-based and cell phone text messages to promote medication adherence in adolescent liver transplant recipients. The pro- posed intervention will be delivered using technology to reduce the time and access constraints often encoun- tered with traditional adherence interventions. The proposed application is innovative because it incorporates tailored communication and technology to allow for the provision of behavior change information that is adapted to fit the unique characteristics, motivation, and behavioral patterns of the individual. This project is significant because it provides an urgently needed tailored intervention to enhance medication adherence among adolescent liver transplant recipients. The proposed research aims will be accomplished in 2 phases and will integrate qualitative and quantitative research methods. In Phase 1, the candidate will work with the University of Michigan Center for Health Communications Research (CHCR) to build upon preliminary work to develop a tailored medication adherence intervention for adolescent liver transplant recipients. The intervention will involve tailored educational, motivational and behavioral strategies delivered through cell phone text mes- sages and web-based modules. Tailoring variables will include perceived medication adherence, allocation of responsibility for health management tasks, barriers to medication adherence, values, sources of motivation (e.g., intrinsic/extrinsic), and regimen knowledge. The candidate will conduct focus groups and semi-structured interviews to assess the relevance and usability of tailored text messages and web-based modules. In Phase 2, the candidate will conduct a randomized pilot feasibility test of the intervention among 40 adolescent liver transplant recipients to explore the impact of the intervention on medication adherence. To evaluate the acceptability of the intervention, the candidate will conduct a process analysis using semi-structured interviews to evaluate participant reaction and receptivity. Career development activities will include training in advanced theories and techniques related to the implementation of tailored behavioral interventions, advanced knowledge of the design and conduct of mixed methods research, and evaluation of cost effectiveness. The goals of this project will be accomplished with the support of a multidisciplinary and highly experienced team of mentors with expertise in health behavior theory, pediatric health services research, qualitative research methods and pediatric transplantation. This research agenda, coupled with the acquisition of health behavior research skills and interaction with mentors and supporting faculty, will advance the career development of Dr. Emily Fredericks, a pediatric psychologist, as a productive, independent investigator.

Public Health Relevance

The proposed research is relevant to public health because medication non-adherence in adolescent liver transplant recipients is associated with substantial clinical and economic consequences. By using technology to communicate individually relevant information to adolescents, the proposed intervention could remarkably enhance medication adherence and could potentially reach large numbers of adolescents with minimal incremental costs. Thus, the proposed research is relevant to the part of NIH's mission that pertains to the application of knowledge to extend healthy life and reduce the burdens of illness.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Mentored Patient-Oriented Research Career Development Award (K23)
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Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Program Officer
Podskalny, Judith M,
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University of Michigan Ann Arbor
Schools of Medicine
Ann Arbor
United States
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Bilhartz, Jacob L; Lopez, M James; Magee, John C et al. (2015) Assessing allocation of responsibility for health management in pediatric liver transplant recipients. Pediatr Transplant 19:538-46
Whitfield, Emily P; Fredericks, Emily M; Eder, Sally J et al. (2015) Transition readiness in pediatric patients with inflammatory bowel disease: patient survey of self-management skills. J Pediatr Gastroenterol Nutr 60:36-41
Fredericks, Emily M; Magee, John C; Eder, Sally J et al. (2015) Quality Improvement Targeting Adherence During the Transition from a Pediatric to Adult Liver Transplant Clinic. J Clin Psychol Med Settings 22:150-9
Gleit, Rebecca; Freed, Gary; Fredericks, Emily M (2014) Transition Planning: Teaching Sexual Self-Management. Contemp Pediatr 31:16-22
Duncan, Christina L; Mentrikoski, Janelle M; Wu, Yelena P et al. (2014) Practice-Based Approach to Assessing and Treating Non-Adherence in Pediatric Regimens. Clin Pract Pediatr Psychol 2:322-336
Fredericks, Emily M; Zelikovsky, Nataliya; Aujoulat, Isabelle et al. (2014) Post-transplant adjustment--the later years. Pediatr Transplant 18:675-88
Drayton, Amy K; Andersen, Melissa N; Knight, Rachel M et al. (2014) Internet guidance on time out: inaccuracies, omissions, and what to tell parents instead. J Dev Behav Pediatr 35:239-46
Andersen, Melissa N; Dore-Stites, Dawn; Gleit, Rebecca et al. (2014) A pilot study of the association between sleep disturbance in children with liver transplants and parent and family health-related quality of life. J Pediatr Psychol 39:735-42
Wu, Yelena P; Rohan, Jennifer M; Martin, Staci et al. (2013) Pediatric psychologist use of adherence assessments and interventions. J Pediatr Psychol 38:595-604
Sundaram, Shikha S; Alonso, Estella M; Haber, Barbara et al. (2013) Health related quality of life in patients with biliary atresia surviving with their native liver. J Pediatr 163:1052-7.e2

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