Are two youth-focused interventions sufficient to empower youth with chronic health conditions in their transition to adult healthcare: a mixed-methods longitudinal prospective cohort study

• Published in: BMJ open Vol. 5; no. 5; p. e007553
• Main Authors: Gorter, Jan Willem, Stewart, Deb, Cohen, Eyal, Hlyva, Oksana, Morrison, Andrea, Galuppi, Barb, Nguyen, Tram, Amaria, Khush, Punthakee, Zubin
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 06.05.2015; BMJ Publishing Group
• Subjects: Activities of daily living; Adolescent; Adult; Adults; Canada; Caregivers; Chronic Disease; Chronic illnesses; Delivery of Health Care - organization & administration; Empowerment; Female; Goal setting; Humans; Likert scale; Longitudinal Studies; Male; Patient-Centred Medicine; Pediatrics; Pediatrics - organization & administration; Prospective Studies; Qualitative Research; Questionnaires; Self Efficacy; Surveys and Questionnaires; Transition to Adult Care - standards; Transition to Adult Care - statistics & numerical data; Websites; Young Adult; Canada; Longitudinal research; Transition into adult heathcare; Disabilities; Chronic conditions; QUALITATIVE RESEARCH
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2014-007553

Objectives To assess use, utility and impact of transition interventions designed to support and empower self-management in youth with chronic health conditions during transition into adult healthcare. Design A 4-year mixed-method prospective cohort study. Setting 2 academic paediatric hospitals (13 clinics) in Canada. Participants 50 adolescents (42% male; mean age 17.9±0.9 years; 20 underlying diagnoses) with transfer to adult care planned within 1 year. Interventions The Youth KIT (an organisational tool that includes goal setting activities); an online transition mentor. Main outcome measures Frequency of use, utility and impact of the transition interventions; goal achievement; post-transfer qualitative interviews with youth. Results 50 participants were enrolled during their last year of paediatric care; 36 (72%) were followed into adult care. All participants had access to the transition interventions from enrolment until the end of the study (exposure time: 12–47 months). Most youth (85%) reported using the medical/health section of the Youth KIT at least once; 20 (40%) participants engaged in chats with the mentor. The overall perceived utility of both interventions was modest; the Youth KIT received the highest ratings for ‘help with goal setting’: (mean (SD): 4.2 (2.3)) on a 7-point Likert scale. 45 (90%) participants set 294 transition goals. Goal achievement performance and satisfaction increased over time (p≤0.001). The qualitative evidence revealed reasons behind the variability in use and utility of the interventions, the interconnectedness of life-course and healthcare transitions, and the need for stronger partnerships between paediatric and adult healthcare systems. Conclusions Participants’ perceptions about the utility of the Youth KIT and the online mentor were modest. Transition supports need to be carefully tailored, timed and integrated into healthcare systems. Individualised goal setting may be an important ‘active ingredient’ in optimising transition supports and outcomes. Interventions that focus on youth only are insufficient for empowering self-management.