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Poor transition knowledge causes decreased self-efficacy in teens with heart disease
According to recent data in The Journal of Pediatrics, poor transition readiness for pediatric patients with heart disease results in knowledge deficits associated with decreased self-efficacy, self-management skills and quality of life.
“Greater transition knowledge and perceived self-efficacy are associated with better psychosocial quality of life,” Karen Uzark, PhD, CPNP, of the departments of pediatrics and cardiac surgery at the University of Michigan Mott Children’s Hospital, and colleagues wrote.
The researchers developed and administered a transition readiness assessment to 164 patients, aged 13 to 25 years, with congenital heart disease or who had undergone heart transplantation. The assessment included questions related to patient perception of their own knowledge and capacity, in terms of self-efficacy, self-management behaviors, autonomy regarding use of medications, making appointments and asking questions.
The average percentage of items assessed with no knowledge, or the perceived knowledge deficit score, was 25.7%. Deficits in knowledge were negatively related to self-efficacy and self-management (P < .0001), while higher psychosocial quality of life scores were associated with lower gaps in knowledge and (P = .01) higher perceived self-efficacy scores (P < .0001).
In addition, a request for information checklist was added to gauge patients’ desire to fill knowledge gaps. Sixty-six percent of patients requested this information, most commonly centered on exercise and stress management.
“Routine assessment of transition readiness with patient and provider recognition of transition knowledge and behavior deficits will prompt interventions to promote successful transition to adulthood and maximize lifelong physical and psychosocial functioning,” Uzark and colleagues wrote.
In a related editorial, Adrienne H. Kovacs, PhD, of the University Health Network Toronto, and Gary D. Webb, MD, of Cincinnati Children’s Hospital Medical Center, voiced their approval for the researchers’ transition readiness assessment, but wrote that challenges remain.
“First, from a practical standpoint, how do we use information gleaned from tools like the Transition Readiness Assessment developed by Uzark, et al?” Kovac and Webb wrote. “Second, how do we assess transition readiness and provide appropriate transition care to patients without the cognitive ability to eventually assume full responsibility for their health care management? [And] third, given that there are multiple stakeholders in the transition process, how can we evaluate and improve transition readiness among parents, pediatric providers, and adult providers?” – by David Costill
Disclosure: The researchers report no relevant financial disclosures.
