Review on barriers to medical adherence among chronically ill adolescents

Teenagers with chronic illnesses face special barriers that may interfere with how well they adhere to their medical treatment, according to a new review in the Journal of Adolescent Health.

"The most surprising finding for us was that some barriers seem to be specific to adolescence and probably related to adolescent development itself," said Kirsten Boisen, PhD., MD, pediatric staff specialist at the Center of Adolescent Medicine at Copenhagen University Hospital Rigshospitalet in Denmark, and an author of the review.

About 10 percent of adolescents have some type of chronic medical condition, such as asthma, cystic fibrosis or diabetes.

According to the World Health Organization, adherence is the extent to which a person's behavior—for example, taking medication—corresponds with agreed recommendations from a health care provider; non-adherence can have serious consequences for one's health.

The review analyzed 28 studies in which teenagers with a range of chronic conditions reported barriers to taking their medication. The review identified multiple barriers including relationships with peers, parents, and health care providers; issues particular to adolescence, such as wanting to be normal and wanting to control their own lives; as well as forgetfulness or unwanted side effects.

"Many barriers seem to be the same across very different conditions in adolescence despite significant differences in treatment burden," noted Boisen. Adolescence as a phase of life appears to affect medical adherence more than the type of chronic illness present, she said.

"This article looked at studies that asked young people to reflect as best they can on their own experience," said Peter Scal, MD, MPH, assistant professor at the University of Minnesota Medical School in Minneapolis. Keeping the teenager engaged with their own treatment may depend on collaboration and on good communication with compassionate health care providers, he explained. "Young people do want to have a caring connection with an adult."

Physicians who treat teenagers with chronic conditions need to understand how adolescence affects how they view their disease and treatment, and how to communicate with teenagers so that they can better follow their treatment regimens, suggest the review authors.

"There is an urgent need for interventions targeted to adolescents as these patients seem to have particular difficulties in adhering to medical treatment," Boisen added. Health care providers need to be aware of the crucial role that relationships with peers and parents play, she added. "An adolescent's sense of normality as a part of their construction of identity is worth paying special attention to," she said.