Scripties UMCG - Rijksuniversiteit Groningen
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Therapy Adherence in Children with Functional Constipation : A cross-sectional questionnaire study

(2017) Wassenaer, E.A. van

Introduction: Functional constipation (FC) is a common problem in children. It affects patient’s quality of life, as well as healthcare costs. Therapy adherence is considered to be essential for effective treatment of FC, but the determinants that influence adherence in children with FC are understudied. The aim of this study was to assess determinants of therapy adherence, focusing on the medication beliefs, illness perceptions, satisfaction with treatment, and information about the treatment in children with FC.
Methods: Cross-sectional survey study in children (0-18 years) with FC who receive treatment. Adherence was measured using the Medication Adherence Report Scale (MARS-5) - a validated questionnaire - which was scored by parents. The score for this scale ranges from 5-25, higher scores representing better adherence. Patients scoring ≥23 were defined as adherent. Illness perceptions, beliefs about medication, satisfaction with treatment and with information about the treatment were measured with the Beliefs about Medication Questionnaire, the brief Illness Perception Questionnaire (B-IPQ), the Treatment Satisfaction Questionnaire for Medication (TSQM), and the Satisfaction with Information about Medicines Questionnaire. Differences between adherent- and non-adherent patients were analyzed with the Mann-Whitney U test. Associations between the questionnaire scores and adherence were analyzed with regression analyses. Significance was defined by a p-value <0.05.
Results: A total of 103 children (42 (41%) boys, median age 7 years, IQR 4-10 years, range 0-18) were included, of whom 42 (41%) were adherent. The median MARS-5 score was 22 (IQR: 20-24). When comparing the non-adherent and adherent group, there was a significant difference for median scores of emotional perceptions of FC, measured by the B-IPQ (7 (IQR:6-9) vs. 6(IQR:5-7) p<0.01), and for the median scores for perceived convenience of using medication, measured by the TSQM (67 (IQR: 42-85) vs. 86 (IQR: 62-86), p<0.01). In the regression model (R2=0.29), the MARS-5 score was associated with convenience of using medication (β=0,42, p<0,01), and higher concerns about medication (β= 0.24, p<0.05). In the univariate analysis, global satisfaction with treatment was also associated (rs= 0.25, p=0.01).
Conclusions: In this sample 42% of children were considered adherent, according to proxy-reports. Higher convenience of taking medication and lower emotional impact of FC were reported in the adherent group. Furthermore, higher proxy-reported adherence scores were associated with higher levels of convenience and more concerns about the medication, which needs to be investigated further. Discussing satisfaction with treatment and concerns about the medication with parents and patients could potentially help identifying specific beliefs, and improve therapy adherence.

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