Project Overview +

Nonadherence 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 cellphone text messages to promote medication adherence in adolescent liver transplant recipients who are transitioning from pediatric to adult-centered transplant care. The iSTART (Individualized Self-management Training for Adolescent/Young Adult Recipients of Transplantation) intervention is delivered using technology to reduce the time and access constraints often encountered with traditional adherence interventions.

Aims +

Phase I: Development of a Tailored Intervention to Promote Medication Adherence

  • Aim 1: Develop a tailored intervention to promote medication adherence in adolescent liver transplant recipients. The iSTART (Individualized Self-management Training for Adolescent/Young Adult Recipients of Transplantation) intervention involves tailored educational, motivational and behavioral strategies delivered through text messages and web-based modules. Tailoring variables include perceived adherence, allocation of responsibility for health management tasks, barriers to medication adherence, values, sources of motivation (e.g., intrinsic/extrinsic), and regimen knowledge.
  • Aim 2: Assess the relevance and usability of tailored text messages and web-based modules that emphasize personalization, feedback and content matching.
Phase II: Pilot Feasibility Test of a Tailored Intervention to Promote Medication Adherence
  • Aim 3: Explore the impact of the intervention on medication adherence using a randomized, wait-list control design. 
  • Aim 4: Examine the acceptability of the intervention among participants and parent/caregivers.

Participants +

Adolescent/young adult liver transplant recipients (aged 16-22)

Intervention +

Research aims will be accomplished in 2 phases across 4 years.

Phase I:
The iSTART intervention is developed to enhance post-transplant medication regimen adherence. A collection of tailored text messages is composed and tailoring algorithms link the responses from the baseline assessment with the appropriate message from the feedback library. Tailoring includes personalization, adaptation and feedback messages. The iSTART web modules is tailored to focus on the individual's a) health-related knowledge, b) motivation/values, and c) cognitive-behavioral skills including communication, organizational, and problem-solving skills. Focus groups, semi-structured interviews, and field testing is used to assess the relevance and usability of tailored text messages and web-based modules.

Phase II:
A randomized pilot feasibility test of the iSTART intervention is conducted among adolescent/young adult liver transplant recipients to explore the impact of the intervention on medication adherence, and to evaluate the acceptability of the intervention.

iSTART

11/01/2009 - 08/31/2016

Sponsor(s)

National Cancer Institute

Principal Investigator:

Emily MacDonald Fredericks, PhD