@article{67fef132c703498299c7f167cd7e3117,
title = "Perceived medication adherence barriers mediating effects between gastrointestinal symptoms and health-related quality of life in pediatric inflammatory bowel disease",
abstract = "Objectives: The primary objective was to investigate the mediating effects of patient-perceived medication adherence barriers in the relationship between gastrointestinal symptoms and generic health-related quality of life (HRQOL) in adolescents with inflammatory bowel disease (IBD). The secondary objective explored patient health communication and gastrointestinal worry as additional mediators with medication adherence barriers in a serial multiple mediator model. Methods: The Pediatric Quality of Life Inventory{\texttrademark} Gastrointestinal Symptoms, Medicines, Communication, Gastrointestinal Worry, and Generic Core Scales were completed in a 9-site study by 172 adolescents with IBD. Gastrointestinal Symptoms Scales measuring stomach pain, constipation, or diarrhea and perceived medication adherence barriers were tested for bivariate and multivariate linear associations with HRQOL. Mediational analyses were conducted to test the hypothesized mediating effects of perceived medication adherence barriers as an intervening variable between gastrointestinal symptoms and HRQOL. Results: The predictive effects of gastrointestinal symptoms on HRQOL were mediated in part by perceived medication adherence barriers. Patient health communication was a significant additional mediator. In predictive analytics models utilizing multiple regression analyses, demographic variables, gastrointestinal symptoms (stomach pain, constipation, or diarrhea), and perceived medication adherence barriers significantly accounted for 45, 38, and 29 percent of the variance in HRQOL (all Ps < 0.001), respectively, demonstrating large effect sizes. Conclusions: Perceived medication adherence barriers explain in part the effects of gastrointestinal symptoms on HRQOL in adolescents with IBD. Patient health communication to healthcare providers and significant others further explain the mechanism in the relationship between gastrointestinal symptoms, perceived medication adherence barriers, and HRQOL.",
keywords = "Crohn{\textquoteright}s disease, Gastrointestinal symptoms, Inflammatory bowel disease, Medication adherence barriers, Patient communication, PedsQL, Ulcerative colitis",
author = "{on behalf of the Pediatric Quality of Life Inventory{\texttrademark} Gastrointestinal Symptoms Module Testing Study Consortium} and Varni, {James W.} and Shulman, {Robert J.} and Self, {Mariella M.} and Saeed, {Shehzad A.} and Zacur, {George M.} and Patel, {Ashish S.} and Samuel Nurko and Neigut, {Deborah A.} and Franciosi, {James P.} and Miguel Saps and Denham, {Jolanda M.} and Dark, {Chelsea Vaughan} and Bendo, {Cristiane B.} and Pohl, {John F.} and Varni, {James W.} and Jolanda Denham and Shulman, {Robert J.} and Self, {Mariella M.} and Neigut, {Deborah A.} and Samuel Nurko and Patel, {Ashish S.} and Franciosi, {James P.} and Shehzad Saeed and Zacur, {George M.} and Miguel Saps and Barbara Verga and Pohl, {John F.}",
note = "Funding Information: Conflict of interest Item development for the PedsQLTM Gastrointestinal Symptoms Module was previously supported by Takeda Pharmaceuticals North America, Inc. Data collection for the healthy controls sample was supported by intramural funding from the Texas A&M University Foundation. Dr. Varni holds the copyright and the trademark for the PedsQLTM and receives financial compensation from the Mapi Research Trust, which is a nonprofit research institute that charges distribution fees to for-profit companies that use the PedsQLTM. Dr. Varni received investigator-initiated funding from Takeda Pharmaceuticals North America, Inc. (Deerfield, Illinois) for the previous item generation qualitative methods study. Dr. Pohl received investigator-initiated funding from Takeda Pharmaceuticals North America, Inc. (Deerfield, Illinois) for the previous item generation qualitative methods study. Drs. Varni and Pohl did not receive funding from Takeda Pharmaceuticals North America, Inc. for the current quantitative methods field test study. Dr. Pohl has received the following funding: INSPPIRE to Study Acute Recurrent and Chronic Pancreatitis is Children, Grant #10987759, National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases. Dr. Pohl is on the speaker{\textquoteright}s bureau for Medical Education Resources, Inc. Dr. Shulman is supported by NIH grants R01 NR013497 and T32 DK007664 and receives research funding from Mead-Johnson and is a consultant for Nutrinia. Dr. Nurko is supported by NIH grant K24DK082792A. Dr Saeed is on the speaker{\textquoteright}s bureau for Abbvie, Inc. These grants are not related to the current study. The other authors report no competing interests related to this study. Funding Information: The PedsQL{\texttrademark} Gastrointestinal Symptoms Module Testing Study Consortium sites include a Network and Statistical Center at the Center for Health Systems & Design, Colleges of Architecture and Medicine, Texas A&M University, College Station, TX (PI: James W. Varni, PhD), and 9 primary research data collection sites: Division of Pediatric Gastroenterology, Nationwide Children{\textquoteright}s Hospital, Ohio State University School of Medicine, Columbus, OH (PI: Jolanda Denham, MD); Department of Pediatrics, Baylor College of Medicine, Children{\textquoteright}s Nutrition Research Center, Texas Children{\textquoteright}s Hospital, Houston, TX (PIs: Robert J. Shulman, MD and Mariella M. Self, PhD); Division of Gastroenterology, Hepatology and Nutrition, Children{\textquoteright}s Hospital Colorado, Aurora, CO (PI: Deborah A. Neigut, MD); Center for Motility and Functional Gastrointestinal Disorders, Boston Children{\textquoteright}s Hospital, Harvard Medical School, Boston, MA (PI: Samuel Nurko, MD); Division of Pediatric Gastroenterology, Children{\textquoteright}s Medical Center of Dallas, University of Texas Southwestern Medical School, Dallas, TX (PI: Ashish S. Patel, MD); Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children{\textquoteright}s Hospital Medical Center, Cincinnati, OH (PIs: James P. Franciosi, MD, Shehzad Saeed, MD, and George M. Zacur, MD); Division of Gastroenterology, Hepatology and Nutrition, Lurie Children{\textquoteright}s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL (PI: Miguel Saps, MD); Division of Pediatric Gastroenterology, Hepatology and Nutrition, Goryeb Children{\textquoteright}s Hospital, Morristown Medical Center, Morristown, NJ (PI: Barbara Verga, MD); Department of Pediatric Gastroenterology, Primary Children{\textquoteright}s Hospital, University of Utah, Salt Lake City, UT (PI: John F. Pohl, MD) No funding was specifically designated for the PedsQL{\texttrademark} Gastrointestinal Symptoms Module field test study data collection effort or manuscript preparation. Investigators for the Pediatric Quality of Life Inventory{\texttrademark} Gastrointestinal Symptoms Module Testing Study Consortium are listed in “Acknowledgements”. The PedsQL{\texttrademark} is available at http://www.pedsql.org. Item development for the PedsQL{\texttrademark} Gastrointestinal Symptoms Module was previously supported by Takeda Pharmaceuticals North America, Inc. Data collection for the healthy controls sample was supported by intramural funding from the Texas A&M University Foundation. Dr. Varni holds the copyright and the trademark for the PedsQL{\texttrademark} and receives financial compensation from the Mapi Research Trust, which is a nonprofit research institute that charges distribution fees to for-profit companies that use the PedsQL{\texttrademark}. Dr. Varni received investigator-initiated funding from Takeda Pharmaceuticals North America, Inc. (Deerfield, Illinois) for the previous item generation qualitative methods study. Dr. Pohl received investigator-initiated funding from Takeda Pharmaceuticals North America, Inc. (Deerfield, Illinois) for the previous item generation qualitative methods study. Drs. Varni and Pohl did not receive funding from Takeda Pharmaceuticals North America, Inc. for the current quantitative methods field test study. Dr. Pohl has received the following funding: INSPPIRE to Study Acute Recurrent and Chronic Pancreatitis is Children, Grant #10987759, National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases. Dr. Pohl is on the speaker{\textquoteright}s bureau for Medical Education Resources, Inc. Dr. Shulman is supported by NIH grants R01 NR013497 and T32 DK007664 and receives research funding from Mead-Johnson and is a consultant for Nutrinia. Dr. Nurko is supported by NIH grant K24DK082792A. Dr Saeed is on the speaker{\textquoteright}s bureau for Abbvie, Inc. These grants are not related to the current study. The other authors report no competing interests related to this study. Publisher Copyright: {\textcopyright} 2017, Springer International Publishing AG.",
year = "2018",
month = jan,
day = "1",
doi = "10.1007/s11136-017-1702-6",
language = "English (US)",
volume = "27",
pages = "195--204",
journal = "Quality of Life Research",
issn = "0962-9343",
publisher = "Springer Netherlands",
number = "1",
}