James W Varni1, Robert J Shulman2, Mariella M Self3, Shehzad A Saeed4, George M Zacur4, Ashish S Patel5, Samuel Nurko6, Deborah A Neigut7, James P Franciosi4, Miguel Saps8, Jolanda M Denham9, Chelsea Vaughan Dark10, Cristiane B Bendo11, John F Pohl12. 1. Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, TX, 77843-3137, USA. jvarni@tamu.edu. 2. Department of Pediatrics, Baylor College of Medicine, Children's Nutrition Research Center, Texas Children's Hospital, Houston, TX, USA. 3. Departments of Psychiatry and Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA. 4. Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 5. Division of Pediatric Gastroenterology, Children's Medical Center of Dallas, University of Texas Southwestern Medical School, Dallas, TX, USA. 6. Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. 7. Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital Colorado, Aurora, CO, USA. 8. Division of Gastroenterology, Hepatology and Nutrition, Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 9. Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA. 10. Department of Psychology, Texas A&M University, College Station, TX, USA. 11. Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil. 12. Department of Pediatric Gastroenterology, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA.
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™ 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.
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™ 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.
Authors: James W Varni; Marie T Kay; Christine A Limbers; James P Franciosi; John F Pohl Journal: J Pediatr Gastroenterol Nutr Date: 2012-05 Impact factor: 2.839
Authors: Eva Szigethy; Simona I Bujoreanu; Ada O Youk; John Weisz; David Benhayon; Diane Fairclough; Peter Ducharme; Joseph Gonzalez-Heydrich; David Keljo; Arvind Srinath; Athos Bousvaros; Margaret Kirshner; Melissa Newara; David Kupfer; David R DeMaso Journal: J Am Acad Child Adolesc Psychiatry Date: 2014-05-10 Impact factor: 8.829
Authors: James W Varni; Robert J Shulman; Mariella M Self; Shehzad A Saeed; Ashish S Patel; Samuel Nurko; Deborah A Neigut; Miguel Saps; James P Franciosi; Jolanda M Denham; George M Zacur; Chelsea V Dark; Cristiane B Bendo; John F Pohl Journal: J Pediatr Gastroenterol Nutr Date: 2016-12 Impact factor: 2.839
Authors: James W Varni; Robert J Shulman; Mariella M Self; Samuel Nurko; Miguel Saps; Shehzad A Saeed; Cristiane B Bendo; Ashish S Patel; Chelsea Vaughan Dark; George M Zacur; John F Pohl Journal: J Pediatr Gastroenterol Nutr Date: 2015-09 Impact factor: 2.839
Authors: James W Varni; Samuel Nurko; Robert J Shulman; Mariella M Self; Miguel Saps; Cristiane B Bendo; Chelsea Vaughan Dark; John F Pohl Journal: J Pediatr Gastroenterol Nutr Date: 2015-10 Impact factor: 2.839