iSTART: Individualized Self-management Training for Adolescent/Young Adult Recipients of Transplantation

Faculty Contact: Emily Fredericks, PhD

Background:
Nonadherence to immunosuppressant medications is common among adolescent liver transplant recipients, and is a leading cause of chronic rejection and graft loss. In the event of graft failure, pediatric liver transplant recipients will either die or require retransplantation. There is an urgent need to develop and test strategies to improve medication adherence in this population. Emerging evidence suggests that interventions delivered using web-based and cellphone technology are met with high satisfaction and have improved medication adherence in adolescent/young adults with other childhood diseases. Tailored interventions allow for the provision of behavior change information that is adapted to fit the unique characteristics, motivation and behavioral patterns of an individual. Given the significant risks associated with nonadherence in adolescent transplant recipients, it is critical that tailored interventions be tested in this population.

Objectives:
The overall objective of this project is to systematically design and evaluate a tailored intervention delivered using mHealth technology to promote medication adherence in adolescent liver transplant recipients who are preparing to transition from pediatric to adult-centered transplant care.

Methods:
Phase I: The iSTART (Individualized Self-management Training for Adolescent/Young Adult Recipients of Transplantation) intervention will be developed to enhance medication adherence among adolescent/young adult recipients. Tailoring will include personalization, adaptation and feedback messages delivered via SMS text messages and web modules. The iSTART intervention will be tailored according to the individual's a) health-related knowledge, b) motivation/values, c) cognitive-behavioral skills, and d) perceived medication adherence. Focus groups, semi-structured interviews, and field testing will be used to assess relevance and usability.

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

Phase III: To adapt iSTART into a native mobile application (app) for use among adolescent/young adult liver, kidney and heart transplant recipients

Funding Sources:
KL2 Mentored Scholars Program, Michigan Institute for Clinical and Health Research (MICHR).NCCR/CTSA (UL1RR024986)
NIH K23 Grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (5K23DK090202)
University of Michigan Center for Health Communications Research Development Award
University of Michigan Department of Pediatrics Charles Woodson Interdisciplinary Research Award

For more information, please contact:
Emily M. Fredericks, PhD
University of Michigan, Division of Pediatric Psychology
Child Health Evaluation and Research (CHEAR) Unit
300 North Ingalls Building, Room 6E18
Ann Arbor, MI 48109-5456
Email: emfred[at]med.umich[dot]edu