strategies are probably quite different; research in this area should identify predictors of long-term maintenance of health behaviors.
Although research suggests that the relationship of patients and their parents with health care providers is a significant determinant of compliance, there are no controlled studies targeting this relationship to impact on patient compliance with pediatric chronic disease regimens. Interventions that focus on the health care provider in terms of education about developmental issues and training in relationship enhancement methods, providing regimen instructions, individual tailoring and gradual implementation of the regimen, and effective monitoring and reinforcement, would appear to be a very fruitful area for future research to pursue.
Most studies have been conducted with children who have been identified as having compliance problems. Very few compliance intervention studies have targeted children with newly diagnosed chronic disease. In the long term it would seem a cost-efficient method to intervene at early stages in the disease course in order to prevent compliance problems later on. Controlled work in this area should include measures of the cost of prevention-based intervention programs, as well as the expected savings related to predicted future health care costs.
In conclusion, education seems necessary but not sufficient to ensure compliance with chronic disease regimens. Regimen skills need to be retrained and reinforced; behavioral techniques such as modeling, rehearsal, feedback, and reinforcement have been shown to improve skills necessary for regimens to manage diabetes, renal disease, and hemophilia. Behavioral interventions facilitate short-term compliance to various regimen targets but may not generalize to other regimen behaviors or persist across time. Younger and older children are probably quite different with respect to compliance barriers, cognitive processing of the regimen, and responsiveness to different types of interventions involving peers and families. Health care provider-patient interactions seem to influence compliance, but the parameters of this relationship have not been well studied or tested in compliance intervention research. Finally, compliance interventions conducted early in the disease course may prevent later compliance problems and health complications; further work in this area should include cost analyses to demonstrate potential savings.
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