NIV Congres

Background There is much evidence for elevated levels of medication nonadherence among patients who undergo transplantation at a young age. The aim of this study was to investigate how coping and satisfaction of psychological needs (autonomy, competence and relatedness) are related to medication adherence among young transplant recipients.

Method We conducted a cross-sectional, face-to-face interview study among kidney transplant recipients aged 21-30 years currently enrolled at out our out-patient clinic. Adherence was measured using the Basel Assessment of Adherence to Immunosuppressive Medication Scale (BAASIS©). Independent variables were: age at transplantation (Group 1 < 18; Group 2 > 18); socio-demographic characteristics, psychological needs (Basic Psychological Needs Scale); coping strategies [COPE-easy]; and mood (Positive And Negative Affect Schedule).

Results Of the 93 invited, 66 (71%) patients participated (67% male; median age 25; 47% in Group 1 and 53% in Group 2). Sixty-four percent of patients were classified nonadherent in past 4 weeks. Twenty participants (30%) reported nonadherence on the Taking dimension (missing a dose at least once) while 34 (51.5%) reported nonadherence on the Timing dimension (doses taken >2 hrs before or after prescribed time). Age at first transplantation, socio-demographic characteristics, satisfaction of psychological needs and coping were not significantly related to adherence classification. However, greater satisfaction of autonomy and relatedness needs was related to higher self-rated overall adherence. Nonadherent recipients also scored significantly lower on negative affect.

Conclusion A high level of nonadherence was found among young transplant recipients. Promoting autonomy and relatedness may offer a way of increasing medication adherence in young patients. Contrary to the literature, adherent patients were found to have higher negative affect than nonadherent patients. The strict medication regime may be experienced as limiting and thus influence mood among some young patients, or conversely, fear of rejection may also generate negative mood but promote adherence.