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295 Feasibility, acceptability, and efficacy of a multi-level intervention to promote autonomy and competence in transition-aged youth (ipact) with chronic health conditions
  1. Constance M Wiemann1,
  2. Beth H Garland1,
  3. Mary Majumder2,
  4. Blanca Sanchez-Fournier1,
  5. Jordyn Babla1,
  6. Cortney T Zimmerman1,
  7. Marietta De Guzman1,
  8. Kimberly Houck1,
  9. Seema Walsh1,
  10. Albert C Hergenroeder1
  1. 1Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas, USA
  2. 2Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA


Introduction During their development, Adolescents and Young Adults with Chronic Health Conditions (AYACHC) develop decision-making strategies and autonomy in illness self-management, and require supportive partnerships with parents and providers. This report focuses on a multi-level intervention produced with input from and targeted to AYACHC, parents, and providers, to promote autonomy and competence in transition-aged youth (IPACT).

Methods 165 dyads (18-year-old AYACHC and parents) participated in either 1) a three-session intervention (based on the socioecological model and Self-Determination Theory [SDT]), or 2) historical control (standard care) group to compare outcomes of their perceived competence in and knowledge of healthcare transition/self-management; self-efficacy; and SDT constructs. Twenty-two providers from four pediatric clinical services participated in a two-session virtual intervention that supported AYACHC autonomy practicing skills. Intervention feasibility, acceptability, and efficacy metrics were assessed/summarized.

Results 100% of IPACT sessions were implemented as planned (feasibility). Over 80% of AYACHC, parents, and providers were very satisfied with IPACT sessions (acceptability). With respect to efficacy, AYACHC pre/post-IPACT scores increased (p<0.05) and participants in the IPACT versus control groups were higher (p<0.05) across all constructs except provider support for autonomy. 89% of providers thought IPACT should be required for all providers; two-thirds (n=12) were very likely to continue inviting parents out of the room during clinic visits. Intervention AYACHC interviewed by providers without a parent present increased from 21% at baseline to 79% after providers participated in IPACT (p<0.001), versus 36% interviewed alone in the control group (p<0.001).

Discussion This is the first multi-level intervention to engage parents and providers as partners in the promotion of autonomy and competence in AYACHC’s self-management. This brief, easily implemented intervention promoted improved skills for all stakeholder groups.

Conclusion Findings set the stage for taking IPACT to scale for all 17-year-olds with chronic illnesses, as a standard component of their clinic visits.

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