A review of biopsychosocial strategies to prevent and overcome early-recognized poor adherence in growth hormone therapy of children

Figures & data

Figure 1.  Summary of the objective factors and subjective attitudes contributing to adherence issues with GH therapy.

Figure 2.  Phases of the individual counseling/therapy decision.

Table 1.  Features of a patient-oriented procedure for optimization of adherence.

Comprehensive biopsychosocial history of the patient

Provision of medical information and discussion of treatment protocols

Supply of individual resources related to implementation of the physician’s treatment recommendations, based on the patient’s condition and therapy-related demands

Individual personal counseling for improvement of health-related quality of life

Adherence as a continuous treatment goal and challenge for the patient, family and physician, which requires a long-term honest and confidential dialogue between the parties

Figure 3.  Transfer of biopsychosocial competences from healthcare professionals to empower patients and parents.

Table 2.  Challenges to adherence in GH therapy and associated interventions13,47.

Challenge to adherence	Patient training intervention
Inappropriate concept of treatment	• Restructuring the treatment beliefs
	• Modification/correction of the false beliefs regarding therapy
Lack of knowledge about the treatment	• Offering education regarding the effect of medication and goals of therapy
Impaired treatment skills	• Education and behavioral training to develop independence in administration of treatment
Reduced understanding of treatment	• Training and education to describe the physical effects and changes the treatment will have on the patient
Fear of side-effects from treatment	• Education about possible side-effects
	• Discussion about balancing benefits of therapy with the side-effects
	• Discussion with patients about their experiences
Handling problems in administering treatment	• Explanation and discussion of the process for treatment administration, accompanied by practical examples
	• Selection of the most appropriate injection device with the patient
Questioning efficacy of treatment	• Training of and discussion about the treatment

Haverkamp F, Johansson L, Dumas H, et al. Observations of nonadherence to recombinant human growth hormone therapy in clinical practice. Clin Ther 2008;30:307-16

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