Medication adherence after heart transplantation: adolescents and their issues

Medication nonadherence among adolescent heart transplant recipients can have overwhelming negative consequences including rejection and mortality. Because of issues specific to adolescents such as peer pressure, risk taking, independence, self-image, and self-esteem, they are a population susceptible to nonadherence. Adherence may be associated with a supportive environment, fewer physical and cosmetic side effects, and a sufficient knowledge of therapies. Adherence also may be related to regimens with fewer medications, predominantly fewer immunosuppressive drugs.

To examine the differences in motivation between adolescents who are more adherent and those who are less adherent to their medication regimen following transplant surgery.

A descriptive design and mixed methodology, including a modified written survey, the Frazier Noncompliance Inventory; a self-report measure of overall medication adherence; and an interview designed by the investigator. Interview questions were reviewed for content validity by nurse clinicians and researchers.

A heart transplant follow-up clinic in the southeastern United States.

Findings for 2 participants revealed striking contrasts in adolescent issues and factors affecting adherence. These findings are presented in a case comparison. Data show that a supportive environment and knowledge of medications were significant in increasing self-responsibility and adherence in adolescent transplant recipients. Also, experiencing rejection early in treatment because of less adherence led to increased adherence for fear of further rejections or death.