Self-perceived importance and confidence of adolescents transitioning to adult care

Motivational interviewing (MI) techniques are used by health care teams to engage adolescents and young adults (AYAs) in health care self-management and pediatric to adult health care transition (HCT) planning efforts. The aim of this study was to assess the initial level of motivation of AYAs prior to receipt of HCT anticipatory guidance and to determine associations with demographic and health coverage factors.

This retrospective study included 5112 AYAs, aged 12-26 years, from four health systems. All AYAs completed the Got Transition readiness assessment that includes MI questions on importance and confidence related to the move to an adult provider.Independent variables included demographic and health coverage factors: age, sex, race, ethnicity, language, and insurance type. The statistical approach included summary statistics, chi-square tests of independence and log-likelihood ratio tests, and generalized linear models and contrasts.

The study results demonstrate initial trends in importance and confidence scores for AYAs before they became part of a HCT planning process. Importance scores increased from 12-14 through 18-20 years of age, then decreased in the 21-26-year group. Confidence scores increased from the 12-14 through the 21-26-year group.Confidence scores were generally higher than importance scores and were accompanied by smaller standard deviations. Ethnicity and insurance type also demonstrated an association with MI scoring.

This study provides baseline scores on two key MI importance and confidence questions that can facilitate clinician understanding of AYA engagement in discussing the changes needed to move to adult care and guides the clinician to start earlier than just before transfer that often occurs around age 21.