Medication self-management during the developmental transition of responsibility among Chinese adolescent liver...

Adolescence is a high-risk period for non-adherence to immunosuppressive therapy after pediatric liver transplantation, especially as medication responsibility shifts from parent-led routines toward increasing adolescent participation. However, limited evidence explains how adolescents manage medication demands in daily life within school, family, and peer contexts. We conducted a single-center qualitative descriptive study in a tertiary pediatric liver transplant clinic in Southwest China. Using purposive sampling, we recruited adolescents aged 13-17 years who were at least 1 year post-transplant and remained in pediatric follow-up at the time of interview (N = 12). None had transferred to adult services. Semi-structured one-to-one interviews were conducted between July and August 2025, audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis. Analytic depth was supported through reflexive memoing, post-interview debriefing, preliminary coding during recruitment, dialogic discussion within the research team, and an audit trail. Four interrelated tensions shaped medication self-management during the developmental transition of responsibility: (1) regimen requirements versus school-day routines; (2) growing expectations for autonomy versus uneven readiness for self-management; (3) family and school support that was both enabling and conflict-provoking; and (4) a desire for empowerment and peer normalcy in the context of stigma and limited youth-oriented resources. Participants described overlapping self-management patterns rather than fixed types. In two accounts, episodes of repeated compromise, treatment fatigue, or reduced engagement suggested ongoing vulnerability in particular contexts. Conclusions: Medication non-adherence in adolescence may be shaped by contextual constraints as well as knowledge or motivation. Support should extend beyond standardized education to include individualized medication planning, staged autonomy-building within pediatric follow-up, practical school-day planning, and discreet youth-centered adherence strategies that better fit adolescents' daily lives.