Association Between Posttraumatic Growth, Medication Adherence, and Barriers to Adherence in Pediatric Solid Organ Transplant Patients and Their Caregivers

Living with a chronic illness can be a traumatic experience, yet there is also evidence that adverse experiences may facilitate positive psychological changes, such as posttraumatic growth (PTG). Little is known about PTG in pediatric solid organ transplant (SOT) patients and their caregivers or PTG's relationship with health behaviors. Study aims were to longitudinally evaluate 1) the role of medication nonadherence and BTA on PTG, and 2) PTG's influence on medication nonadherence and barriers to adherence (BTA). It was hypothesized that 1) Greater baseline medication nonadherence and BTA would predict greater follow-up PTG, and 2) greater baseline PTG would predict lower follow-up medication nonadherence and fewer BTA. Participants included 43 pediatric SOT patient-caregiver dyads at baseline (range: .11-17.09 years post SOT) and follow-up (range: .87-3.37 years post baseline). Baseline measures of PTG, medication nonadherence, BTA, and psychosocial factors were obtained. Follow-up measures of primary outcomes were also collected. Baseline medication nonadherence (β = -.05, SE = .87), patient-rated BTA (β = -.17, SE = .10), and caregiver-rated BTA (β = -.24, SE = .12), did not predict follow-up patient PTG. More baseline caregiver-rated BTA (β = .29, SE = .30), but not medication nonadherence (β = .07, SE = 3.02) or patient-rated BTA (β = .20, SE = .20), predicted greater follow-up caregiver PTG. Baseline patient PTG (β = -.01, SE = .04) and caregiver PTG (β = -.25, SE = .01) did not predict follow-up medication nonadherence. Higher baseline caregiver PTG (β = -.25, SE = .08), but not patient PTG (β = -.07, SE = .26), predicted fewer follow-up patient-rated BTA. Greater baseline patient PTG (β = -.01, SE = .21), but not caregiver PTG (β = -.04, SE = .06), predicted more follow-up caregiver-rated BTA. Exploratory analyses were also conducted to identify psychosocial predictors of primary outcomes. Results suggest that strengthening PTG in caregivers of pediatric SOT patients may be important for reducing BTA. Further research needed to determine whether specific domains of PTG and BTA are associated. Findings have the potential to inform strength-based interventions focused on decreasing BTA for pediatric SOT patients.