Original article
Readiness to Transfer to Adult Care of Adolescents with Chronic Conditions: Exploration of Associated Factors

https://doi.org/10.1016/j.jadohealth.2010.07.009Get rights and content

Abstract

Purpose

To explore associations between adolescents' perception of their readiness to transfer to adult care and socio-demographic and disease-related characteristics, effect of the condition, self-management ability, and attitude toward transition.

Methods

A cross-sectional study was conducted in a Dutch university hospital, where all adolescents (12–19 years) with somatic chronic conditions (n = 3,648) were invited to participate in a web-based questionnaire. Invitations were issued to those without an intellectual disability and who had been under treatment for at least 3 years.

Results

In all, 30% (n = 1,087) of the adolescents responded; 954 assessed their perception of readiness for transfer. The majority (56%) felt that they were ready for transfer. Logistic regression analyses showed that 48% of the total variance in transfer readiness (TR) could be explained. Feeling more self-efficacious in skills for independent hospital visits and a greater perceived independence during consultations were found to be most strongly associated with being ready to transfer. Higher TR was associated with older age, but age did not prove to be the most important explaining variable. Adolescents with a more positive attitude toward transition and those who reported more discussions related to future transfer also felt more ready. Disease-related factors and effect of the condition including quality of life were only weakly associated with higher TR.

Conclusions

Adolescents' attitude to transition and their level of self-efficacy in managing self-care seem to be the keystones to TR. This study suggests that individual transition plans and readiness assessments might prove to be beneficial. Strengthening adolescents' independence and self-management competencies, combined with early preparation and repeated discussions on transition, seem to be useful strategies to increase adolescents' readiness for transfer to adult care.

Section snippets

Participants

The target group was selected from the hospital database, which consisted of all adolescents who were aged 12–19 years and who in mid-2006 were under active long-term treatment for a somatic chronic condition either in the Department of Pediatrics or the Department of Pediatric Surgery at the Erasmus MC-Sophia Children's Hospital. Inclusion criteria included the following:

  • Before July 1, 2006, the adolescent should have been under treatment for >3 years;

  • The adolescent should have made outpatient

Study population

Of the original sample of 3,861, a total of 213 subjects were not included in the study because they either met the exclusion criteria (179 intellectual disabilities; four already transferred) or inadvertently did not receive the letter (n = 30). Therefore, a total of 3,648 formed the study population (Figure 1). A response was received from 1,318 adolescents (36.1%). However, 231 of them returned the response card explaining why they could not participate in the study: of these, 144 (62.3%)

Discussion

This study investigated factors that might be associated with perception of being ready to transfer to adult care. Age proved to be an important factor in this sense, whereas other socio-demographic variables and disease-related factors (including quality of life) did not prove to be important. Moreover, adolescents' attitude toward transition and their level of self-efficacy in managing day-to-day self-care and in hospital consultations were strongly associated with TR.

Similar to our study,

Conclusion

Apart from age, adolescents' attitude toward transition, and their level of self-efficacy in managing day-to-day self-care and hospital consultations seem to be the keystones to TR. Strengthening adolescents' independence and self-management competencies, combined with early preparation and repeated discussions about the forthcoming transition, seems to be a useful strategy in increasing adolescents' readiness to transfer.

Acknowledgments

This work was supported by a grant from the Dutch charity foundation Kinderpostzegels (no. 23764/1/4). The authors thank all young people who participated in the study. They also thank all members of the advisory board, who provided advice at all stages of the research, and to Mathilde Strating, Adriaan Visser, Margo Trappenburg, and Ko Hagoort for valuable comments on earlier drafts of this paper.

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