Understanding and Promoting Medical Transition Readiness in Adolescents and Young Adults with Chronic Illness

Few psychosocial interventions for adolescents and young adults (AYAs) with chronic illness aim to promote medical transition readiness (i.e., preparation to transfer from pediatric to adult medical care), an important developmental task. Inadequate medical transition readiness can result in poor psychological, financial and health-related outcomes. Guided by research and theory in Positive Youth Development (PYD), childhood chronic illness and medical transitions, the primary goals of the studies comprising this dissertation were to identify and promote factors that contribute to medical transition readiness. First, a systematic review of the literature was conducted to identify studies that assessed self-efficacy for disease management in AYA cancer survivors. In the second study, young adults with chronic illness were randomly assigned to a Coping Skills Intervention (CSI) condition, representing a life skills intervention in line with PYD theory; or a print control condition (Informational Materials; IM). All participants received weekly emails with information that aims to promote medical transition readiness. Participants in the CSI condition also attended an eight-week cognitive behavioral therapy group. Findings from the systematic review indicated 1) that self-efficacy for disease management is positively associated with health-promoting behaviors and inversely related to physical and mental health problems; and 2) that behavioral and educational interventions have the potential to increase self-efficacy. Results of the randomized controlled trial demonstrated that at two months (immediately post-intervention), CSI (vs. IM) participants were significantly more likely to have initiated the transition to adult medical care. There was no significant impact of group assignment on disease-related skills and knowledge, medical regimen adherence, quality of life, or depressive symptoms. CSI (vs. IM) group members demonstrated significantly higher illness-related benefit finding, self-efficacy and approach-oriented coping, as well as lower anxiety and perceived illness-related threat. Future research and clinical intervention refinement should build on the current findings by incorporating additional components of Positive Youth Development programs and by evaluating the CSI in diverse populations and settings. Additional directions for research include the need for validated measures of self-efficacy for disease management for AYA cancer survivors, as well as interventions that target the health care team’s role in promoting self-efficacy