Socioeconomic Factors

Socioeconomic risk factors refer to demographic factors and family-related determinants. A number of demographic factors have been identified that may increase the risk of poor adherence, including ethnicity (i.e., non-white race), onset of disease at a younger age, and the high burden of cost of medication (24). Male adolescents seem to be more prone to poor adherence (5), because they generally exhibit greater risk-taking behavior, putting them at a higher risk for experimentation with their medication, and thus increasing the risk for poor adherence.

Another group of socioeconomic factors are related to social and family functioning. Adolescence implies transition from care provided by the parents to self-care. Active involvement of the parents in the treatment process during this transition process is of particular importance, as adolescents bearing the sole responsibility for medication management, or experiencing little parent supervision are more prone to poor adherence (17,51). Family cohesion, lack of conflict, and good parent-child communication will positively affect adherence (1,51,52). Practical and emotional support from family members can assist patients in adherence and may function as facilitators or cheerleaders (51). In contrast, parents being anxious and concerned about the health and the future of their chronically

Table 1 Potential Risk Factors for Poor Adherence

Socioeconomic factors

Ethnicity: belonging to minority ethnic group Gender: male

Disease-status: younger age of disease onset Economic: greater burden of medication costs Family

Less parental support (practical and emotional) Less family cohesion Poorer parent-child communication Greater conflict

Greater parental anxiety, parental overprotection Patient-related factors

Lower level of cognitive/intellectual functioning Lower level of knowledge Forgetfulness Low self-efficacy

Negative/incompatible health beliefs Low therapeutic motivation

Emotional disturbance (depression, low self-esteem, body-image disturbance) Condition-related factors Longer disease duration Low disease activity Less fear of acute problems Treatment-related factors

Body-altering/visible treatment effects Poly-pharmacy

Longer duration of treatment regimen Greater complexity of regimen Unstable efficacy of treatment Health care system/team

Less active involvement in decision-making Less patient-centered care (i.e., more condition-focused) Poor patient-provider communication Less follow-up

Shorter duration of specialist care ill child may cause parents to become overprotective and controlling, or may render parents unable to give emotional support to the adolescent patient (1,51,52). Moreover, overprotection can compound an adolescent's existing social isolation and peer interaction owing to functional limitations, frequent interruptions of daily activities by treatment requirements, and changed physical appearance (1,51). Friends and peers may help to overcome these feelings of being different by accepting their ill friend with his or her physical limitations (53).

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