Iran Journal of Nursing

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Shirkavand L, Alaee Karahroudy F, Mohtashami J, Ghasemi E. Effects of Coping Style Training on the Treatment Adherence in Adolescents with Congenital Heart Disease. IJN 2019; 32 (119) :76-86
URL: http://ijn.iums.ac.ir/article-1-2992-en.html

Background & Aims: Congenital heart disease (CHD) is the commonest birth defect worldwide, affecting millions of newborns every year. There is a growing need for proper healthcare services for adults and youth with CHDs, who have had a good childhood. These needs include medical, social, emotional, and functional needs in life. A chronic disease, CHD always imposes limits on the quality of life, especially when they need recurrent and complicated surgeries and have to cope with the physical, social and psychological consequences of illness and problems in various aspects of their quality of life. Most chronic diseases are generally not cured and the goal is to just support the child in passing the acute and critical period of the disease. The adolescent may show the outburst of contradictions in the form of a lack of cooperation with the treatment plan and denying the disease to maintain their similarity with their peers. One of the common problems faced by healthcare staff is the lack of adherence to treatment in patients with chronic diseases, especially those in adolescence and puberty. Poor adherence to treatment is alarming for both patients and healthcare systems. Clinically speaking, lack of proper adherence to treatment reduces its beneficial effects, increases the disease’s symptoms and hospitalization period, and may even cause mortality. Therefore, understanding coping mechanisms can be applied in the prevention and treatment of disorders, and preventive measures that are taken during adolescence and even childhood through teaching various coping strategies can help people face problems. Therefore, the present study aimed to determine the effects of coping style training on treatment adherence in adolescents with congenital heart disease.
Materials & Methods: This experimental study was conducted with a pretest-posttest design and a control group on 70 adolescents aged 9- 19 years with CHD at Shahid Rajaee Heart Center in Tehran, Iran in 2018. The patients were selected via continuous sampling and divided into two groups of intervention and control via simple random sampling. The research tools included a demographic characteristics questionnaire and psychometric properties of the adherence questionnaire in chronic patients. In addition to routine care, the subjects in the intervention group received training based on stress coping styles in the form of educational content. Data were collected using Folkman and Lazarus ways of coping questionnaire, and the control group received routine care within the department. For adolescents who were included in the intervention group, coping techniques and stress reduction techniques were taught by lecturing, group discussion, Q&A, and role-playing and in a cross-sectional manner in four sessions of 1.5 hours with break time and catering was provided from each group. The generalities of the program and Lazarus and Folkman’s model were introduced in the first session, while different coping strategies were covered and explained in the second and third sessions. The fourth session focused on ways to prevent stress. At the end of the education, the adherence questionnaire was completed by both groups again, and the educational package was provided to the control group along with an educational session to cover the content. Data analysis was performed in SPSS version 16 using independent and paired t-test, Chi-square, and Fisher's exact test.
Results: In this study, the mean age of the subjects in the intervention and control groups was 13.42 ± 2.11 and 13.77 ± 2.42 years, respectively. According to the results, no significant difference was observed between the two groups in terms of mean age, gender, birth order, paternal occupational status, maternal occupational status, and level of education. In addition, there was no significant difference between the two groups regarding the mean score of treatment adherence (P=0.175). At the end of the study, the mean score of treatment adherence was significantly higher in the intervention group, compared to the control group (P=0.002). Similarly, the mean scores of making effort for treatment (P=0.03), intention to take the treatment (P<0.001), and commitment to treatment (P<0.001) were significantly higher after education in the intervention group, compared to the control group. Overall, commitment to treatment was significantly higher in the intervention group, compared to the control group (P=0.002). In the intervention group, adherence to treatment, intention to take the treatment, adaptability, and commitment to treatment were significantly higher after the intervention, compared to before the intervention. It is notable that overall adherence to treatment in this group was significantly higher after the intervention, compared to before the intervention. In the control group, adherence to treatment and its dimensions were significantly higher one month after the intervention, compared to before the intervention. The paired t-test results were indicative of a significant difference between the first and second times of treatment regarding the mean score of treatment adherence in the control group, and the scores obtained were significantly higher in the second time of treatment (P<0.001). In the intervention group, there was a significant difference between the mean score of treatment adherence before and after the intervention, and the score was significantly higher at the end of the education (P<0.001).
Conclusion: According to the results, there was a significant difference between the two groups regarding treatment adherence and its dimensions after the intervention. In other words, training strategies to cope with stress increased treatment adherence in adolescents with CHDs. This is due to the fact that education led to the management of stress in adolescents and more attendance in treatment plans. Moreover, since the education of coping strategies improved the adolescents’ emotional style, it could be used as an effective technique in this regard. According to the results, while no intervention was carried out in the control group, the routine training in the ward somehow increased the subjects’ intention to adhere to treatment in this group. The use of coping style training programs in adolescents with chronic diseases, in parallel with routine treatment measures and training appropriate to the age and developmental conditions of adolescents, increases awareness and behavior change and thus increases the level of self-efficacy, adherence to treatment and overcoming treatment complications and threats posed by the disease. It will also increase their self-confidence and ability to adapt to stressful conditions during the illness. Given the results obtained in the present study, it is suggested that teaching coping strategies be considered by healthcare providers in educational and counseling programs to improve treatment adherence in adolescents with CHDs.