Medication Adherence in Pediatric MS: Barriers and Facilitators (P2.106)
Bibliographic record
Abstract
BACKGROUND: Disease modifying therapies (DMT) are used widely in pediatric multiple sclerosis (POMS), but up to half of children with MS have poor medication adherence. Social and medical consequences may result, including increased relapse rate and missed school. Reasons for poor medication adherence in pediatric MS are unknown, but elucidation of these reasons may improve outcomes in this population. OBJECTIVE: To identify factors influencing medication adherence in POMS. DESIGN/METHODS: Children with MS from 9 North American centers were enrolled in a randomized-control trial of medication adherence including electronic monitoring paired with motivational interviewing (MI) vs. attention control. Children with a diagnosis of MS on DMT for at least 6 months were included in the study. Interviews followed MI theory, and were used to evoke reasons and methods for behavioral change in participants. Qualitative thematic analysis of 14 baseline interviews with participants randomized to the MI arm of the study (9 female, 15±2 yrs.) captured emergent themes. RESULTS: Themes included: (1) Importance of medication adherence: participants referred to symptoms at diagnosis (“numbness”, “tingling”, “no vision in right eye”) as motivators. (2) Strategies for remembering to take medication: parental reminders, alarms, routines. (3) Obstacles to adherence: distractions, going out with friends, ability to self-inject. (4) Reactions to using electronic monitoring: participants described tracking daily patterns of medication adherence as helpful. CONCLUSIONS: Through MI, children with MS identified barriers and facilitators to medication adherence. Facilitators included use of the tracking device, the identification of specific strategies related to routinization, and recall of neurological symptoms. Barriers included challenges with self-injection as well as those related to changes in daily routine. Surprisingly, pain and fear did not emerge as barriers to medication use. Future studies will evaluate whether thematic changes occurred through the course of the study, and whether changes in adherence accompanied thematic changes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".