Self-Efficacy And Resilience Predict Transition Readiness Independent Of Age And Disease Parameters In Adolescent Inflammatory Bowel Disease

Background: Many adolescents and young adults (AYA) with pediatric-onset inflammatory bowel diseases (IBD) are faced with the challenge of transitioning to adult centered care between the ages of 18 and 23 years old. This age group is vulnerable to poor outcomes due to suboptimal disease self-management skills and reduced continuity of care. IBD transition programs focus on disease knowledge and remission status as indicators of readiness; scores on the validated Transition Readiness Assessment Questionnaire (TRAQ) are also common. Attempts to identify predictors of TRAQ scores to date have yielded only age as a predictive factor, reducing the utility of the tool in identifying younger patients at risk. We sought to determine whether assessment of 2 psychological strengths-resilience (grit; one's ability to bounce back from adversity), and self-efficacy (confidence in one's ability to perform disease-specific tasks) could predict transition readiness. Methods: Patients with ulcerative colitis (UC) and Crohn´s Disease (CD) 16 to 23 years were recruited as part of the study “Improving Transition Readiness in Pediatric IBD with Novel Behavioral Interventions.” Baseline data were used for the current study. Disease activity was measured by the Simple Clinical Colitis Activity Index or Harvey Bradshaw Index. Sex, age and age at diagnoses and parent's education level were collected. The IBD Self-Efficacy Scale-AYA version consists of 13 items and measures confidence in managing medical care; managing everyday life with IBD; managing feelings; managing the future with IBD (range 13–65). The Connor Davison Resilience Scale consists of 10 item concerning how well challenges are typically handled (range 10–50). The TRAQ consist of 20 items divided in 5 domains: appointment keeping; tracking health issues; managing medications; talking with providers; managing daily activities. All 3 questionnaires used a 5 point Likert scale; higher scores represent better performance. General Linear Modelling (GLM) was performed to investigate predictors of TRAQ scores. Results: Eighty-seven patients were included (male/female: 51/36; CD/UC: 62/25; mean age 18.64 SD 1.67, range 16–23). The mean score (SD) of the questionnaires were: Self Efficacy: 52.49 (5.43); Resilience 40.45 (5.49); TRAQ 75.14 (13.87). Self-Efficacy scores independently predicted TRAQ independent of age and other disease parameters (F(1) = 11.69, R2 = 0.16, P = 0.001), accounting for 16% of the variance. Resilience also independently predicted TRAQ score distinct from age and other disease parameters (F(1) = 6.45, R2 = 0.7, P = 0.01), accounting for 9% of the variance. Self-efficacy and resilience were entered in separate models because of their high autocorrelation (r = 0.044, P = 0.001); when added together, only self-efficacy was predictive of TRAQ. Conclusions: Transition readiness is independently predicted by either self-efficacy or resilience; both confidence and grit can be increased with skills-based behavioral interventions. Because self-efficacy and resilience scores predict transition readiness independent of age and other disease parameters, they may be useful tools for identifying risk and targeting behavioral interventions towards children at highest risk pre-transition.