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Improving Medication Adherence

in Teens and Young Adults

Poor medication adherence (not taking medications as prescribed) is believed to be one of the most important reasons for graft loss. Transplant recipients of all ages may have trouble taking their medications as prescribed, but young people seem to be at especially high risk for poor adherence. This may explain why young people 17-24 years old are at higher risk for graft loss than any other age group. 

A previous study, called TAKE-IT, found that adherence was better when young people worked with an adherence Coach, who helped them figure out what got in the way of taking their medication and how to improve. Young people who received the TAKE-IT intervention used a multi-dose electronic pillbox that tracked their medication-taking and could send them text-message reminders when they did not take their medications on time. However, there were 2 things that could prevent the TAKE-IT intervention from being used in real life. First, the Coaches were not part of the usual transplant team. We don’t know if the transplant team could do what the coaches did. Second, the pillbox was not ideal for all young people. Many said they would prefer a smaller, more portable device.

Our Objectives

Aim 1: To understand the needs and preferences of kidney transplant recipients, parents, and healthcare professionals in order to optimize the TAKE-IT intervention for ‘real world’ use.

Aim 2: To design and evaluate the usability and acceptability of an e-pillbox, and companion adherence-tracking website. 

Aim 3: To conduct a pilot cluster randomized trial testing the adapted intervention, including the e-pillbox, to assess feasibility of a larger trial and further refine the intervention.

Take-It Too Stages


Stage 1: Separate focus groups of patients and parents will be conducted at transplant centers in the United States and Canada to optimize effectiveness and acceptability of the multicomponent intervention and inform e-pillbox design. Focus groups with health care professionals will identify ways to facilitate implementation of an adherence-promoting intervention in clinical practice.

Stage 2: Patients will participate in a series of one-on-one device-development sessions, providing input and feedback on the usability and design of the e-pillbox. Health care professionals will also participate in a series of one-on-one sessions to provide input and feedback on the design of the adherence-tracking website.

Stage 3: Centers will be randomized to either provide the new, adapted intervention, including the new e-pillbox and companion website or to provide usual care. Adherence will be measured at all centers using the new e-pillbox.

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