RS16-002 Facilitators and Barriers to Adherence to Prescribed Bowel Management Programs by Adolescents with Neurogenic Bowel Conditions

Anne Jinbo, Ph.D., APRN-RN, MPH, CWOCN, CPNP, Hawaii Wound, Ostomy and Continence Services, Honolulu, HI, and Donna Z. Bliss, Ph.D., RN, FAAN, FGSA, School of Nursing, University of Minnesota, Minneapolis, MN

Background:  Adolescents with neurogenic bowel conditions need to assume the performance of their prescribed bowel management program (BMP) but information about their adherence is lacking.

Purpose:  To describe adolescents’ level of adherence to prescribed BMPs and examine factors influencing their adherence.

Methods:  Adolescents in the practice of a CWOCN pediatric nurse practitioner were invited to participate in this study with a descriptive design.  Level of adherence to BMPs and adherence facilitators and barriers were assessed using lists of specific factors and open-ended questions, whose development was guided by the Reason Action Approach framework. Frequencies of responses to lists were calculated; responses to open-ended questions were analyzed for themes using content analysis.

Results:  30 adolescents (age=16(4) Mean(sd) years; male=57%; Asian/Pacific Islander=66%, White=10%, other=23%) participated.  90% were enrolled in school and 23% of those had special-education classes.

52% of adolescents adhered to their BMP 75-100% of the time; 40% had <50% adherence to BMP.  Specific perceived benefits of BMPs were: avoidance of accidents (80% of adolescents), increased confidence around friends (80%), and feelings of normalcy (80%). Specific barriers to BMPs were:  continued accidents (36% adolescents), feeling different than others (33%), and length of time to complete BMPs (30%).

Themes of factors facilitating BMP adherence were:  interventions to help ease defecation, benefits of having a BMP, and being able to control the timing of BMP routine. Themes of barriers to BMP adherence were: physical discomforts/side effects, lengthiness of BMP, and need for physical assistance.

Conclusions: Approximately half of the adolescents need consultation from WOC nurses to improve adherence to prescribed BMPs, and study findings offer guidance for developing appropriate strategies. Decreasing barriers to adherence may include reducing physical side effects, adjusting BMPs according to developmental/physical abilities, and providing emotional support. Reinforcing BMP benefits and allowing choice in the timing of the BMP routine may promote continued adherence.


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