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Pediatr Blood Cancer. 2018 Nov;65(11):e27387. doi: 10.1002/pbc.27387. Epub 2018 Jul 26.

Token economy to improve adherence to activities of daily living.

Author information

1
Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
2
Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
3
James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
4
Division of Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
5
Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
6
Information Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Abstract

BACKGROUND:

Participation in key activities of daily living (ADL), including daily bathing, physical activity, and oral hygiene, can decrease the risk of bloodstream infections, oral complications, and deconditioning in pediatric patients undergoing hematopoietic stem cell transplant (HSCT). However, many patients fail to perform ADL during their inpatient stay. To improve inpatient adherence to ADL, we tested a token economy to engage patients, families, and the clinical team in improving adherence to these important health behaviors during this critical time.

METHODS:

We used a controlled before-after study design to test our hypothesis. All patients were prescribed three ADL. We used an "all or none" measurement for each component of the ADL 1-2-3 initiative to measure adherence. HSCT patients with poor ADL adherence (<20%) were eligible to receive the intervention, which consisted of rewarding patients through an ADL via a token economy.

RESULTS:

Twenty-one patients participated in the study. ADL adherence for the 14 days prior to intervention in study subjects (n = 294 inpatient days) averaged 0.51 ADL per day (95% CI 0.45-0.57). In the 14 days postinitiation of the token economy intervention (n = 294 inpatient days), the average adherence was 2.5 ADL per day (95% CI 2.4-2.5; P = <0.001).

DISCUSSION:

Positive reinforcement through a token economy system is associated with improved adherence to ADL in hospitalized pediatric patients who demonstrated poor ADL adherence at baseline. We believe this intervention can positively impact adherence to targeted health behaviors with the ability to correlate with improved health outcomes.

KEYWORDS:

activities of daily living; adherence; bloodstream infections; hematopoietic stem cell transplant; operant conditioning; token economics

PMID:
30051581
PMCID:
PMC6150780
[Available on 2019-11-01]
DOI:
10.1002/pbc.27387

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