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Token economy to improve adherence to activities of daily living
Author(s) -
Hickey Victoria,
Flesch Laura,
Lane Adam,
Pai Ahna L.H.,
Huber John,
Badia Priscila,
Davies Stella M.,
Dandoy Christopher E.
Publication year - 2018
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.27387
Subject(s) - medicine , activities of daily living , token economy , intervention (counseling) , physical therapy , bathing , nursing , psychology , social psychology , pathology , reinforcement
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.