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Sticker Charts: A Method for Improving Adherence to Treatment of Chronic Diseases in Children

Authors

  • Kara Luersen B.A.,

    1. Departments of Dermatology, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
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  • Scott A. Davis M.A.,

    1. Departments of Dermatology, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
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  • Sebastian G. Kaplan Ph.D.,

    1. Child and Adolescent Psychiatry Section, Department of Psychiatry and Behavioral Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
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  • Troy D. Abel M.F.A., Ph.D.,

    1. Visual Communication Design, Perception and Usability Testing Laboratory, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
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  • Woodrow W. Winchester Ph.D.,

    1. Industrial and Systems Engineering, Laboratory for User-Centric Innovations in Design, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
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  • Steven R. Feldman M.D., Ph.D.

    1. Departments of Dermatology, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
    2. Departments of Pathology, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
    3. Departments of Public Health Sciences, Center for Dermatology Research, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
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Address correspondence to Steven R. Feldman, M.D., Ph.D., Department of Dermatology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA, or e-mail: sfeldman@wakehealth.edu.

Abstract

Abstract:  Poor adherence is a common problem and may be an underlying cause of poor clinical outcomes. In pediatric populations, positive reinforcement techniques such as sticker charts may increase motivation to adhere to treatment regimens. To review the use of sticker charts to improve adherence in children with chronic disease, Medline and PsycINFO searches were conducted using the key words “positive reinforcement OR behavior therapy” and “adherence OR patient compliance” and “child.” Randomized controlled retrospective cohort or single-subject-design studies were selected. Studies reporting adherence to the medical treatment of chronic disease in children using positive reinforcement techniques were included in the analysis. The systematic search was supplemented by identifying additional studies identified through the reference lists and authors of the initial articles found. Positive reinforcement techniques such as sticker charts increase adherence to medical treatment regimens. In several studies, this effect was maintained for months after the initial intervention. Better adherence correlated with better clinical outcomes in some, but not all, studies. Few studies examining the use of sticker charts were identified. Although single-subject-design studies are useful in establishing the effect of a behavioral intervention, larger randomized controlled trials would help determine the precise efficacy of sticker chart interventions. Adherence to medical treatments in children can be increased using sticker charts or other positive reinforcement techniques. This may be an effective means to encourage children with atopic dermatitis to apply their medications and improve clinical outcomes.

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