P3.011: From Adolescence to Adulthood: The Impact of Psychosocial Factors on Transition Readiness

Background: Health care transition (HCT) is the process of moving from pediatric- to adult-centered care with focus on AYA independence in managing their own health. Psychosocial factors influence health outcomes and overall wellbeing. Our objective was to assess associations between positive psychosocial screening and transition readiness in AYA.

Methods: A retrospective cohort study conducted in an adolescent primary care clinic (January 2020-March 2024) evaluated whether positive psychosocial screening was associated with the 20-item Transition Readiness Assessment Questionnaire (TRAQ) responses. TRAQ domains include managing medications, keeping appointments, managing health issues, and communicating with providers. Responses dichotomize as ‘no’ don’t know how/want to learn vs. ‘yes’ have started/always do. Patients completed TRAQ assessments every six months during medical visits. Randomization software selected one visit per patient. Factor analysis for the 14-item psychosocial screener discerned six subscales: financial stress(food/housing), drugs/appointments, resources (doctor/education), harm (others/self), mood, (need to) talk. Appropriate bivariate statistics were used to compare positive SDOH to those with negative screens. The IRB approved the study as exempt.

Results: Patients (N=1,210; ages 18-25 years; median=19.6 years; 67% female; 48% Hispanic) with positive psychosocial screens were more likely to be non-Hispanic White (21% v. 17%) and non-Hispanic Black (26% v. 21%); p=0.033. Groups were similar in age, legal sex, and insurance. Patients with at least one item positive on psychosocial screening were less likely to keep a calendar for appointments (72% v. 82%; p=0.034) as were those screening positive on the financial subscale (65% v. 81%; p=0.004). Patients positive on the resources subscale were less likely to report communication readiness skills (96% v. 88%; p=0.037). Those positive on the harm subscale were less likely to be ready to make appointments (65% v. 83%; p=0.036). Patients with a positive mood subscale were less likely to report unusual changes (57% v. 76%; p=0.043), make follow-up appointments (61% v. 79%; p=0.042), and attend visits alone (72% v. 88%; p=0.009). Patients positive for talking to someone exhibited less readiness for keeping an appointment calendar (69% v. 80%; p=0.05) but had increased readiness for asking providers to explain items (99% v. 92%; p=0.049).

Conclusion: AYA with positive psychosocial factor screening had lower readiness for appointments and communication. Psychosocial factors and social determinants of health contribute to health disparities and inequities and may impact successful transition to adult care. Addressing these topics frequently and with shared decision-making processes may be a key consideration for successful HCT in adolescents and young adults.