{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:44:19Z","timestamp":1785545059907,"version":"3.56.0"},"reference-count":34,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Pediatr Parent"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Managing a child undergoing growth hormone treatment (GHt) can be burdensome for the families, which can lead to psychological problems and poor treatment adherence. The Adhera Caring Digital Program (ACDP) is a mobile-based digital health intervention designed to support the physical and mental well-being of families of individuals with chronic conditions.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to evaluate the clinical feasibility of a digital intervention to support families by focusing on caregivers of children undergoing GHt and its impact on treatment adherence.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This is a prospective observational study. A total of 51 caregivers of children undergoing GHt with low adherence (below 85%) to treatment were recruited at the Pediatric Endocrinology Unit at the Miguel Servet Children\u2019s University Hospital and enrolled into the ACDP for 3 months.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 51 parents participated in the digital intervention for 3 months. The use of ACDP was associated with a significant increase in adherence rate (\n P<\/jats:italic>\n <.001). At baseline, all families had suboptimal adherence (below 85%), and after the intervention, 75% (n=38) of the families reached optimal levels of adherence. Also, the perceived pain of injection was reduced, as well as anxiety and stress. Initially, 21.56% (n=11) of caregivers reported depression symptoms, categorized as mild (11.76%, n=6), moderate (7.84%, n=4), and extremely severe (1.96%, n=1), while post intervention, only 1.96% (n=1) of caregivers reported depression as \u201csevere.\u201d Anxiety levels at baseline were reported by a total of 23.53% (n=12) of caregivers (mild: 7.84%, n=4, moderate: 13.73%, n=7, and severe: 1.96%, n=1). After the intervention, only 11.76% (n=6) reported mild (5.88%, n=3) or moderate (5.88%, n=3) anxiety levels. Initially, 23.5% (n=12) of caregivers reported stress as mild (7.84%, n=4), moderate (13.72%, n=7), and severe (1.96%, n=1) stress, and following the intervention, these symptoms reduced to 7.84% (n=4) (mild: 5.88%, n=3, severe: 1.96%, n=1).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The ACDP is a promising tool, and it has been demonstrated to significantly increase the adherence rate, adding value to the patient and caregiver journey, and improving the management of growth hormone deficiency while promoting the overall well-being of family caregivers. Our results show that the digital support provided by the solution significantly increased the quality of life of the caregivers by increasing their psychological, emotional, and social well-being and decreasing their depression, anxiety, and stress symptoms.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/67102","type":"journal-article","created":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T18:53:03Z","timestamp":1761591183000},"page":"e67102-e67102","source":"Crossref","is-referenced-by-count":1,"title":["Enhancing Adherence and Mental Well-Being in Pediatric Growth Hormone Therapy: Feasibility Prospective Observational Study of a Family-Centered Digital Companion"],"prefix":"10.2196","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2865-5813","authenticated-orcid":false,"given":"Antonio","family":"de Arriba Mu\u00f1oz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7839-1256","authenticated-orcid":false,"given":"Amalia M","family":"Garc\u00eda-Dur\u00e1n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6546-3193","authenticated-orcid":false,"given":"Patricia","family":"Sanz-Aznar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4007-8617","authenticated-orcid":false,"given":"Silvia","family":"Quer-Palomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1435-4358","authenticated-orcid":false,"given":"Ioannis","family":"Bilionis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9023-2432","authenticated-orcid":false,"given":"Alba","family":"Xifra-Porxas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0359-6095","authenticated-orcid":false,"given":"Joia","family":"Nu\u00f1ez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5449-0267","authenticated-orcid":false,"given":"Ricardo C","family":"Berrios","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8165-9904","authenticated-orcid":false,"given":"Luis","family":"Fern\u00e1ndez-Luque","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,10,27]]},"reference":[{"issue":"7","key":"R1","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1016\/j.paed.2019.04.001","article-title":"A review of growth hormone deficiency","volume":"29","author":"Dattani","journal-title":"Paediatr Child Health (Oxford)"},{"issue":"3","key":"R2","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1007\/s00431-010-1299-z","article-title":"Health-related quality of life and cognitive functioning in pediatric short stature: comparison of growth-hormone-na\u00efve, growth-hormone-treated, and healthy samples","volume":"170","author":"Stephen","journal-title":"Eur J Pediatr"},{"issue":"2","key":"R3","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1080\/02739615.2012.657068","article-title":"Multidimensional Fatigue Scale","volume":"41","author":"Varni","journal-title":"Child Health Care"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.1994.tb13413.x","article-title":"Psychosocial assessment of children with short stature: a preliminary report","volume":"406","author":"Skuse","journal-title":"Acta Paediatr Suppl"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.1159\/000048136","article-title":"Impact of growth hormone (GH) therapy on quality of life along the lifespan of GH-treated patients","volume":"56 Suppl 1","author":"Stabler","journal-title":"Horm Res"},{"issue":"1","key":"R6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/00004703-199402000-00001","article-title":"Academic achievement and psychological adjustment in short children","volume":"15","author":"Stabler","journal-title":"J Dev Behav Pediatr"},{"issue":"2","key":"R7","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1093\/schbul\/8.2.310","article-title":"Cognitive and emotional functioning in hypopituitary short-statured children","volume":"8","author":"Abbott","journal-title":"Schizophr Bull"},{"issue":"1-2","key":"R8","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1159\/000184754","article-title":"Growth, growth hormone and cognitive functions","volume":"45","author":"Sartorio","journal-title":"Horm Res"},{"issue":"3","key":"R9","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1001\/archpedi.158.3.236","article-title":"Short stature and functional impairment: a systematic review","volume":"158","author":"Wheeler","journal-title":"Arch Pediatr Adolesc Med"},{"issue":"3","key":"R10","doi-asserted-by":"publisher","first-page":"744","DOI":"10.1542\/peds.2003-1169-L","article-title":"Height and social adjustment: are extremes a cause for concern and action?","volume":"114","author":"Sandberg","journal-title":"Pediatrics"},{"issue":"11","key":"R11","doi-asserted-by":"publisher","first-page":"636","DOI":"10.1111\/j.1440-1754.2009.01586.x","article-title":"Depressive tendency in children with growth hormone deficiency","volume":"45","author":"Abe","journal-title":"J Paediatr Child Health"},{"issue":"5","key":"R12","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1038\/nrendo.2018.22","article-title":"Growth hormone - past, present and future","volume":"14","author":"Ranke","journal-title":"Nat Rev Endocrinol"},{"key":"R13","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S271453","article-title":"Adherence to r-hGH therapy in pediatric growth hormone deficiency: Current perspectives on how patient-generated data will transform r-hGH treatment towards integrated care","volume":"16","author":"Savage","journal-title":"Patient Prefer Adherence"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2431-4-1","article-title":"Caregiving process and caregiver burden: conceptual models to guide research and practice","volume":"4","author":"Raina","journal-title":"BMC Pediatr"},{"issue":"1","key":"R15","doi-asserted-by":"publisher","first-page":"e107","DOI":"10.1002\/cpp.2146","article-title":"Children\u2019s psychosocial functioning and parents\u2019 quality of life in paediatric short stature: The mediating role of caregiving stress","volume":"25","author":"Silva","journal-title":"Clin Psychol Psychother"},{"issue":"4","key":"R16","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1093\/jpepsy\/jsp068","article-title":"The effects of parental depression and parenting practices on depressive symptoms and metabolic control in urban youth with insulin dependent diabetes","volume":"35","author":"Eckshtain","journal-title":"J Pediatr Psychol"},{"issue":"4","key":"R17","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1097\/ANS.0000000000000262","article-title":"Towards a definition of caregiver fatigue: A concept analysis","volume":"42","author":"Beydoun","journal-title":"ANS Adv Nurs Sci"},{"key":"R18","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S268972","article-title":"Exploring potentially modifiable factors that influence treatment non-Adherence amongst pediatric growth hormone deficiency: A qualitative study","volume":"14","author":"Graham","journal-title":"Patient Prefer Adherence"},{"key":"R19","doi-asserted-by":"publisher","DOI":"10.1016\/j.pedn.2019.09.005","article-title":"Mothers\u2019 experiences of caring for children receiving growth hormone treatment","volume":"49","author":"Alsaigh","journal-title":"J Pediatr Nurs"},{"key":"R20","doi-asserted-by":"publisher","DOI":"10.1155\/2016\/7586385","article-title":"The design, usability, and feasibility of a family-focused diabetes self-care support mHealth intervention for diverse, low-income adults with type 2 diabetes","volume":"2016","author":"Mayberry","journal-title":"J Diabetes Res"},{"issue":"8","key":"R21","doi-asserted-by":"publisher","first-page":"914","DOI":"10.1530\/EC-18-0172","article-title":"Adherence and long-term growth outcomes: results from the easypod","volume":"7","author":"Koledova","journal-title":"Endocr Connect"},{"issue":"1","key":"R22","doi-asserted-by":"publisher","DOI":"10.1186\/s12911-022-01935-1","article-title":"Digital health for emotional and self-management support of caregivers of children receiving growth hormone treatment: a feasibility study protocol","volume":"22","author":"Cervera-Torres","journal-title":"BMC Med Inform Decis Mak"},{"key":"R23","doi-asserted-by":"publisher","DOI":"10.2196\/27446","article-title":"An eHealth Framework for Managing Pediatric Growth Disorders and Growth Hormone Therapy","author":"Dimitri","journal-title":"J Med Internet Res"},{"issue":"4","key":"R24","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1177\/20552076231171967","article-title":"Digital health interventions to support family caregivers: An updated systematic review","volume":"9","author":"Zhai","journal-title":"Journal of Digital Health"},{"key":"R25","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2020.104310","article-title":"Mobile applications for caregivers of individuals with chronic conditions and\/or diseases: Quantitative content analysis","volume":"145","author":"Lorca-Cabrera","journal-title":"Int J Med Inform"},{"issue":"6","key":"R26","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1037\/\/0022-3514.54.6.1063","article-title":"Development and validation of brief measures of positive and negative affect: the PANAS scales","volume":"54","author":"Watson","journal-title":"J Pers Soc Psychol"},{"issue":"3","key":"R27","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1016\/0005-7967(94)00075-u","article-title":"The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories","volume":"33","author":"Lovibond","journal-title":"Behav Res Ther"},{"issue":"3","key":"R28","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1002\/cpp.572","article-title":"Evaluation of the Mental Health Continuum-Short Form (MHC-SF) in Setswana-speaking South Africans","volume":"15","author":"Keyes","journal-title":"Clin Psychol Psychother"},{"key":"R29","doi-asserted-by":"crossref","unstructured":"Schwarzer R Jerusalem M . Self-efficacy measurement: Generalized Self-Efficacy Scale. In: Measures in Health Psychology: A User\u2019s Portfolio. 1995. URL: https:\/\/www.researchgate.net\/publication\/284672098_Measures_in_Health_Psychology_A_User\u2019s_Portfolio_Causal_and_Control_Beliefs","DOI":"10.1037\/t00393-000"},{"issue":"10","key":"R30","doi-asserted-by":"publisher","first-page":"1487","DOI":"10.1007\/s11136-010-9706-5","article-title":"Reliability, construct and criterion validity of the KIDSCREEN-10 score: a short measure for children and adolescents\u2019 well-being and health-related quality of life","volume":"19","author":"Ravens-Sieberer","journal-title":"Qual Life Res"},{"issue":"1","key":"R31","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7525-11-76","article-title":"Assessing the quality of life of health-referred children and adolescents with short stature: development and psychometric testing of the QoLISSY instrument","volume":"11","author":"Bullinger","journal-title":"Health Qual Life Outcomes"},{"key":"R32","unstructured":"Adhera precision digital companion: your partner in pediatric health management. Adhera Health. URL: https:\/\/www.adherahealth.com\/precisiondigitalcompanion [Accessed 23-09-2025]"},{"key":"R33","unstructured":"Arriba D . Can a mobile solution improve adherence to growth hormone treatment by modifying the emotional state of parents\/caregivers? Presented at: Spanish Congress of Pediatric Endocrinology; May 10-12, 2023; Palma Malloca, Spain."},{"key":"R34","unstructured":"Arriba D . Supporting the mental wellbeing of caregivers of children under growth hormone treatment: mix-methods evaluation of the Adhera\u00ae Caring Program. Presented at: 60th Annual ESPE (ESPE 2022); Sep 15-17, 2022; Rome, Italy. 2022."}],"container-title":["JMIR Pediatrics and Parenting"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/pediatrics.jmir.org\/2025\/1\/e67102","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:28:13Z","timestamp":1785536893000},"score":1,"resource":{"primary":{"URL":"https:\/\/pediatrics.jmir.org\/2025\/1\/e67102"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,27]]},"references-count":34,"URL":"https:\/\/doi.org\/10.2196\/67102","relation":{},"ISSN":["2561-6722"],"issn-type":[{"value":"2561-6722","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,27]]},"article-number":"v8i7e67102"}}