The Effect of the SystemCHANGETM Intervention on Systems Thinking in a Randomized Controlled Trial of Adult Kidney Transplant Recipients: A Secondary Data Analysis

Objective: The SystemCHANGETM intervention is an approach that harnesses patients' recurring personal systems of established routines of daily living, environments, and important others as reliable 'personalized system solutions' to support habitual medication-taking and improve medication adherence. In a secondary data analysis, we (1) analyzed the association between the longitudinal trajectories of systems thinking and medication adherence, and (2) examined the extent that demographic characteristics and the SystemCHANGETM intervention influenced these trajectories. Methods: Participants were >= 18 years of age who had received a kidney-only transplant, self-administered at least one prescribed immunosuppressive medication twice daily, had a functioning kidney transplant, were not in the hospital, and had no diagnosis that would immediately shorten the lifespan. We conducted a single-blinded (participants), 2-arm randomized controlled trial (RCT). An intervention group received the 6-month SystemCHANGETM intervention, and the attention-control group received the 6-month education intervention. Systems thinking was measured using the Systems Thinking Scale (adapted for patients). Results: The parallel process growth curve model with time-invariant predictors suggested that participants with higher levels of systems thinking at baseline demonstrated greater gains in systems thinking over time (r=0.407). White participants exhibited greater baseline levels of systems thinking than African-American participants (d=0.76). Participants assigned to the SystemCHANGETM group maintained their medication adherence rates over time, whereas control counterparts demonstrated significantly different, declining trajectories of medication adherence (d=-0.41). Conclusion: We found shared co-variance between systems thinking and medication adherence and the SystemCHANGETM intervention. The SystemCHANGETM intervention was efficacious in improving and sustaining medication adherence in adult kidney transplant recipients.