The Impact of COVID-19 on Pediatric Adherence and Self-Management

Jill M. Plevinsky, PHD; Melissa A. Young, PSYD; Julia K. Carmody, PHD; Lindsay K. Durkin, MS; Kaitlyn L. Gamwell, PHD; Kimberly L. Klages, PHD; Shweta Ghosh, PHD; Kevin A. Hommel, PHD


J Pediatr Psychol. 2020;45(9):977-982. 

In This Article

Healthcare Disparities

Notably, the detrimental impacts of the COVID-19 pandemic that can exacerbate nonadherence are disproportionately higher in low-socioeconomic communities, compounding pre-existing health disparities. Over one-third of vulnerable populations have reported job losses and material hardship, which may have ended insurance coverage for many youth (Jenco, 2020; Millett et al., 2020; Van Dorn et al., 2020). Telehealth has offered benefits to vulnerable populations (i.e., removing transportation barriers, not missing work due to a child's medical appointment). Still, the pandemic created additional barriers to healthcare service delivery for underserved youth and their families, including barriers to telemedicine (e.g. inability to acquire appropriate technology, affordability of internet access), changes to medical appointment scheduling, difficulty accessing interpreter services, and visitor restrictions (e.g., only one caregiver being allowed to accompany the child) at the hospital. Quickly having to learn and navigate new technology systems to access healthcare can result in frustration and reduced utilization of care for these families as well (Children's Health Fund, 2020). Additionally, adherence and self-management support via psychology, social work or child life services may be limited given reduced capacity of these services due to limited staff hours, reduction in hospital revenue resulting in temporary discontinuation of services, or time needed to transition to telehealth platforms. Last, pediatric patients from underserved populations likely face reduced community supports (i.e., Boys and Girls Club) and reduced access to supportive health services via their school system (e.g., physical education, school nurse support). Given that the pandemic is differentially affecting underserved populations, they are more vulnerable and therefore at greater risk for poorer adherence and self-management as a result.