ImportanceDespite elevated health risks during young adulthood, many adolescents and young adults with serious health care needs face barriers during the transfer to an adult specialty practitioner, and health disparities may occur during the transition.ObjectiveTo validate the content of an updated Social-Ecological Model of Adolescent and Young Adult Readiness for Transition to Promote Health Equity (SMART-E) in a group of adolescents and young adults with sickle cell disease (SCD) and their supports.Design, Setting, and ParticipantsHealth equity framework components were reviewed. Systems of power (eg, institutional and practitioner bias) and environments or networks (eg, peer or school support) were added as SMART-E preexisting factors, and health literacy was included within readiness factors. Adolescents and young adults aged 16 to 29 years with SCD, caregivers, and practitioners participated in this convergent, mixed-methods study within Children’s Hospital of Philadelphia between January and August 2022.Main Outcomes and MeasuresContent validity was assessed through nominations of top 3 most important transition barriers prior to interviews and focus groups, ratings on importance of SMART-E factors (0-4 scale; ratings >2 support validity) after interviews and focus groups, nominations of 3 most important factors for transition and for health equity, and qualitative content analysis of interview transcripts.ResultsThe study enrolled 10 pediatric adolescents and young adults (mean [SD] age, 18.6 [2.9] years; 4 female and 6 male), 10 transferred adolescents and young adults (mean [SD] age, 22.9 [2.1] years; 8 female and 2 male), 9 caregivers (mean [SD] age, 49.8 [8.7] years; 5 female and 4 male), and 9 practitioners (mean [SD] age, 45.6 [10.5] years; 8 female and 1 male). Quantitative ratings supported the content validity of SMART-E and met established criteria for validity. Systems of power was the most endorsed transition barrier (14 of 38 participants) reported prior to interviews and focus groups. After the interview, participants endorsed all SMART-E factors as important for transition, with new factors systems of power and environments and networks rated at a mean (SD) 2.8 (1.23) and 3.1 (0.90), respectively, on a 0 to 4 scale of importance. The most important factors for transition and equity varied by participant group, with all factors being endorsed, supporting the comprehensiveness of SMART-E. Qualitative data corroborated quantitative findings, further supporting validity, and minor modifications were made to definitions.Conclusions and RelevanceSMART-E obtained initial content validation with inclusion of health equity factors for adolescents and young adults with SCD, caregivers, and practitioners. The model should be evaluated in other populations of adolescents and young adults with chronic disease.

中文翻译：

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向成人护理过渡的更新公平准备模型

重要性尽管成年初期的健康风险较高，但许多有严重医疗保健需求的青少年和年轻人在转至成人专科医师的过程中面临障碍，并且在过渡期间可能会出现健康差异。 目的验证更新的社会生态模型的内容一组患有镰状细胞病 (SCD) 的青少年和年轻人及其支持的青少年和年轻人准备过渡以促进健康公平 (SMART-E)。设计、设置和参与者对健康公平框架组成部分进行了审查。权力系统（例如，机构和从业者偏见）和环境或网络（例如，同伴或学校支持）被添加为 SMART-E 预先存在的因素，健康素养也被纳入准备因素中。2022 年 1 月至 8 月期间，16 至 29 岁患有 SCD 的青少年和年轻人、护理人员和从业人员参加了费城儿童医院的这项融合、混合方法的研究。主要结果和措施通过提名前 3 个最重要的内容来评估内容有效性访谈和焦点小组之前的过渡障碍、访谈和焦点小组之后 SMART-E 因素重要性的评级（0-4 等级；评级 >2 支持有效性）、提名 3 个对过渡和健康公平最重要的因素以及访谈记录的定性内容分析。结果该研究招募了 10 名儿科青少年和年轻人（平均 [SD] 年龄，18.6 [2.9] 岁；4 名女性和 6 名男性），10 名转入的青少年和年轻人（平均 [SD] 年龄，22.9 [2.1] 岁；8 名女性和 2 名男性）、9 名护理人员（平均 [SD] 年龄，49.8 [8.7] 岁；5 名女性和 4 名男性）和 9 名从业者（平均 [SD] 年龄，45.6 [10.5]岁；8 名女性和 1 名男性）。定量评级支持 SMART-E 内容的有效性并符合既定的有效性标准。权力系统是在访谈和焦点小组之前报告的最受认可的过渡障碍（38 名参与者中的 14 名）。访谈结束后，参与者认可所有 SMART-E 因素对转型很重要，其中电力、环境和网络的新因素系统的平均值 (SD) 分别为 0 至 4 的 2.8 (1.23) 和 3.1 (0.90)。重要性的规模。过渡和公平最重要的因素因参与者群体而异，但所有因素都得到认可，支持 SMART-E 的全面性。定性数据证实了定量研究结果，进一步支持了有效性，并对定义进行了细微修改。结论和相关性SMART-E 获得了初步内容验证，其中纳入了患有 SCD 的青少年和年轻人、护理人员和从业者的健康公平因素。该模型应该在其他患有慢性病的青少年和年轻人群体中进行评估。