Background: Prior to transferring from pediatric to adult congenital heart disease (CHD) care, dedicated transition programs can help teach patients fundamental CHD knowledge and skills. Without patient willingness to engage or be receptive to educational sessions, time devoted to transition services may be ineffective. Existing psychotherapy modelling has been used to objectively rate patient readiness to assume adult behaviors and level of engagement, but little is known regarding how these ratings change while in a CHD transition program.

Methods: An existing REDCap database for adolescent participants in the Texas Children’s Hospital (TCH) transition program from 2019 to 2021 was utilized. Inclusion criteria included patients aged 14-21 with either CHD or electrophysiological (EP) diagnoses. Patients with significant developmental delay were excluded. The transtheoretical model of behavior change, commonly called the Stages of Change (SOC), and Level of Engagement (LOE) model was used for assessment. The primary outcome variables were progression in SOC or LOE. Sociodemographics were primary predictor variables. Multivariate mixed linear regression modeling accounted for repeated measures and were adjusted for age and transition clinic visit number.

Results: A total of 520 patients had 716 serial transition encounters of which, 52% were male, 42.8% were Hispanic or Black, 21.5% had public insurance, 29.5% had complex CHD, 22.5% had EP diagnoses, and 13% had a genetic syndrome. Increasing transition visit number was an independent predictor of progression in both SOC and LOE regardless of age, although this was significant only between the first two visits (p<0.01 and p=0.02 respectively). On multivariable SOC analyses, patients with either no or military insurance were significantly more likely to be at lower SOC. Patients with EP conditions were more likely to be at a higher SOC. Sex, race/ethnicity, primary language, CHD severity, obesity, and genetic diagnosis were not associated with difference in SOC. On multivariable LOE analyses, patients with public insurance and Black race had a lower LOE. Sex, ethnicity, primary language, CHD severity, obesity, EP diagnosis, and genetic diagnosis were not associated with difference in LOE. 

Conclusions: Regardless of age, increasing transition visits were associated with increased Stage of Change and Level of Engagement, but this was only significant between the first two visits. Beyond teaching transition knowledge and skills, incorporating psychotherapy modelling may be an important aspect of transition education. Future work is needed to determine if a higher SOC or LOE is associated with more effective transition.