ESPE Abstracts

Factors Influencing the Selection of Injection Areas during Self-Therapy for Growth Hormone Therapy among Patients 10–15 Years old.

Background: It is known that consistency in growth hormone therapy has major influence on long term linear growth. Many studies have researched the connections between varied growth hormone preparations, ease of use and adherence to treatment. No research was found on preference of specific injection areas and reasons for such. Every year over 180 children begin growth hormone therapy at the institute. Training and monitoring them is a major part of the staff’s daily work. The institute aims to optimize and personalize growth hormone self-therapy training, to improve self-therapy adherence.

Objective: Investigate the preferred injection areas for children aged 10–15. Investigate variables that influence the selection of preferred injection areas.

Methods: Fifty-one children between the ages of 10–15, in treatment for over 6 weeks, took part in a questionnaire study. The questionnaire examined several factors and their effect on the choice of injection areas: knowledge, patient environment (training staff, acquaintances also in treatment), pain, and personal factors (age, weight, BMI, previous experience, superstition). (These are preliminary results for the full study which aims to cover 100 children).

Results: The study population consisted of 27 boys and 24 girls 51 aged 10–15 (mean 12.64), who were treated with growth hormone between 2 month and 10 years (mean 3 years). Preference of injection areas (descending order) was: arms, buttocks, thighs and abdomen, with no prominent side preference. Boys reported more subjective pain than girls (NS). Children reporting a fear of injection in the abdomen also reported severe pain (mean of 6.9 vs. 2.66 for those that reported no fear of injection in abdomen: P<0.005). Those children were treated longer with growth hormone (mean of 3.7 years vs 2.1 years for those who reported no fear of injection in the abdomen, P<0.011) 11% of the children received a recommendation for a preferred injection area from another patient. Sex, age, and familiarity with recommended injection areas were not found to impact choice of preferred injection area. There was no concern among children regarding whether or the injection will leave visible marks that can be seen by others.

Conclusions: Pain and fear of pain are the main factors influencing the selection preferred injection sites. Time does not constitute a mitigating factor, and sometimes fear increases as the treatment continues.