Table 2.

Recommendations for improving adherence.

Interaction with the healthcare team
Age-appropriate education and awareness of treatment objectives and the importance of adherence, particularly when administration shifts from caregiver to child (16, 29, 31)
Increased patient engagement, such as in selecting the device (16, 30) and in shared decision-making (11)
Ongoing feedback of treatment efficacy, to encourage compliance (16)
Adherence reminder tools
Electronic injection reminders, mobile phone reminders, and applications (13)
Gamified interventions that include goal setting, incentive-based engagement, and education (13)
Real-time monitoring of adherence using internet-connected devices (13)
Use of an electronic monitoring device to track adherence (12, 13, 23)
Device
Improvements in device design that reduce pain (29)/needle anxiety (32) and increase convenience (16)
Product
A product that does not require cold storage (i.e., storage-flexible rhGH) (21)
Reduction in the number of injections from daily to weekly (14)

rhGH, recombinant human growth hormone.