A mixed methods exploratory study assessing youth knowledge, self-efficacy and mental health outcomes in transition to adult healthcare.

Background: Transition from adolescence to adulthood is a change in status yielding self-sufficiency, independence, and participation in adult roles. There are numerous efforts to define transition elements and encourage formalized processes readying youth for adulthood, yet significant challenges remain. Methods: We recruited individuals who were age 12 years or older and not transitioned or 18 years and older who transitioned within 24 months to complete questionnaires and participate in a focus group. Results: 25 participants (Mean age 17.9 years) completed questionnaires and 76 % participated in focus groups. Youth 18 years and older had mean scores in the reason for concern range on 7 of 9 NIH Toolbox scales de. Transition readiness was lower in adults across all five categories. Key themes include misunderstanding the concept of transition and self-determination in transition. Conclusions: Few youth understood what "transition" entails. Most considered it a single issue, such as aging out of insurance or leaving their pediatric specialist. Youth self-efficacy and life outlook declines in the late teens and early adulthood, exacerbating perceived inability to self-manage and gain independence. Most concerning is the emotional well-being and self-esteem of our adults who scored in the reason for concern range in 7 of 9 scales whereas adolescent peers did not. A directed attempt to create self-efficacy for youth in transition through training in health management, understanding the meaning of transition and promoting a positive perception prior to transition is needed.