DISCUSSION
comorbidity, multimorbidity, wasting
WASTING
This patient‐oriented, mixed methods study aimed to understand the transition readiness of youth with co‐occurring chronic health and mental health conditions utilizing a combination of quantitative and qualitative data. The phase 1 results, which indicate relatively high TRAQ subscale scores, underscore the role of resilience within this population, whereas phase 2 highlights the criticality of understanding each youth's individual experiences, symptoms, coping strategies and available supports as they relate to transition preparedness. The integrated phase 3 findings necessitate individualized approaches to transition planning which use a combination of readiness assessments, in‐depth conversations and tailored resources given the complexity of this group's needs.In combining the findings from phases 1 and 2, it became apparent that a transition readiness score using a well‐validated tool is insufficient to capture the breadth of factors contributing to self‐management and preparedness for adult care for youth with co‐occurring health and mental health conditions. It is evident that transition readiness encompasses a variety of skills, capacities, experiences and system‐level factors that may be difficult to address in a single readiness assessment for this group. As has been described by Straus,Though the influence of a mental health comorbidity on transition readiness in youth with chronic conditions exiting pediatric care has not been specifically investigated in the literature, research has examined aspects of self‐management amongst individuals with multimorbidity (i.e., the presence of ≥2 chronic conditions).Mental health problems fluctuate, thus the need for support with managing daily activities from healthcare providers, family members and/or peers may wax and wane depending on the acuity of mental health symptoms for youth with co‐occurring conditions. The TRAQ, as it is currently worded, does not capture possible temporal variations in readiness based on vacillating symptoms given the questions are prefaced by the following statement: ‘Please check the box that describes your skill level in the following areas that are important for transition to adult health care’.While first‐time interactions with adult healthcare providers are anxiety‐provoking for the majority of youth with chronic health conditions,Barriers and facilitators to medication adherence have been well studied amongst individuals with multiple chronic conditions across the lifespan;The ability to self‐advocate through communicating one's needs to healthcare providers is a core component of successful chronic condition self‐management.The phase 2 results are largely consistent with prior research in the adult population which identified that feelings of hopelessness, high levels of emotional distress and fears of wasting healthcare providers' time were barriers to effective communication and self‐advocacy in patient–provider interactions.The progression of self‐management, communication and advocacy skills in youth transitioning to adult care is dependent upon a series of interwoven factors ranging from one's mental health symptoms, familial support, the complexity of their chronic condition(s) and their relationships with care providers, all of which are endorsed in the social‐ecological model of adolescent and young adult readiness for transition.