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Ann Am Thorac Soc. 2015 Jun;12(6):838-46. doi: 10.1513/AnnalsATS.201408-379OC.

Adherence Determinants in Cystic Fibrosis: Cluster Analysis of Parental Psychosocial, Religious, and/or Spiritual Factors.

Author information

1
1 Division of Pulmonary Medicine.
2
2 Division of Biostatistics and Epidemiology, and.
3
3 University of Alabama Birmingham/Children's Hospital of Alabama Cystic Fibrosis Center, Birmingham, Alabama; and.
4
4 Department of Psychology, University of Miami, Miami, Florida.
5
5 James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Abstract

RATIONALE:

Cystic fibrosis is a progressive disease requiring a complex, time-consuming treatment regimen. Nonadherence may contribute to an acceleration of the disease process. Spirituality influences some parental healthcare behaviors and medical decision-making.

OBJECTIVES:

We hypothesized that parents of children with cystic fibrosis, when classified into groups based on adherence rates, would share certain psychosocial and religious and/or spiritual variables distinguishing them from other adherence groups.

METHODS:

We conducted a multisite, prospective, observational study focused on parents of children younger than 13 years old at two cystic fibrosis center sites (Site 1, n= 83; Site 2, n = 59). Religious and/or spiritual constructs, depression, and marital adjustment were measured by using previously validated questionnaires. Determinants of adherence included parental attitude toward treatment, perceived behavioral norms, motivation, and self-efficacy. Adherence patterns were measured with the Daily Phone Diary, a validated instrument used to collect adherence data. Cluster analysis identified discrete adherence patterns, including parents' completion of more treatments than prescribed.

MEASUREMENTS AND MAIN RESULTS:

For airway clearance therapy, four adherence groups were identified: median adherence rates of 23%, 52%, 77%, and 120%. These four groups differed significantly for parental depression, sanctification of their child's body, and self-efficacy. Three adherence groups were identified for nebulized medications: median adherence rates of 35%, 82%, and 130%. These three groups differed significantly for sanctification of their child's body and self-efficacy.

CONCLUSIONS:

Our results indicated that parents in each group shared psychosocial and religious and/or spiritual factors that differentiated them. Therefore, conversations about adherence likely should be tailored to baseline adherence patterns. Development of efficacious religious and/or spiritual interventions that promote adherence by caregivers of children with cystic fibrosis may be useful.

KEYWORDS:

cystic fibrosis; parents; psychosocial; spirituality; treatment adherence

PMID:
25803407
PMCID:
PMC4590021
DOI:
10.1513/AnnalsATS.201408-379OC
[Indexed for MEDLINE]
Free PMC Article

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