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Observational Study
. 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

Daniel H Grossoehme  1 , Rhonda D Szczesniak  1   2 , LaCrecia L Britton  3 , Christopher M Siracusa  1 , Alexandra L Quittner  4 , Barbara A Chini  1 , Sophia M Dimitriou  1 , Michael Seid  1   5
Affiliations
Observational Study

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

Daniel H Grossoehme et al. Ann Am Thorac Soc. 2015 Jun.

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.

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Figures

Figure 1.
Figure 1.
The theory of reasoned action.
Figure 2.
Figure 2.
Participant enrollment diagram.
Figure 3.
Figure 3.
Four-cluster model of parents’ adherence to their child’s prescribed daily frequency of airway clearance treatments.
Figure 4.
Figure 4.
Three-cluster model of parents’ adherence to their child’s prescribed daily frequency of nebulized medication treatments.
See this image and copyright information in PMC

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