title: Adherence Determinants in Cystic Fibrosis: Cluster Analysis of Parental Psychosocial, Religious, and/or Spiritual Factors.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  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.
authors: 1 Division of Pulmonary Medicine.
authors: Daniel H
authors: DH
authors: Grossoehme
authors: 1 Division of Pulmonary Medicine.|2 Division of Biostatistics and Epidemiology, and.
authors: Rhonda D
authors: RD
authors: Szczesniak
authors: 3 University of Alabama Birmingham/Children's Hospital of Alabama Cystic Fibrosis Center, Birmingham, Alabama; and.
authors: LaCrecia L
authors: LL
authors: Britton
authors: 1 Division of Pulmonary Medicine.
authors: Christopher M
authors: CM
authors: Siracusa
authors: 4 Department of Psychology, University of Miami, Miami, Florida.
authors: Alexandra L
authors: AL
authors: Quittner
authors: 1 Division of Pulmonary Medicine.
authors: Barbara A
authors: BA
authors: Chini
authors: 1 Division of Pulmonary Medicine.
authors: Sophia M
authors: SM
authors: Dimitriou
authors: 1 Division of Pulmonary Medicine.|5 James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors: Michael
authors: M
authors: Seid
mesh_terms: D000328:Adult; D000407:Alabama; D001294:Attitude to Health; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D003550:Cystic Fibrosis / Q000523:psychology / Q000628:therapy; D003863:Depression / Q000453:epidemiology / Q000209:etiology; D005192:Family Health; D005260:Female; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology*; D010349:Patient Compliance / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data; D011584:Psychology; D020377:Self Efficacy; D029181:Spirituality
keywords: cystic fibrosis; parents; psychosocial; spirituality; treatment adherence