Adherence to treatment in children and adolescents with cystic fibrosis: a cross-sectional, multi-method study investigating the influence of beliefs about treatment and parental depressive symptoms.
BACKGROUND
Adherence to treatment is often reported to be low in children with cystic fibrosis. Adherence in cystic fibrosis is an important research area and more research is needed to better understand family barriers to adherence in order for clinicians to provide appropriate intervention. The aim of this study was to evaluate adherence to enzyme supplements, vitamins and chest physiotherapy in children with cystic fibrosis and to determine if any modifiable risk factors are associated with adherence.


METHODS
A sample of 100 children (≤18 years) with cystic fibrosis (44 male; median [range] 10.1 [0.2-18.6] years) and their parents were recruited to the study from the Northern Ireland Paediatric Cystic Fibrosis Centre. Adherence to enzyme supplements, vitamins and chest physiotherapy was assessed using a multi-method approach including; Medication Adherence Report Scale, pharmacy prescription refill data and general practitioner prescription issue data. Beliefs about treatments were assessed using refined versions of the Beliefs about Medicines Questionnaire-specific. Parental depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale.


RESULTS
Using the multi-method approach 72% of children were classified as low-adherers to enzyme supplements, 59% low-adherers to vitamins and 49% low-adherers to chest physiotherapy. Variations in adherence were observed between measurement methods, treatments and respondents. Parental necessity beliefs and child age were significant independent predictors of child adherence to enzyme supplements and chest physiotherapy, but parental depressive symptoms were not found to be predictive of adherence.


CONCLUSIONS
Child age and parental beliefs about treatments should be taken into account by clinicians when addressing adherence at routine clinic appointments. Low adherence is more likely to occur in older children, whereas, better adherence to cystic fibrosis therapies is more likely in children whose parents strongly believe the treatments are necessary. The necessity of treatments should be reinforced regularly to both parents and children.
School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK. Nicola.Goodfellow@nictu.hscni.net.
Nicola A
NA
Goodfellow
School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK. a.hawwa@aston.ac.uk.|Aston Pharmacy School, Aston University, Birmingham, B4 7ET, UK. a.hawwa@aston.ac.uk.
Ahmed F
AF
Hawwa
Northern Ireland Paediatric Cystic Fibrosis Centre, Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE, UK. alastair.reid@belfasttrust.hscni.net.
Alastair Jm
AJ
Reid
UCL School of Pharmacy, BMA House, Tavistock Square, London, WC1H 9JP, UK. r.horne@ucl.ac.uk.
Rob
R
Horne
Centre for Infection and Immunity, Queen's University Belfast, Belfast, UK. m.shields@qub.ac.uk.|Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE, UK. m.shields@qub.ac.uk.
Michael D
MD
Shields
School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK. j.mcelnay@qub.ac.uk.
James C
JC
McElnay
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003550:Cystic Fibrosis / Q000628:therapy*; D003863:Depression / Q000523:psychology*; D056947:Enzyme Replacement Therapy / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D010290:Parents / Q000523:psychology*; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D012138:Respiratory Therapy / Q000706:statistics & numerical data*; D014815:Vitamins / Q000627:therapeutic use*; D016903:Drug Monitoring
D014815:Vitamins