title: Adolescents' Spirituality and Cystic Fibrosis Airway Clearance Treatment Adherence: Examining Mediators.
abstract: Adolescent cystic fibrosis (CF) treatment adherence is a significant multidimensional issue. Using the Theory of Reasoned Action (TRA), this study examined the role of spiritual factors in adherence.
  
  
  
  Forty-five 11-19-year-olds diagnosed with CF completed questionnaires concerning psychosocial, spiritual, and adherence-related constructs and Daily Phone Diaries to calculate treatment adherence. Exploratory Factor Analysis identified two spiritual factors used in subsequent analyses. The mediating roles of attitude toward the treatment's value (utility), subjective behavioral norms (the product of perceived behavioral norms and one's motivation to comply with them), self-efficacy for completing the treatments and treatment intentions in the relationship between spiritual factors and treatment adherence were tested with path analysis.
  
  
  
  Lower 'spiritual struggle' and greater 'engaged spirituality' predicted treatment attitude (utility) and subjective behavioral norms, which, together with self-efficacy, predicted treatment intentions. Finally, treatment intentions predicted airway clearance adherence.
  
  
  
  Findings were consistent with the TRA. Engaged spirituality supports pro-adherence determinants and behavior. Spiritual struggle's negative associations with outcomes warrant screening and intervention.
authors.affiliation: Division of Pulmonary Medicine daniel.grossoehmc@cchmc.org.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Grossoehme
authors.affiliation: Division of Pulmonary Medicine Division Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center.
authors.forename: Rhonda D
authors.initials: RD
authors.lastname: Szczesniak
authors.affiliation: Department of Psychology, University of Alabama - Birmingham.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Mrug
authors.affiliation: Division of Pulmonary Medicine.
authors.forename: Sophia M
authors.initials: SM
authors.lastname: Dimitriou
authors.affiliation: Division of Pulmonary Medicine.
authors.forename: Alec
authors.initials: A
authors.lastname: Marshall
authors.affiliation: Division of Pulmonary Medicine.
authors.forename: Gary L
authors.initials: GL
authors.lastname: McPhail
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D001290:Attitude; D002648:Child; D003430:Cross-Sectional Studies; D003550:Cystic Fibrosis / Q000523:psychology* / Q000628:therapy*; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D009042:Motivation; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D000297:Psychology, Adolescent; D020377:Self Efficacy; D029181:Spirituality; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Theory of Reasoned Action; adherence; adolescent; cystic fibrosis