Mixed Methods Approach to Evaluating Barriers to Nutritional Adherence in Adolescents with Cystic Fibrosis

评估囊性纤维化青少年营养依从障碍的混合方法

• 批准号: 9908691
• 负责人: Kristine Durkin
• 金额: $ 4.55万
• 依托单位: WEST VIRGINIA UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-03-15 至 2022-03-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9908691
• 关键词: Adherence; Adolescent; Age; Area; Bacterial Infections; Behavior; Behavior Therapy; Behavioral; Behavioral Research; Behavioral Sciences; Body Image; Calories; Caring; Child; Child Health; Child Rearing; Childhood; Choices and Control; Chronic; Chronic Disease; Clinic; Clinic Visits; Clinical Research; Collaborations; Communication; Competence; Consumption; Cystic Fibrosis; Data; Development; Diet; Dietary intake; Dietitian; Disease; Energy Intake; Ensure; Enzymes; Exocrine pancreatic insufficiency; Face; Fatty acid glycerol esters; Focus Groups; Food; Foundations; Future; Genetic; Goals; Health; Hour; Intake; Intervention; Interview; Joints; Learned Helplessness; Life; Link; Literature; Longevity; Lung; Malnutrition; Measures; Medical; Medical Care Team; Mentors; Methodology; Methods; Minerals; Modeling; Motivation; National Research Service Awards; Nutritional; Nutritional Support; Nutritional status; Outcome; Parents; Participant; Predictive Factor; Proteins; Provider; Public Health; Randomized Controlled Trials; Recommendation; Regimen; Regression Analysis; Reporting; Research; Research Personnel; Resources; Respiratory physiology; Risk; Sampling; Self Efficacy; Site; Surveys; Teenagers; Training; Training Programs; Visit; Vitamins; Youth; base; behavior change; career; children with cystic fibrosis; cystic fibrosis patients; design; dietary supplements; experience; health literacy; improved; indexing; innovation; neglect; novel; nutrient absorption; recruit; satisfaction; translational scientist

! PROJECT SUMMARY Adhering to dietary recommendations and nutritional supplements to deter inadequate absorption of nutrients the development of malnutrition in patients with cystic fibrosis (CF) is critical, given that nutritional status is significantly related to health outcomes (e.g., lung functioning) and longevity. Yet, non-adherence to the CF care regimen, including nutritional recommendations, is high in adolescents, in particular. Though behavioral interventions have been very effective in improving nutritional intake in young children with CF, little is known about what factors are associated with nutritional non-adherence in adolescents with CF. With increased independence and control over dietary intake, adolescents likely have adherence challenges that are different than their younger counterparts. Therefore, using a [convergent mixed methods design], the overall goal of this study is to identify factors related to adherence to nutritional recommendations in adolescents with CF and to obtain rich qualitative data from key stakeholders (i.e., adolescents & dietitians) regarding barriers to nutritional adherence and challenges in working together in clinic to improve it. We will apply an organizing framework, the Capability-Opportunity-Motivation-Behavior (COM-B) model, to interpret our findings and identify specific factors necessary for behavior change in future interventions. This study is innovative, as no other behavioral research has focused on understanding adolescent-specific challenges to nutritional adherence in the CF care regimen. [A total of 132 adolescents (ages 12-18) will be recruited from 5 CF centers across the US to obtain a sample of at least 110 adolescents after possible attrition]. For Specific Aim 1, adolescents will complete surveys measuring a range of potential factors associated with adherence, as well as 2 random days of 24-hour diet recall to indirectly assess nutritional adherence through the CF-INTAKE measure (daily caloric intake, fat grams, enzyme use, number of meals & snacks). Regression analyses will examine which factors significantly predict nutritional adherence scores. For Specific Aim 2, 20 adolescents will be randomly selected from the larger sample to provide in-depth stakeholder perspectives on the difficulties they experience around nutritional adherence. Six dietitians (from our 5 recruitment sites) also will take part in [focus groups] to share their perspective on challenges they experience in communicating with and supporting adolescents on nutritional adherence. Qualitative results will be integrated with quantitative findings for final analysis [using a comparison joint display table]. Results from this NRSA project are expected to provide better understanding of behavioral determinants for adolescent nutritional non-adherence so that a developmentally-sensitive, yet practical, clinic-based adherence promotion intervention can be developed to target these factors in the future. ! !

！ 项目概要 遵守饮食建议和营养补充剂，以防止营养吸收不足 鉴于营养状况较差，囊性纤维化 (CF) 患者出现营养不良至关重要 与健康结果（例如肺功能）和寿命显着相关。然而，不遵守 CF 护理方案，包括营养建议，在青少年中尤其如此。虽然行为上 干预措施对于改善患有 CF 的幼儿的营养摄入非常有效，但目前所知甚少 关于哪些因素与 CF 青少年营养不依从相关。随着增加 独立性和对饮食摄入的控制，青少年可能面临依从性挑战 与年轻的同行不同。因此，采用[收敛混合方法设计]，总体 本研究的目的是确定与青少年遵守营养建议相关的因素 与 CF 并从主要利益相关者（即青少年和营养师）获得有关 营养依从性的障碍以及临床合作改善营养依从性的挑战。我们将申请一个 组织框架，能力-机会-动机-行为（COM-B）模型，来解释我们的 调查结果并确定未来干预措施中行为改变所需的具体因素。这项研究是 创新，因为没有其他行为研究专注于了解青少年面临的特定挑战 CF 护理方案中的营养依从性。 [总共132名青少年（12-18岁）将从 美国各地的 5 个 CF 中心在可能的减员后获得了至少 110 名青少年的样本]。为了 具体目标 1，青少年将完成调查，衡量与以下问题相关的一系列潜在因素 依从性，以及随机 2 天的 24 小时饮食回忆，通过以下方式间接评估营养依从性： CF-INTAKE 测量（每日热量摄入、脂肪克数、酶的使用、正餐和零食的数量）。 回归分析将检查哪些因素可以显着预测营养依从性评分。为了 具体目标 2，将从较大样本中随机选择 20 名青少年，以提供深入的研究 利益相关者对他们在营养坚持方面遇到的困难的看法。六名营养师（来自 我们的 5 个招聘网站）也将参加[焦点小组]，分享他们对挑战的看法 与青少年沟通和支持青少年营养依从性的经验。定性结果 将与最终分析的定量结果相结合[使用比较联合显示表]。结果 预计该 NRSA 项目将能够更好地理解行为决定因素 青少年营养不依从的问题，以便制定一种对发育敏感但实用的、基于临床的方法 未来可以针对这些因素制定依从性促进干预措施。 ！ ！