Improving health outcomes among youth with poorly controlled type I diabetes: The role of treatment fidelity in a randomized clinical trial of multisystemic therapy
Improving health outcomes among youth with poorly controlled type I diabetes: The role of treatment fidelity in a randomized clinical trial of multisystemic therapy
复制标题
DOI：
10.1037/0893-3200.21.3.363
复制
发表时间：
2007-09-01
影响因子：
2.7
通讯作者：
Cunningham, Phillippe B.
中科院分区：
文献类型：
--
作者：
Ellis, Deborah A.;Naar-King, Sylvie;Cunningham, Phillippe B.
该研究的目的是评估在一项随机临床试验中，对10- 16岁慢性控制不良的1型糖尿病青少年进行多系统治疗的治疗师治疗忠实度是否可以预测治疗结果（N = 40）。治疗保真度是通过客观评定治疗过程和由护理人员和治疗师完成的问卷来评估的。评估了保真度测量之间的关系。使用结构方程模型（SEM）来测试高保真度是否会提高方案依从性，并通过方案依从性改善代谢控制结果。治疗保真度的客观评分与治疗师报告的治疗保真度显著相关，但与护理者报告的治疗保真度无关。扫描电镜结果支持治疗保真度和代谢控制之间的完全介导途径，治疗方案依从性介导了这一关系。结果表明，进行具有高度保真度的复杂行为干预可以改善青少年慢性疾病的治疗效果。
The purpose of the study was to assess whether therapist treatment fidelity was a predictor of treatment outcome in a randomized clinical trial of multisystemic therapy with 10- to 16-year-old youths with chronically poorly controlled Type I diabetes (N = 40). Treatment fidelity was assessed by objective ratings of therapy sessions and questionnaires completed by caregivers and by therapists. Relationships between fidelity measures were assessed. Structural equation modeling (SEM) was used to test whether high fidelity would lead to improved regimen adherence and to improved metabolic control outcomes via regimen adherence. Objective ratings of treatment fidelity were significantly related to therapist-reported but not to caregiver-reported treatment fidelity. SEM results supported a completely mediated pathway between treatment fidelity and metabolic control, with regimen adherence mediating the relationship. Results suggest that conducting complex behavioral interventions with a high degree of fidelity can improve treatment outcomes among youths with chronic illnesses.