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: 10300986
• 负责人: Kristine Durkin
• 金额: $ 1.37万
• 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 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10300986
• 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; Dissemination and Implementation; 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; 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; dietary supplements; experience; health literacy; improved; indexing; innovation; neglect; novel; nutrient absorption; pulmonary function; recruit; satisfaction; stakeholder perspectives; 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. ! !

好了！ 项目总结 坚持饮食建议和营养补充剂，以防止营养物质的吸收不足 囊性纤维化(CF)患者营养不良的发展是至关重要的，因为营养状况 与健康结果(例如，肺功能)和寿命显著相关。然而，不遵守《反腐败公约》 护理养生法，包括营养建议，在青少年中尤其普遍。虽然行为上 干预措施在改善患有CF的幼儿的营养摄入方面非常有效，但鲜为人知 关于哪些因素与患有CF的青少年的营养不坚持有关。随着增加 独立和控制饮食摄入量，青少年很可能会面临坚持的挑战 与年轻的同龄人不同。因此，采用[收敛混合方法设计]，总体上 这项研究的目的是确定与青少年坚持营养建议相关的因素。 并从关键利益相关者(即青少年和营养师)那里获得丰富的定性数据 营养坚持的障碍和在临床上共同努力改善营养坚持的挑战。我们将应用一个 组织框架，能力-机会-动机-行为(COM-B)模型，来解释我们的 并确定在未来干预中改变行为所需的具体因素。这项研究是 创新性，因为没有其他行为研究专注于了解青少年面临的挑战 CF护理方案中的营养依从性。[共计132名青少年(12至18岁)将从 全美5个CF中心，在可能的自然减员后，获得至少110名青少年的样本]。为 具体目标1，青少年将完成测量与以下方面相关的一系列潜在因素的调查 坚持，以及随机两天的24小时饮食召回，通过以下方式间接评估营养坚持 卡路里摄入量测量(每日卡路里摄入量、脂肪克、酵素使用量、进餐和零食数量)。 回归分析将检验哪些因素对营养依从性得分有显著预测作用。为 具体目标2，将从较大的样本中随机选择20名青少年进行深入调查 利益相关者对他们在营养坚持方面遇到的困难的看法。六位营养师(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 将与量化结果结合起来进行最终分析[使用对比联合陈列表]。结果 将提供对以下行为决定因素的更好理解 青少年营养不坚持，使一个对发育敏感，但实用，以临床为基础的 未来可以针对这些因素开展依从性促进干预。 好了！ 好了！