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

! 项目摘要 坚持膳食建议和营养补充剂，防止营养素吸收不足 囊性纤维化（CF）患者营养不良的发展至关重要，因为营养状况 与健康结果显着相关（例如，肺功能）和寿命。然而，不遵守CF 特别是在青少年中，保健方案，包括营养建议的比例很高。虽然行为 干预措施在改善CF幼儿的营养摄入方面非常有效，但知之甚少 哪些因素与青少年CF的营养不依从性有关。具有增加 独立和控制饮食摄入，青少年可能有坚持的挑战， 与年轻人不同。因此，使用[收敛混合方法设计]，总体 本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那里获得丰富的定性数据（即，青少年和营养师） 营养依从性的障碍和在临床上共同努力改善营养依从性的挑战。我们将应用一种 组织框架，能力-机会-动机-行为（COM-B）模型，以解释我们的 调查结果，并确定在未来的干预措施中改变行为所需的具体因素。本研究 创新，因为没有其他行为研究专注于了解特定的挑战， CF护理方案中的营养依从性。[将招募132名青少年（12-18岁）， 美国5家CF中心，在可能的减员后获得至少110名青少年的样本]。为 具体目标1，青少年将完成调查，测量与下列各项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，以间接评估营养依从性， CF-INTAKE测量（每日热量摄入，脂肪克数，酶使用，膳食和零食数量）。 回归分析将检查哪些因素显著预测营养依从性评分。为 具体目标2，将从较大样本中随机抽取20名青少年， 利益相关者对他们在坚持营养方面遇到的困难的看法。6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， 在与青少年沟通和支持青少年坚持营养方面的经验。定性结果 将与定量调查结果结合起来进行最后分析[使用比较联合显示表]。结果 从这个NRSA项目，预计将提供更好的理解行为的决定因素， 青少年营养不遵守，使发展敏感，但实际的，临床为基础的 未来可以针对这些因素开发依从性促进干预。 ! !

! 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. ! !