CONTEXTUAL MODEL OF FAMILY COPING WITH CYSTIC FIBROSIS

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The purpose of the current study is to develop a measure of situation- specific stressors and coping strategies for chronically ill children and their parents. Prior research on stress an coping has been limited by the use of poorly defined constructs and a failure to consider contextual factors such as the severity of the stressor and the developmental tasks of the individual and family. To ameliorate these inadequacies, the proposed study will employ a situational analysis of the specific problems and demands associated with chronic childhood illness and normal development. The specific objectives of study 1 are: 1) to assess the problems and coping behaviors of two developmental cohorts of children with cystic fibrosis (CF) and their parents, 2) To develop empirically-derived ratings of the effectiveness of specific coping strategies for particular problems, and 3) To examine relationships among problem severity, choice of coping strategies, and functional outcomes. Sixty children with CF (30 school age and 30 adolescents) and their parents from Riley Hospital for Children, Indiana University Medical Center and Children's Hospital of Pittsburgh, Pittsburgh University School of Medicine will participate in Study 1. Structured interviews, daily diaries and standardized questionnaires will be used to develop the inventory of problem situations. Ratings of the competence of various coping strategies will be derived from judgments of children with CF, parents, and health care professionals. Following construction of the problem inventory and raters manual, Study 2 will employ a two-wave longitudinal design with the following objectives: 1) To assess the criterion-oriented validity of the measure, 2) To test the mediating effects of coping behaviors on the frequency and severity of specific problems and related outcomes, and 3) To assess the impact of discrepancies in perception of stress and use of coping strategies among family members. Sixty adolescents with CF and their parents from Riley Hospital for Children will be asked to complete the problem inventory, standardized questionnaires, and the Activity Pattern Indicators at two points over a 6-8 month period. By linking problems directly to effective coping behaviors for both the child and family, this study will provide the basis for developing preventive behavioral interventions.