Adherence to treatment in children and adolescents with cystic fibrosis: a cross-sectional, multi-method study investigating the influence of beliefs about treatment and parental depressive symptoms

BMC Pulmonary Medicine

James C McElnay⁴  Michael D Shields²  Rob Horne⁵  Alastair JM Reid³  Ahmed F Hawwa¹  Nicola A Goodfellow⁴ 

[1] Aston Pharmacy School, Aston University, Birmingham, UK;Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK;Northern Ireland Paediatric Cystic Fibrosis Centre, Royal Belfast Hospital for Sick Children, Belfast, UK;School of Pharmacy, Queen’s University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, UK;UCL School of Pharmacy, BMA House, Tavistock Square, London, UK

关键词: Beliefs;    Child;    Adolescent;    Parents;    Cystic fibrosis;    Medication adherence;   

Others  :  1177618
DOI  :  10.1186/s12890-015-0038-7

 received in 2014-10-02, accepted in 2015-04-15,  发布年份 2015

【 摘 要 】

Background

Adherence to treatment is often reported to be low in children with cystic fibrosis. Adherence in cystic fibrosis is an important research area and more research is needed to better understand family barriers to adherence in order for clinicians to provide appropriate intervention. The aim of this study was to evaluate adherence to enzyme supplements, vitamins and chest physiotherapy in children with cystic fibrosis and to determine if any modifiable risk factors are associated with adherence.

Methods

A sample of 100 children (≤18 years) with cystic fibrosis (44 male; median [range] 10.1 [0.2-18.6] years) and their parents were recruited to the study from the Northern Ireland Paediatric Cystic Fibrosis Centre. Adherence to enzyme supplements, vitamins and chest physiotherapy was assessed using a multi-method approach including; Medication Adherence Report Scale, pharmacy prescription refill data and general practitioner prescription issue data. Beliefs about treatments were assessed using refined versions of the Beliefs about Medicines Questionnaire-specific. Parental depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale.

Results

Using the multi-method approach 72% of children were classified as low-adherers to enzyme supplements, 59% low-adherers to vitamins and 49% low-adherers to chest physiotherapy. Variations in adherence were observed between measurement methods, treatments and respondents. Parental necessity beliefs and child age were significant independent predictors of child adherence to enzyme supplements and chest physiotherapy, but parental depressive symptoms were not found to be predictive of adherence.

Conclusions

Child age and parental beliefs about treatments should be taken into account by clinicians when addressing adherence at routine clinic appointments. Low adherence is more likely to occur in older children, whereas, better adherence to cystic fibrosis therapies is more likely in children whose parents strongly believe the treatments are necessary. The necessity of treatments should be reinforced regularly to both parents and children.

【 授权许可】

   
2015 Goodfellow et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Sabaté E: Adherence to long-term therapies: evidence for action. World Health Organisation, Geneva; 2003.
• [2]Sawicki GS, Ren CL, Konstan MW, Millar SJ, Pasta DJ, Quittner AL: Treatment complexity in cystic fibrosis: trends over time and associations with site-specific outcomes. J Cyst Fibros 2013, 12:461-7.
• [3]Modi AC, Quittner AL: Barriers to treatment adherence for children with cystic fibrosis and asthma: what gets in the way? J Pediatr Psychol 2006, 31:846-58.
• [4]Eakin MN, Bilderback A, Boyle MP, Mogayzel PJ, Riekert KA: Longitudinal association between medication and lung health in people with cystic fibrosis. J Cyst Fibros 2011, 10:258-64.
• [5]Briesacher BA, Quittner AL, Saiman L, Sacco P, Fouayzi H, Quittell LM: Adherence with tobramycin inhaled solution and health care utilisation. BMC Pulm Med 2011, 11:5. BioMed Central Full Text
• [6]Horne R, Weinman J: Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res 1999, 47:555-67.
• [7]Phatak HM, Thomas J 3rd: Relationships between beliefs about medications and non-adherence to prescribed chronic medications. Ann Pharmacother 2006, 40:1737-42.
• [8]Horne R: Assessing perceptions of medication: psychological perspectives. In Handbook of drug use research methodology. 1st edition. Edited by McGavock H. Drug Utilization Research Group, UK; 2000:1-20.
• [9]Horne R, Buick D, Fisher M, Leake H, Cooper V, Weinman J: Doubts about necessity and concerns about adverse effects: identifying the types of beliefs that are associated with non-adherence to HAART. Int J STD AIDS 2004, 15:38-44.
• [10]Bucks RS, Hawkins K, Skinner TC, Horn S, Seddon P, Horne R: Adherence to treatment in adolescents with cystic fibrosis: the role of illness perceptions and treatment beliefs. J Pediatr Psychol 2009, 34:893-902.
• [11]Sawicki GS, Heller KS, Demars N, Robinson WM: Motivating adherence among adolescents with cystic fibrosis: Youth and parent perspectives. Pediatr Pulmonol 2015, 50:127-36.
• [12]Conn KM, Halterman JS, Lynch K, Cabana MD: The impact of parent’s medication beliefs on asthma management. Pediatrics 2007, 120:e521-6.
• [13]Bartlett SJ, Krishnan JA, Riekert KA, Butz AM, Malveaux FJ, Rand CS: Maternal depressive symptoms and adherence to therapy in inner-city children with asthma. Pediatrics 2004, 113:229-37.
• [14]Quittner AL, Goldbeck L, Abbott J, Duff A, Lambrecht P, Solé A, et al.: Prevalence of depression and anxiety in patients with cystic fibrosis and parent caregivers: results of The International Depression Epidemiological Study across nine countries. Thorax 2014, 69:1090-7.
• [15]Quittner AL, Barker DH, Geller D, Butt S, Gondor M: Effects of maternal depression on electronically monitored enzyme adherence and changes in weight for children with CF. J Cyst Fibros 2007, 6(Suppl 1):S78.
• [16]Smith BA, Wood BL: Psychological factors affecting disease activity in children and adolescents with cystic fibrosis: medical adherence as a mediator. Curr Opin Pediatr 2007, 19:553-8.
• [17]Smith BA, Modi AC, Quittner AL, Wood BL: Depressive symptoms in children with cystic fibrosis and parents and its effects on adherence to airway clearance. Pediatr Pulmonol 2010, 45:756-63.
• [18]Sheehan J, Massie J, Hay M, Jaffe A, Glazner J, Armstrong D, et al.: The natural history and predictors of persistent problem behaviours in cystic fibrosis: a multi-centre, prospective study. Arch Dis Child 2012, 97:625-31.
• [19]Horne R, Weinman J: Self-regulation and self-management in asthma: exploring the role of illness perceptions and treatment beliefs in explaining non-adherence to preventer medication. Psychol Health 2002, 17:17-32.
• [20]McCullough AR, Tunney MM, Quittner AL, Elborn JS, Bradley JM, Hughes CM: Treatment adherence and health outcomes in patients with bronchiectasis. BMC Pulm Med 2014, 14:107. BioMed Central Full Text
• [21]Haynes RB, Taylor DW, Sackett DL, Gibson ES, Bernholz CD, Mukherjee J: Can simple clinical measurements detect patient non-compliance? Hypertension 1980, 2:757-64.
• [22]Hess LM, Raebel MA, Conner DA, Malone DC: Measurement of adherence in pharmacy administrative databases: a proposal for standard definitions and preferred measures. Ann Pharmacother 2006, 40:1280-8.
• [23]Radloff LS: The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1977, 1:385-401.
• [24]Driscoll KA, Montag-Leifling K, Acton JD, Modi AC: Relations between depressive and anxious symptoms and quality of life in caregivers of children with cystic fibrosis. Pediatr Pulmonol 2009, 44:784-92.
• [25]Geisser ME, Randy R, Robinson ME: Assessing depression among persons with chronic pain using the Centre for Epidemiological Studies-Depression Scale and the Beck Depression Inventory: a comparative analysis. Clin J Pain 1997, 13:163-70.
• [26]White T, Miller J, Smith GL, McMahon WM: Adherence and psychopathology in children and adolescents with cystic fibrosis. Eur Child Adolesc Psychiatry 2009, 18:96-104.
• [27]Llorente RPA, Garcia CB, Martin JJD: Treatment compliance in children and adults with cystic fibrosis. J Cyst Fibros 2008, 7:359-67.
• [28]Daniels T, Goodacre L, Sutton C, Pollard K, Conway S, Peckham D: Accurate assessment of adherence: self-report and clinician report vs electronic monitoring of nebulizers. Chest 2011, 140:425-32.
• [29]Simon SL, Duncan CL, Horky SC, Nick TG, Castro MM, Riekert KA: Body satisfaction, nutritional adherence and quality of life in youth with cystic fibrosis. Pediatr Pulmonol 2011, 46:1085-92.
• [30]Duff AJ, Abbott J, Cowperthwaite C, Sumner C: Anxiety and depression in CF in the UK (TIDES-UK). J Cyst Fibros 2012, 11(Suppl 1):S138.