Semester

Spring

Date of Graduation

2022

Document Type

Dissertation

Degree Type

PhD

College

Eberly College of Arts and Sciences

Department

Psychology

Committee Chair

Christina Duncan

Committee Co-Chair

Christa Lilly

Committee Member

Amy Gentzler

Committee Member

Daniel McNeil

Abstract

Background: Adhering to dietary recommendations and nutritional supplements to ensure adequate absorption of nutrients and malnutrition plays an important role in the health of patients with cystic fibrosis (CF). Non-adherence to the CF care regimen, including nutritional recommendations, is high in adolescents. Therefore, the overall goal of this study was to identify factors related to adherence to nutritional recommendations in adolescents with CF.

Method: A total of 42 adolescents (ages 12-18) were recruited from 5 CF centers across the US. Adolescents completed surveys measuring body image/satisfaction, health literacy, perceived barriers to enzyme use, and self-efficacy, as well as the quality of their interaction with their dietitian. A primary caregiver completed measures on demographic information and perceived barriers to enzyme use. Via video-conference interviews, adolescents completed two 24-hour diet recalls using the Automated Self-Administered Recall System (ASA24®) to obtain daily caloric intake, fat content of food, and enzyme use.

Dietary information from the diet recall interviews was coded using the CF-INTAKE measure to calculate four ratio scores (Meal Score, Enzyme Score, Calorie Score, and Food Choice Score), with higher values representing more missed opportunities to achieve optimal dietary intake. Anthropometric information was gathered from the adolescent’s medical chart. To address the overall objective of the study, we tested the associations between the dependent variables (i.e., for CF-INTAKE scores: Meal, Calorie, Enzyme, and Food Choice) and the primary independent variables (e.g., body satisfaction, health literacy) using Ordinary Least Square (OLS) multiple regressions and multiple logistic regressions.

Results. Body image/satisfaction, health literacy, self-efficacy, and caregiver-reported barriers to enzyme use significantly predicted Meal Score, R2 = .298, F(4,33) = 3.07, p = .032. More caregiver-perceived barriers to enzyme use (β = .318, p = .052) and higher adolescent self-efficacy (β = .409, p = .016) were associated with more missed opportunities for adherence to meals recommendations (i.e., 3 meals, 2 snacks per day).

Discussion: Findings from this study 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 in the future to target these factors.

Embargo Reason

Publication Pending

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