Publication Date

2015-07-27

Availability

Embargoed

Embargo Period

2018-07-26

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PHD)

Department

Psychology (Arts and Sciences)

Date of Defense

2014-10-24

First Committee Member

Alexandra L. Quittner

Second Committee Member

Kristin M. Lindahl

Third Committee Member

Amanda Jensen-Doss

Fourth Committee Member

Rebecca J. Bulotsky Shearer

Fifth Committee Member

Neena M. Malik

Abstract

Adherence to medical regimens is a national public health concern across chronic health conditions (Balkrishnan, 2005), with problem-solving (PS) interventions demonstrating the greatest empirical support (Kahana, Drotar & Frazier, 2008). Prior research indicates adolescents with cystic fibrosis (CF) perform 50% or less of their treatments (Eakin et al., 2011; Modi et al., 2006; Quittner et al., 2014; Chest), resulting in serious health consequences (Briesacher et al., 2011). To address this critical problem, effective interventions need to be conducted in medical centers where patients receive regular care (Quittner, Alpern, & Blackwell, 2013). This will require efforts to train healthcare providers, who have variable levels of expertise in delivering behavioral interventions. This study measured multidisciplinary providers’ fidelity and competence in a behavioral adherence intervention, and examined key predictors of gains in providers’ implementation over time. Although fidelity and competence following one-time training was poor, supervision and practice both predicted improvements in implementation over time. Further, accounting for patient receptivity provided a clearer picture of implementation. Although findings suggest that one-time training is insufficient, providers from various disciplines can deliver this intervention faithfully and skillfully if ongoing supervision is provided. Disseminating evidence-based interventions into specialty medical clinics has the potential to improve more patients’ adherence, health, and quality of life.

Keywords

adolescence, cystic fibrosis, treatment adherence, dissemination

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