Publication Date




Embargo Period


Degree Type


Degree Name

Doctor of Philosophy (PHD)


Psychology (Arts and Sciences)

Date of Defense


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


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.


adolescence, cystic fibrosis, treatment adherence, dissemination