Behavioral Medicine Division, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Social Work Services at the Central Arkanas Veteran Healthcare System, Little Rock, Arkansas.
Respir Care. 2019 Jul;64(7):778-785. doi: 10.4187/respcare.06500. Epub 2019 Mar 19.
Airway clearance therapy (ACT) is a core component of daily treatment for cystic fibrosis (CF). However, surprisingly little is known about sustained or persistent use of ACT over time among adults with CF. This longitudinal study examined persistent adherence to ACT over 12 months and its modifiable predictors, drawing on aspects of Social Cognitive Theory and the Theory of Planned Behavior.
Subjects were drawn from a regional CF center in the southern United States. Predictor variables evaluated at baseline included self-efficacy for ACT (ie, self-confidence in overcoming barriers), outcome expectations (ie, perceived necessity of ACT and concerns about its disruptive effects), and subjective norms (ie, perceptions of being influenced by others). The Cystic Fibrosis Treatment Questionnaire (CFTQ) was used to assess self-reported adherence to ACT at baseline, at 6 months, and at 12 months.
The mean age of subjects was 27.2 ± 9.1 y, and mean FEV% predicted was 65.5 ± 24.8. Forty-six percent of subjects reported persistent use of ACT (classified as adherent at all assessment periods). In bivariate analyses, all social cognitive predictor variables assessed at baseline were significantly related to persistent adherence (all < .03), except subjective norms. In logistic regression analyses that modeled the effects of these predictors simultaneously while controlling for FEV%, fewer baseline concerns about ACT (odds ratio = 0.82, 95% CI 0.69-0.99) and greater self-efficacy (odds ratio = 1.09, 95% CI 1.01-1.18) remained significant independent predictors.
This longitudinal study addresses an important gap in the literature regarding adherence to ACT over time (12 mo) in a routine clinical setting. Persistent adherence was problematic. As anticipated, social cognitive variables (self-confidence and perceived concerns) predicted self-reported persistence, and these may represent practical targets for intervention.
气道清除治疗（ACT）是囊性纤维化（CF）日常治疗的核心组成部分。然而，令人惊讶的是，关于 CF 成人随时间推移持续或持续使用 ACT 的情况知之甚少。这项纵向研究考察了 12 个月内持续坚持 ACT 及其可改变的预测因素，借鉴了社会认知理论和计划行为理论的各个方面。
研究对象来自美国南部一个地区 CF 中心。基线评估的预测变量包括 ACT 的自我效能（即克服障碍的自信）、结果预期（即 ACT 的必要性和对其干扰效果的担忧）和主观规范（即受到他人影响的感知）。使用囊性纤维化治疗问卷（CFTQ）在基线、6 个月和 12 个月时评估自我报告的 ACT 依从性。
受试者的平均年龄为 27.2 ± 9.1 岁，预计 FEV%为 65.5 ± 24.8。46%的受试者报告持续使用 ACT（所有评估期均符合依从性标准）。在单变量分析中，基线评估的所有社会认知预测变量均与持续依从性显著相关（均 <.03），除了主观规范。在同时建模这些预测因素的影响并控制 FEV%的逻辑回归分析中，较少的基线对 ACT 的担忧（比值比=0.82，95%CI 0.69-0.99）和更大的自我效能（比值比=1.09，95%CI 1.01-1.18）仍然是显著的独立预测因素。
这项纵向研究解决了文献中关于在常规临床环境中随时间推移（12 个月）坚持 ACT 的一个重要空白。持续坚持是有问题的。正如预期的那样，社会认知变量（自信和感知到的担忧）预测了自我报告的坚持，这些变量可能代表了干预的实际目标。
