A multicomponent adherence protocol (MAP) was indicated to be appropriate and acceptable by caregivers and clinicians of pediatrics with cystic fibrosis (CF), however, its use among clinicians was inconsistent over a 3-month period, according to a new study published in BMC Health Services Research.

The authors investigated the feasibility, acceptability, and appropriateness of the MAP within an outpatient CF clinic setting. On a scale ranging from 1 (“not helpful”) to 5 (“a lot”), clinicians found the tools included in the MAP to be “appropriate” for their work (median, 5; interquartile range [IQR], 3-5) as well as acceptable (median, 5; IQR, 4-5).

Clinicians also reported that the tools were helpful for families (median, 5; IQR 4-5). Parents reported that the tools were slightly less helpful, however (median, 4; IQR 4-5). While clinicians rated the MAP as acceptable and appropriate, it was not fully utilized with eligible patients who attended the clinic during the 3-month period.

Medical chart audits revealed that the knowledge assessment portion of the MAP (to assess patient knowledge of their disease) was only utilized in 43.8% of cases while the mental health screenings were utilized in 57% of patients by the third month of implementation.

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“Despite the tailored adherence protocol being considered appropriate and acceptable to clinicians and consumers, low fidelity indicates limited feasibility in the outpatient clinic setting, where multi-disciplinary members are all considered responsible for adherence care interventions,” the authors said.

Results of the MAP assessments found that the parent mental health screening tool was the most used tool and it identified that 41.67% of patients 12 years and older and 19% of parents were in the “moderate to severe” range for anxiety and/or depression. Of these patients and parents, 86% received follow-up care.

The knowledge assessment portion of the MAP also found that none of the children below 11 years of age had suboptimal knowledge about their conditions and treatments while 15% of patients 11 years of age and over had assessment scores below 50%.

During the 3-month period, a total of 359 outpatient appointments were completed at the CF clinic with 35 families attending their annual review appointment. Prior to implementation, a group of 13 clinicians participated in focus groups to give feedback to guide the development of the MAP. Consumer interviews were also completed with 8 caregivers and 2 adolescent patients.


Richards B, Osborne SR, Simons M. Introducing a MAP for adherence care in the paediatric cystic fibrosis clinic: a multiple methods implementation study. BMC Health Serv Res. 2022;22(1):109. doi:10.1186/s12913-021-07373-5