Abstract
Malnutrition remains a major clinical problem in Cystic Fibrosis (CF). As the degree of underweight correlates closely with reduced survival, interventions are needed which optimise nutritional outcomes. The focus of this thesis was on developing a home based behavioural nutrition education programme for adults with CF and assessing its effectiveness on nutritional status, knowledge and other psychosocial measures using a randomised control study design. Chapter 2 describes the development of the "Eat well with CF" programme, which used a framework of Social Cognitive Theory. The next investigations aimed to test the programme both with consumers and with peers. The results showed that adults with CF would be motivated to take part and felt they would learn from the programme. The peer review demonstrated that the programme was rated highly with regard to content, accuracy and information. In Chapter 3 the effectiveness of "Eat well with CF" was tested in a randomised trial (n=74) using a control group who received standard care. The results demonstrated a trend towards an increase in weight. After 6 months the average weight gain in the intervention group was 0.57 kg compared to control weight gain of 0.09 kg (p=0.545, 95%CI -1.07-2.0). Subjects undertaking the "Eat well with CF" programme had significantly increased their self-efficacy to cope with their diet, (p=0.003, 1.19-5.67), their specific nutritional knowledge (p<0.001, 4.05-7.38) and their reported dietary fat intake (p=0.014, 0.76-6.50) compared to the control group. At 12 months, the average weight gain was 0.02 kg in the control group and 1.14kg in the intervention group with no statistical differences between the two groups. The intervention group continued to show a marked and significant improvement in CF specific nutritional knowledge and self-efficacy score. Chapter 4 examines the reasons for subject non- participation in the study, which led to the development of an audio version of "Eat well with CF". The positive results of the process evaluation detailed in chapter 5 highlight the significant personal enjoyment and benefit received by the participants. These studies combine to demonstrate the utility, acceptability and efficacy of "Eat Well with CF". In addition they challenge traditional dietetic practice. We suggest this novel behavioural education approach could enhance current dietetic practice, to improve outcomes and lead to life long maintenance of optimal nutritional status for adults with CF.