For teenagers with cystic fibrosis, maintaining a healthy weight can be a daily struggle. Any given day can include two to three hours of medical treatments, eating the caloric equivalent of a daily Thanksgiving meal to maintain nutrients and dealing with the stigmas of body image.
Park Ridge, Illinois, native Kristine Durkin, a fourth-year clinical psychology doctoral student, is conducting a study to identify the factors that contribute to meeting their dietary recommendations.
“It is extremely difficult for adolescents to adhere to these recommendations because they are out of the house in high school, not home eight or nine hours of the day. They are embarrassed to take enzymes in front of friends,” said Durkin. “There are all of these barriers that are making nutritional adherence challenging, in addition to body image and societal expectations on weight.”
Supported by the National Institutes of Health’s Ruth L. Kirschstein Predoctoral Individual National Research Service Award, Durkin is leading a two-year study that will recruit adolescents from cystic fibrosis clinics at Ruby Memorial Hospital in Morgantown, as well as Cincinnati Children’s Hospital Medical Center, Colorado Children’s Hospital, University of Florida Shands Hospital and Children’s Hospital of Virginia at Virginia Commonwealth University.
“Kristine is one of the most passionate and hard-working graduate students I have taught over the past 25 years,” said Christina Duncan, a professor of clinical child psychology and Durkin’s adviser. “She is genuinely dedicated to making a difference in the care of pediatric patients and their families through the research she conducts. I’m very fortunate to have this opportunity to mentor her with this important study in adolescents with CF.”
Durkin and her research team, composed of academic pediatric psychologists, dietitians and graduate and undergraduate psychology students, plan to survey about 110 teen patients to determine if they are meeting nutritional recommendations from their dietitians. Teenagers and their caregivers will complete measures of health literacy, body image, treatment self-efficacy, perceptions of provider communication and barriers to complete their treatments. The project team will call each teen twice, asking them to recount what they ate and drank over the last 24 hours. They also plan to conduct focus groups with a smaller sample of these patients as well as with dietitians at the five study sites.
“We will assess their intake of food and drink as well as enzymes to get a clear picture of what a day looks like for adolescents around dietary recommendations. We will try to understand what is happening right now: What do they see as their strengths, and what do they see as areas for improvement?” Durkin said. “We hope to learn what adolescents are thinking or talking about with regard to the dietary recommendations.”
Durkin hopes the results of the study will lead to the addition of behavioral training for dietitians and nutrition training for psychologists to create an optimal collaborative care environment for these patients.
“We want to see if this kind of a project is feasible with the long-term goal of creating a behavioral intervention about dietary recommendations with adolescents or other populations. I’d love to someday bridge the gaps between these two professions,” Durkin said. “Diet should be integrated into more of what psychologists do. What we put in our bodies greatly affects our mental health, which is really just health. Structuring your environment to promote healthy eating is something we have a lot knowledge about, and we shouldn’t be siloed as researchers. We should work together. My goal was to create a feasible project to maintain those connections.”
The behavioral psychology focus of WVU’s Department of Psychology has empowered Durkin to pursue this study.
“What I love about WVU’s program and what I came here for is the behavioral focus of it. It’s such a wonderful perspective to take in understanding people because it says that people are capable of change. It says that people are not these trait-based things,” Durkin said. “I work with pediatrics. People often say kids are naughty, or kids are bad. Instead, we think about why they are doing this behavior and how we can help set them up for success in the future. It has entirely changed my understanding of people – to take the perspective of no one is stuck in the way things are now and there is a path to change to achieve what you really need in your life. It is an environment of support.”
Durkin plans to graduate from WVU in May 2022 following the conclusion of this study and a year-long internship at an academic medical center. She then hopes to become a pediatric psychologist at academic medical center, splitting her time between providing evidenced-based interventions with pediatric patients in clinic and developing a research program in the lab.
“Research has no heart without people,” Durkin said. “If you lose your connection with the people you work with, you don’t know what they need or want. You can create this amazing behavioral intervention, but then it isn’t what the patients need or isn’t a good fit for the clinic. When you lose that touch and pulse of clinics, then your research program is obsolete. My hope is to have both – I don’t want to ever lose that clinical connection.”
She hopes this NIH fellowship, also known as the F31 award, will be the foundation for launching her career.
“I believe this grant will be a springboard for my next step,” Durkin said. “My experiences through this grant, including my professional connections through the multi-site structure, methods training, working with the patients and running the study, will lead to the beginning of my research program around bridging the gap between the psychology and nutrition professions. I hope to insert more behavioral approaches while also learning from nutritionists’ experiences as well.”