{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T15:04:29Z","timestamp":1790003069369,"version":"4.0.1"},"reference-count":22,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"unspecified","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004748","name":"Mashhad University of Medical Sciences","doi-asserted-by":"publisher","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/501100004748","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,6,10]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Self-care self-efficacy is a key determinant of treatment adherence and long-term disease management among adolescents with cystic fibrosis (CF). However, to the best of our knowledge, no culturally specific and psychometrically validated instrument currently exists to assess this construct among Iranian adolescents with CF. This study aims to develop and validate a theory-informed and culturally appropriate scale to measure self-care self-efficacy in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This protocol describes a sequential exploratory mixed-methods study conducted in two phases. Phase I involves qualitative concept development guided by the Hybrid Model of Concept Development and includes an integrative literature review, semistructured interviews with approximately 15\u201320 adolescents with CF, and analytical integration to refine the conceptual definition and identify measurable indicators. Phase II focuses on scale development and psychometric evaluation. Items derived from qualitative findings will be assessed for face and content validity. Construct validity will be examined using exploratory factor analysis with about 200 adolescents consecutively recruited from two specialised CF referral clinics located in Mashhad and Ahvaz. Reliability will be evaluated using Cronbach\u2019s alpha and test\u2013retest intraclass correlation coefficients. Quantitative analyses will be conducted using SPSS V 29.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval has been obtained from the Ethics Committee of Mashhad University of Medical Sciences (IR.MUMS.NURSE.REC.1403.093). Written informed assent and parental consent will be obtained from all participants. Findings will be disseminated through peer-reviewed publications and conference presentations to inform clinical assessment and intervention planning for adolescents with CF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-115134","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T14:25:24Z","timestamp":1790000724000},"page":"e115134","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Design and validation of a self-care self-efficacy scale among adolescents with cystic fibrosis in Iran: protocol for a sequential-exploratory mixed-methods study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8824-5579","authenticated-orcid":false,"given":"Maryam","family":"Papi","sequence":"first","affiliation":[{"name":"Student Research Committee, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamid Reza","family":"Kianifar","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Akbar Children Hospital, Mashhad University of Medical Sciences, Mashhad, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahra Sadat","family":"Manzari","sequence":"additional","affiliation":[{"name":"Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9681-8231","authenticated-orcid":false,"given":"Jamshid","family":"Jamali","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran"},{"name":"Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tayebe","family":"Pourghaznein","sequence":"additional","affiliation":[{"name":"Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"2026092107251472000_16.9.e115134.1","unstructured":"National Library of Medicine (US) . Cystic fibrosis. medlineplus genetics. Available: https:\/\/medlineplus.gov\/genetics\/condition\/cystic-fibrosis\/ [Accessed 12 Jul 2026]."},{"key":"2026092107251472000_16.9.e115134.2","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-033867","article-title":"A systematic review of patient-reported outcome measures (PROMs) in cystic fibrosis","volume":"10","author":"Ratnayake","year":"2020","journal-title":"BMJ Open"},{"key":"2026092107251472000_16.9.e115134.3","unstructured":"Kaveh S , Sadr S , Hajihoseini M , et al . Appropriate Lifestyle in Pulmonary Symptoms of Cystic Fibrosis from the Perspective of Traditional Iranian Medicine. 2021."},{"key":"2026092107251472000_16.9.e115134.4","article-title":"Interventions for improving adherence to airway clearance treatment and exercise in people with cystic fibrosis","volume":"7","author":"Jones","year":"2023","journal-title":"Cochrane Database Syst Rev"},{"key":"2026092107251472000_16.9.e115134.5","doi-asserted-by":"crossref","DOI":"10.36416\/1806-3756\/e20240416","article-title":"Depression and anxiety in adolescents with cystic fibrosis in Brazil: prevalence, stability over time, and relationship with treatment adherence","volume":"51","author":"Rozov","year":"2025","journal-title":"J Bras Pneumol"},{"key":"2026092107251472000_16.9.e115134.6","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0270100","article-title":"Self-care self-efficacy and depression associated with quality of life among patients undergoing hemodialysis in Vietnam","volume":"17","author":"Nguyen","year":"2022","journal-title":"PLoS One"},{"key":"2026092107251472000_16.9.e115134.7","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1111\/2047-3095.12143","article-title":"Describing Self-Care Self-Efficacy: Definition, Measurement, Outcomes, and Implications","volume":"29","author":"Eller","year":"2018","journal-title":"Int J Nurs Knowl"},{"key":"2026092107251472000_16.9.e115134.8","doi-asserted-by":"crossref","DOI":"10.1002\/nop2.70276","article-title":"Self-Efficacy in People With Chronic Disease: An Evolutionary Concept Analysis","volume":"12","author":"Achury-Salda\u00f1a","year":"2025","journal-title":"Nurs Open"},{"key":"2026092107251472000_16.9.e115134.9","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-021-01391-2"},{"key":"2026092107251472000_16.9.e115134.10","doi-asserted-by":"crossref","first-page":"19","DOI":"10.5460\/jbhsi.v7.2.52889","article-title":"Self-efficacy adn adherence to treatment: The mediating effects of social support","volume":"7","author":"Martos-M\u00e9ndez","year":"2015","journal-title":"J of Beh Hea & Soc Iss"},{"key":"2026092107251472000_16.9.e115134.11","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1007\/s11136-020-02685-1","article-title":"A systematic review of self-care measures for adolescents with health needs","volume":"30","author":"Jiang","year":"2021","journal-title":"Qual Life Res"},{"key":"2026092107251472000_16.9.e115134.12","first-page":"473","article-title":"Psychometric testing of the cross-culturally adapted Thai version of the Self-Care Self-Efficacy Scale version 3.0 in individuals with chronic illnesses","volume":"11","author":"Phonphet","year":"2024","journal-title":"Int J Nurs Sci"},{"key":"2026092107251472000_16.9.e115134.13","unstructured":"Creswell JW , Clark VL . 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