All ETDs from UAB

Advisory Committee Chair

Sigrid Ladores

Advisory Committee Members

Nataliya Ivankova

Patricia Patrician

Sylvie Mrug

Aimee Holland

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Nursing


BACKGROUND: With the life expectancy of individuals with cystic fibrosis (CF) doubling over the last two decades, it is critical that healthcare providers address both quantity and quality of life. Health-related quality of life (HRQoL) encompasses physical, social, psychological, and functional aspects of daily living and how CF impacts each one. Women with CF consistently report having an overall poorer quality of life across international studies, but the cause of the gender difference is unknown. The purpose of this study was to explore gender differences in HRQoL and then build upon those results to better understand gender-specific facilitators and barriers to HRQoL. METHODS: Gender-specific facilitators and barriers to HRQoL were explored using a sequential Quan QUAL mixed methods design. The sample included 123 adults with CF who were recruited within a tertiary care center in the southeastern United States. Data collected included the 50-item CF Questionnaire-Revised (CFQ-R), which is a disease-specific HRQoL questionnaire, a demographics form, and CF Foundation Patient Registry data. The CFQ-R has 12 domains of HRQoL. The CFQ-R scores and descriptive statistics were analyzed using SPSS Statistical Software v. 23. A subsample of 15 men and 15 women, who responded to the quantitative questionnaire, subsequently completed a 30-45 minute, semi-structured interview to further explore gender-specific facilitators and barriers to HRQoL. The interviews were transcribed verbatim and analyzed using Braun and Clarke’s method of thematic analysis with the help of NVivo 11 Pro software. RESULTS: Fifty-seven men and 66 women with CF, aged 19-67, were included in the quantitative analyses. Women reported a better HRQoL compared to men in the areas of body image (63.97 vs. 62.38), weight (73.74 vs. 57.31), and digestion (72.39 vs. 71.54). In the remaining nine areas, women reported a poorer HRQoL than men, with statistically significant differences (p < 0.05) in the areas of physical functioning (p = 0.02), social functioning (p = 0.03), emotional functioning (p = 0.02), and weight (p = 0.02). Five main themes emerged from the qualitative analysis of the interview data that describe facilitators and barriers to HRQoL: 1) Biological and Physiological Factors; 2) External Factors; 3) Functional Status; 4) Perceptions of Preferences, Values, and Mental Health; and 5) Perceived Symptom Status. Having a positive perspective, spirituality, and support were reported as contributing factors to a better HRQoL, whereas negative reactions from others, the treatment burden of CF, and experiencing anxiety and/or depression were reported as contributing to a poorer HRQoL. CONCLUSIONS: Factors that contribute to HRQoL are complex and diverse between genders. Results showed where the differences in HRQoL occur between genders, and also provided insight into potential interventions that could improve the HRQoL of adults with CF.

Included in

Nursing Commons



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