All ETDs from UAB

Advisory Committee Chair

Irena Stepanikova

Advisory Committee Members

William C Cockerham

Magdalena Szaflarski

William T Harris

Robert Weech-Maldonado

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) College of Arts and Sciences


Purpose: This study aimed to determine the relationship between caregivers' socioeconomic status (SES) and adherence to therapy in pediatric patients with cystic fibrosis (CF) and examine the role of adherence in the correlation between SES and health outcomes in this population. Methods: Socioeconomic, demographic, clinical, and adherence data in families of pediatric CF patients (N=110) were evaluated. SES measures included maternal and paternal education and annual household income. CF outcomes included lung function, nutritional status, and pulmonary exacerbations in 12 months. Adherence to therapy was conceptualized as health lifestyle practice of the caregiver. Of all therapeutic modalities, adherence to airway clearance therapy (ACT) was assessed. Both self-reported and objective (utilization data from the ACT device) adherence measures were collected. Results: Maternal college education and household income >$50,000 predicted higher adherence. Paternal college education and income >$100,000 predicted better lung function. However, adherence to ACT with a High Frequency Chest Wall Oscillation (HFCWO) was not correlated with lung function or pulmonary exacerbations. Caregiver-reported adherence was 1.9 times higher than the actual rates, while non-adherence was underestimated 3.5 times. Conclusion: SES is significantly associated with adherence in CF. Sociological approach to clinical research can uncover important relationships and mechanisms associated with the CF disease process and its management.



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.