All ETDs from UAB

Advisory Committee Chair

Sigrid Ladores

Advisory Committee Members

Leigh Bray

Traci Kazmerski

Peng Li

Sylvie Mrug

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Nursing


SELF-EFFICACY AND SEXUAL AND REPRODUCTIVE HEALTH IN WOMEN WITH CYSTIC FIBROSIS: A MIXED METHODS STUDY JANET BROWN DOCTOR OF PHILOSOPHY IN NURSING ABSTRACT BACKGROUND: Cystic fibrosis (CF) is the most common life-limiting genetic disorder among Caucasians. There are approximately 30,000 individuals with CF in the United States and over 70,000 worldwide, with approximately 1,000 new cases diagnosed globally each year. In other chronic diseases, a positive relationship between self-efficacy and behavior has been identified. Self-efficacy may be a factor related to behaviors, including underutilization of sexual and reproductive health (SRH) care services for women with CF.METHODS: Self-efficacy and utilization of SRH care services by women were explored using a concurrent mixed methods study design. The sample included 59 women ages 25 years or older with CF recruited from an accredited CF center located at a university setting in the southeastern United States. Participants completed the Self-Efficacy for Managing Chronic Disease 6-item Scale (SEMCD6) in addition to questions regarding age, marital status, and lung function. The SEMCD6 scores and utilization of SRH care scores were analyzed using R version 3.4.1 software. A subsample of 10 women completed a semi-structured interview to explore self-efficacy and utilization of SRH care services further. The interviews were transcribed verbatim and analyzed using Braun and Clark’s method of thematic analysis and NVivo 12 software. RESULTS: Participants had an age range of 25 to 68 with a median age of 34 years, were Caucasian (95%), had lung function greater than 70% predicted (47%), and mostly married (57%). Quantitative analysis revealed a positive correlation between self-efficacy and utilization of SRH care services (Spearman’s rho = .28, p = .04). Qualitative analysis revealed four overarching themes: (a) women (8/10) felt confident utilizing SRH care services and reported receiving SRH care in the past 12 months; (b) the women’s confidence toward SRH care utilization was attributed to communicating with other women with CF, verbal encouragement from a trusted CF healthcare team member or from a trusted family member or close friend, or from the stories of women with CF related to utilizing SRH care services; (c) information provided by CF care team members about SRH was lacking due to a lack of current research (8/10); and (d) the women’s CF care team did not initiate SRH conversations (9/10). Integration of the findings revealed: (a) women with CF are confident; (b) women with CF utilize SRH care services; (c) there is a positive relationship between self-efficacy and utilization of SRH care services; and (d) better lung function does not relate to higher self-efficacy. CONCLUSIONS: This is the first study to explore self-efficacy in relation to the utilization of SRH services among women with CF. The results of this study may guide future development of care protocols designed to increase the self-efficacy of women with CF toward the utilization of SRH care and assist providers with carrying out these discussions with patients in the future. Keywords: cystic fibrosis, sexual and reproductive health, self-efficacy

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