Understanding the cultural health belief model influencing health behaviors and health-related quality of life between Latina and Asian-American breast cancer survivors

The Cultural Influence of Familismo in Prompting Vaccination Against COVID-19 Among U.S. Latina/o/x Border Residents

This study centers on familismo as a relevant cultural construct that adds a U.S. Latina/o/x perspective to the Health Belief Model. Employing a qualitative lens, we use in-depth semi-structured focus groups and interviews with participants living, working, and attending school in a mid-size city on the U.S./Mexico border on the decision to take the COVID-19 vaccine. We find that, for many members of these communities, getting vaccinated is seen as a way to protect not only oneself but also one's family, especially those with chronic health conditions, reflecting an obligation to prioritize the collective over the individual. We highlight various approaches that families take to discuss COVID-19 vaccines, ranging from women coordinating vaccination to a non-confrontational approach to the unvaccinated. The borderlands as a place also showcase the diversity of the U.S. Latina/o/x experience during the pandemic, since the perceived disparities of vaccine access in Mexico also seemed to cue the decision to get vaccinated. We propose this helps explain the exceptionally high vaccination rate in the city under study and seen in several other border communities. By illuminating how familial ties impact health communication surrounding this important issue, this study adds an expanded Latina/o/x cultural context for aspects of the Health Belief Model such as perceived severity and susceptibility.

A Latent Profile Analysis of COVID-19 and Influenza Vaccine Hesitancy among Economically Marginalized Hispanic Mothers of Children under Five Years of Age in the US

Rates of COVID-19 and influenza vaccine coverage among Hispanic young children continue to be low in comparison to other racial and ethnic groups in the United States. This study utilized a person-centered approach to understand COVID-19 and influenza vaccination hesitancy for young children under the age of five among 309 economically marginalized Hispanic mothers. Drawing on the cultural health belief model, in 2022, following FDA approval of the COVID-19 vaccine for young children, a latent profile analysis was conducted from which three profiles emerged. The Low Acculturation group (Profile 1), was notable for lower acculturation, moderate cultural medical mistrust, lower access to vaccines, and higher financial security. Compared to Profile 1, the two remaining profiles had higher acculturation and lower levels of financial security, but differed in that the High Acculturation group (Profile 2) had higher vaccine accessibility and the Moderate Acculturation group (Profile 3) had higher cultural medical mistrust. Relative to other profiles, Low Acculturation mothers were more likely to plan to vaccinate their child against current and seasonal COVID-19 and seasonal influenza, report that their child's health provider recommended the COVID-19 shot and reported lower COVID-19 and influenza vaccine mistrust. However, they also reported lower vaccine accessibility and moderate levels of cultural medical mistrust. The study highlights the importance of developing person-centered public health strategies that draw on Hispanic cultural values and consider diversity within lower income Hispanic populations to increase future pediatric COVID-19 and flu vaccination coverage among young Hispanic children.

The predictors of voluntary participation in pulmonary tuberculosis screening program: a study in a suburban community of southern Thailand

Background

The health belief model (HBM), baseline health condition, and sociocultural factors impact the decision to participate in a tuberculosis screening program.

Methods

This cross-sectional and descriptive study was carried out among the "Kao Taew" community dwellers aged 18 years and above, who voluntarily underwent the provided pulmonary tuberculosis (PTB) screening by chest radiographs (CXRs). The level of individual HBM domain perception, attitudes toward PTB prevention, and regularity of PTB prevention practices by the participants were evaluated. The significantly associated or correlated factors such as demographic characteristics, individual HBM domain perception, and attitudes toward PTB prevention with the regularity of PTB prevention practices from the univariate analysis were further analyzed by multiple linear regression (p < 0.05) to determine the independent significant predictors of PTB prevention practices.

Results

Among 311 participants comprising 65% women, 57.9% aged ≥ 65 years and 67.2% had an underlying disease. The study participants had a high level of perception of HBM domains but a low level of perception of the barrier. In addition, a high level of attitudes toward PTB prevention and a high regularity of PTB prevention practices were found. A multiple linear regression analysis revealed that the perceived benefits of PTB screening [Beta = 0.20 (0.04, 0.36) p = 0.016] and acquiring underlying diseases [Beta = 1.06 (0.38, 1.73), p = 0.002] were significant predictors for PTB prevention practices, while belief in Islam was a reverse predictor [Beta = -0.84 (-1.47, -0.21), p = 0.010].

Conclusions

The level of perception of the individual domain of HBM, health status, and religious belief significantly predicted voluntary participation in PTB screening programs. Careful consideration by integration of the relevant health psychology, physical, and sociocultural factors is crucial for planning a health screening program.

Risk of contralateral breast cancer among Asian/Pacific Islander women in the United States

PURPOSE

While breast cancer studies often aggregate Asian/Pacific Islander (API) women, as a single group or exclude them, this population is heterogeneous in terms of genetic background, environmental exposures, and health-related behaviors, potentially resulting in different cancer outcomes. Our purpose was to evaluate risks of contralateral breast cancer (CBC) among subgroups of API women with breast cancer.

METHODS

We conducted a retrospective cohort study of women ages 18 + years diagnosed with stage I-III breast cancer between 2000 and 2016 in the Surveillance, Epidemiology and End Results registries. API subgroups included Chinese, Japanese, Filipina, Native Hawaiian, Korean, Vietnamese, Indian/Pakistani, and other API women. Asynchronous CBC was defined as breast cancer diagnosed in the opposite breast 12 + months after first primary unilateral breast cancer. Multivariable-adjusted subdistribution hazard ratios (SHR) and 95% confidence intervals (CI) were estimated and stratified by API subgroups.

RESULTS

From a cohort of 44,362 API women with breast cancer, 25% were Filipina, 18% were Chinese, 14% were Japanese, and 8% were Indian/Pakistani. API women as an aggregate group had increased risk of CBC (SHR 1.15, 95% CI 1.08-1.22) compared to NHW women, among whom Chinese (SHR 1.23, 95% CI 1.08-1.40), Filipina (SHR 1.37, 95% CI 1.23-1.52), and Native Hawaiian (SHR 1.69, 95% CI 1.37-2.08) women had greater risks.

CONCLUSION

Aggregating or excluding API patients from breast cancer studies ignores their heterogeneous health outcomes. To advance cancer health equity among API women, future research should examine inequities within the API population to design interventions that can adequately address their unique differences.

Incident Cardiovascular Disease Risk among Older Asian, Native Hawaiian and Pacific Islander Breast Cancer Survivors

BACKGROUND

Cardiotoxicity among breast cancer survivors is associated with chemotherapy and radiation therapy. The risk of cardiovascular disease (CVD) among Asian, Native Hawaiian and Pacific Islander (ANHPI) breast cancer survivors in the United States is unknown.

METHODS

We used the SEER-Medicare linked database to estimate the risk of CVD among older breast cancer survivors. International Classification of Disease diagnosis codes were used to identify incident CVD outcomes. Cox proportional hazards models were used to estimate HRs and 95% confidence intervals (CI) comparing ANHPI with Non-Hispanic White (NHW) patients with breast cancer for CVD, and among ANHPI race and ethnicity groups.

RESULTS

A total of 7,122 ANHPI breast cancer survivors and 21,365 NHW breast cancer survivors were identified. The risks of incident heart failure and ischemic heart disease were lower among ANHPI compared with NHW breast cancer survivors (HRheart failure, 0.72; 95% CI, 0.61-0.84; HRheart disease, 0.74; 95% CI, 0.63-0.88). Compared with Japanese patients with breast cancer, Filipino, Asian Indian and Pakistani, and Native Hawaiian breast cancer survivors had higher risks of heart failure. ischemic heart disease and death. Among ANHPI breast cancer survivors, risk factors for heart failure included older age, higher comorbidity score, distant cancer stage and chemotherapy.

CONCLUSIONS

Our results support heterogeneity in CVD outcomes among breast cancer survivors among ANHPI race and ethnicity groups. Further research is needed to elucidate the disparities experienced among ANHPI breast cancer survivors.

IMPACT

Filipino, Asian Indian and Pakistani, and Native Hawaiian patients with breast cancer had higher risks of heart failure, ischemic heart disease and death among ANHPI patients with breast cancer.

Comparing factors influencing seasonal influenza vaccine acceptance and intentions among Chinese university students residing in China and UK: A cross-sectional study

University students, who face an elevated risk of influenza due to close living quarters and frequent social interactions, often exhibit low vaccine uptake rates. This issue is particularly pronounced among Chinese students, who encounter unique barriers related to awareness and access, emphasizing the need for heightened attention to this problem within this demographic. This cross-sectional study conducted in May-June 2022 involved 1,006 participants (404 in the UK, 602 in Mainland China) and aimed to explore and compare the factors influencing influenza vaccine acceptance and intentions between Chinese university students residing in the UK (C-UK) and Mainland China (C-M). The study employed a self-administered questionnaire based on the Theoretical Domains Framework and Capability Opportunity Motivation-Behavior model. Results revealed that approximately 46.8% of C-UK students received the influenza vaccine in the past year, compared to 32.9% of C-M students. More than half in both groups (C-UK: 54.5%, C-M: 58.1%) had no plans for vaccination in the upcoming year. Knowledge, belief about consequences, and reinforcement significantly influenced previous vaccine acceptance and intention in both student groups. Barriers to vaccination behavior included insufficient knowledge about the influenza vaccine and its accessibility and the distance to the vaccine center. Enablers included the vaccination behavior of individuals within their social circles, motivation to protect others, and concerns regarding difficulties in accessing medical resources during the COVID-19 pandemic. The findings of this study offer valuable insights for evidence-based intervention design, providing evidence for healthcare professionals, policymakers, and educators working to enhance vaccination rates within this specific demographic.

The Characteristics of Asian American Breast Cancer Survivors with Low Quality of Life: a Decision Tree Analysis

To provide appropriate and adequate information and support for Asian American breast cancer survivors, it would be essential to identify risk groups among them to target in future cancer education interventions. In this secondary analysis, the characteristics of risk groups within Asian American breast cancer survivors who had low quality of life were identified using a decision tree analysis. For this analysis, only the pre-test data of 185 women from a parent study were selected. Multiple instruments including the Functional Assessment of Cancer Therapy Scale-Breast Cancer (FACT-B) were used in the parent study. The data were analyzed using descriptive and inferential statistics and decision tree analyses. The decision tree analyses showed six combined characteristics associated with lower quality of life scores than the total mean quality of life scores. For instance, the women with lower quality of life scores (than the total mean quality of life scores) had high perceived barriers (cut point = 1.84), low self-efficacy for coping (cut point = 81.50), and high global symptom distress (cut point = 2.27). Also, the characteristics linked to the lowest quality life scores were different depending on the dimensions of the quality of life. The characteristics associated with the quality of life of Asian American breast cancer survivors need to be considered in future education programs for this specific population.

COVID-19 Vaccine Hesitancy among Economically Marginalized Hispanic Parents of Children under Five Years in the United States

Hispanic children in the US have high rates of COVID-19-related hospitalizations and deaths. Following FDA emergency approval, COVID-19 vaccination rates for young children under five years have been alarmingly low, especially in border states with significant Hispanic populations. This study identified social and cultural determinants of COVID-19 vaccine hesitancy among economically marginalized Hispanic parents of children under five. In 2022, following FDA approval, 309 Hispanic female guardians in US border states responded to an online survey assessing parental intent to vaccinate their child, demographic characteristics, COVID-19 health and vaccine beliefs, trust in traditional sources of health information, physician and community support, and acculturation to Anglo American norms. The majority (45.6%) did not intend to vaccinate their child or were unsure (22.0%). Kendall’s tau-b indicated vaccine acceptance was negatively associated with COVID-19 specific and general vaccine distrust, belief the vaccine was unnecessary, time living in the U.S., and language acculturation (range tb = −0.13 to −0.44; p = 0.05–0.001) and positively related to trust in traditional resources, doctor’s recommendation, child’s age, household income and parent education (range tb = 0.11 to 0.37; p = 0.05–0.001). This research highlights the importance of COVID-19 vaccination public health strategies that draw on Hispanic cultural values, community partnerships and enhanced pediatrician communication regarding routine and COVID-19-specific vaccinations.

Health Promotion Among Mexican-Origin Survivors of Breast Cancer and Caregivers Living in the United States-Mexico Border Region: Qualitative Analysis From the Vida Plena Study

Background

Hispanic survivors of cancer experience increased cancer burden. Lifestyle behaviors, including diet and physical activity, may reduce the cancer burden. There is limited knowledge about the posttreatment lifestyle experiences of Hispanic survivors of cancer living on the United States–Mexico border.

Objective

This study aims to support the development of a stakeholder-informed, culturally relevant, evidence-based lifestyle intervention for Mexican-origin Hispanic survivors of cancer living in a border community to improve their dietary quality and physical activity.

Methods

Semistructured interviews with 12 Mexican-origin Hispanic survivors of breast cancer and 7 caregivers were conducted through internet-based teleconferencing. The interviews explored the impact of cancer on lifestyle and treatment-related symptoms, perception of lifestyle as an influence on health after cancer, and intervention content and delivery preferences. Interviews were analyzed using a deductive thematic approach grounded in the Quality of Cancer Survivorship Care Framework.

Results

Key survivor themes included perception of Mexican diet as unhealthy, need for reliable diet-related information, perceived benefits of physical activity after cancer treatment, family support for healthy lifestyles (physical and emotional), presence of cancer-related symptoms interfering with lifestyle, and financial barriers to living a healthy lifestyle. Among caregivers, key themes included effects of the cancer caregiving experience on caregivers’ lifestyle and cancer-preventive behaviors and gratification in providing support to the survivors.

Conclusions

The interviews revealed key considerations to the adaptation, development, and implementation of a theory-informed, evidence-based, culturally relevant lifestyle program to support lifestyle behavior change among Mexican-origin Hispanic survivors of cancer living in border communities. Our qualitative findings highlight specific strategies that can be implemented in health promotion programming aimed at encouraging cancer protective behaviors to reduce the burden of cancer and comorbidities in Mexican-origin survivors of cancer living in border communities.

Chronic Illness Management in Culturally and Linguistically Diverse Patients: Exploring the Needs, Access, and Understanding of Information

In Canada, people from culturally and linguistically diverse (CALD) backgrounds are at a greater risk of developing a chronic illness, and are more likely to experience adverse health effects and challenges in accessing high-quality care compared with Canadian-born individuals. This, in part, has been attributed to having inadequate access to information and resources needed to manage their illness(es). A qualitative descriptive design and inductive content analysis were used to explore the information needs of 24 CALD patients with chronic illnesses. Participants identified medical, lifestyle, and psychosocial information needs. How much information was needed depended on such antecedents as illness trajectory, severity, and perception. Most information needs remained unmet. A number of communication strategies were identified to bridge language barriers that go beyond translation and are based on effective health education strategies. Findings can help health care professionals better identify CALD patients' information needs and provide strategies that go beyond translation.

Survivorship Care Plan Preferences and Utilization Among Asian American Breast Cancer Survivors

PROBLEM IDENTIFICATION

The survivorship care plan (SCP) is an individualized document with cancer diagnosis, treatment, surveillance, and health promotion recommendations. This integrative review synthesizes the extant literature to understand preferences and utilization of SCPs among Asian American survivors.

LITERATURE SEARCH

The CINAHL®, Embase®, PsycINFO®, and PubMed® databases were searched for articles about Asian American women with breast or cervical cancer and SCPs.

DATA EVALUATION

Two independent reviewers evaluated 481 titles and abstracts according to inclusion and exclusion criteria. Of those 481 titles and abstracts, 14 articles were selected for inclusion.

SYNTHESIS

There was little evidence surrounding utilization of SCPs. Articles identified addressed only survivors of breast cancer, predominately of Southeast Asian descent. Asian American women with breast cancer reported preferences surrounding their survivorship needs. Barriers to delivery of the SCP were related to socioeconomic factors.

IMPLICATIONS FOR RESEARCH

There is a paucity of information guiding evidence-based delivery of SCPs in the vastly heterogenous population of Asian American survivors. More work is needed to provide high-quality care to these survivors.

Enhancing equitable access to cancer information for culturally and linguistically diverse (CALD) communities to complement beliefs about cancer prognosis and treatment

PURPOSE

Populations affected by cancer from culturally and linguistically diverse (CALD) backgrounds with low English proficiency have poorer health outcomes than the Australian population. They also have limited access to cancer information and may hold health beliefs that affect health-seeking behaviour. A leading cancer support organisation in Australia conducted research with the largest language groups in Australia with the lowest English proficiency to guide the development of appropriate translated resources.

METHOD

Six focus groups were conducted with Arabic, Chinese (Mandarin and Cantonese) and Vietnamese speaking cancer survivors, carers and those significantly affected by cancer to understand their health beliefs, information needs and preferred modes of access. Thirteen interviews were also conducted with service providers supporting these communities.

RESULTS

Communities lacked access to, and knowledge of, cancer information in their language on Australian cancer-related websites. They had easier access to information in their language from overseas health and local ethnic organisations, and from family and friends. Participants trusted health professionals but were dissatisfied with the information and care provided. Cultural beliefs, combined with a lack of information in their language, were not conducive to accessing appropriate information. The impact of beliefs about fate was significant, but they did not rule out using Western treatment or actively seeking cancer information.

CONCLUSIONS

The results reinforce the need to fully explore the cultural beliefs and the structural barriers to accessing cancer information. They also demonstrate that religious-based fatalistic beliefs need not prevent access to information but can co-exist with Western medical treatments.

The Illness Belief Network Questionnaire: Development and Evaluation of a Psychosomatic Assessment Tool

Objective: Patients’ beliefs and emotions toward an illness can influence their coping responses, illness behaviors, adherence to treatment, quality of life, and even the psychoneuroimmune responses. The aim of present study was to develop and validate a novel questionnaire assessing both rational and irrational beliefs of patients regarding their illness.

Method: In a cross sectional methodological study, the items of the Illness Belief Network (IBN) were developed regarding patients and clients’ opinions about and attribution of their disease extracted from 400 clinical interviews and were coded based on Leventhal’s self-regulation model. An expert panel coded the items. A total of 400 patients with different medical conditions completed the questionnaire. Participants additionally rated the Illness Perceptions Questionnaire in its revised form (IPQ-R) to assess convergent validity. Construct validity was examined by conducting exploratory and confirmatory factor analysis. The Cronbach alpha and Intracluster Correlation Coefficient (ICC) were used for examining Internal consistency and test-retest reliability of the IBN.

Results: The IBN questionnaire was finalized with 84 items, and the results of factor analysis revealed 5 factors: psychosocial causes, environmental causes, control, meaning, and consequence/timeline; extracted factors were confirmed by confirmatory factor analysis. Cronbach’s α coefficient for scale was 0.92 and it ranged from 0.79 to 0.89 for the subscales. IBN indicated excellent test-retest reliability results based on ICC 0.842(95%CI: 0.798-0.846). The correlation coefficients of all items exceeded the prespecified acceptable value of 0.40, indicating satisfactory item discriminant validity, and correlation between IBN and IPQ-R subscales were statistically significant (all p values < 0.01), indicating acceptable convergent validity.

Conclusion: The IBN questionnaire is a valid and reliable phenomenological, non-judging, and clinical tool to assess patient’s rational and irrational or faith-based beliefs about the illness. This tool can be used to improve doctor-patient communication by exploring the complex nature of human thinking.

Influenza Vaccination Among U.S. College or University Students: A Systematic Review

OBJECTIVE

Influenza is one of the major causes of morbidity. This study summarized major components that influence college/university students' use of the vaccination using Ecological System Theory; and evaluated racial differences in key predictors of influenza vaccination/intention.

DATA SOURCE

Sixteen engines (e.g., PsycINFO, Academic Search Premier, Science Citation Index) were used to search for cross-sectional studies (2009-2019).

STUDY INCLUSION/EXCLUSION CRITERIA

PI/CO criteria were applied (U.S. students, multidimensional ecological system, influenza vaccination/intention).

DATA EXTRACTION

25 cross-sectional studies were included from the initial 810 citations. Four reviewers performed the cross-checking.

DATA SYNTHESIS AND RESULTS

Higher SES (e.g., education, vaccine affordability, healthcare resource) were positively associated with vaccination/intention. Under micro levels, both internal factors (e.g., positive beliefs, perceptions, attitudes) and external factors (e.g., supports/recommendations from physicians, families or peers, information, engagement in campus activities) enhanced influenza vaccination/intention of students. Meso level factors (private university, dorm-residence, or student housing) also influenced influenza vaccination/intention. Despite limited information on the effects of race on influenza vaccination, the current study synthesized the racial variances in vaccination behaviors of students.

CONCLUSIONS

Enhancing positive beliefs, perceptions, or attitudes toward influenza vaccination with students is critical. Information about the safety and effectiveness of vaccination could be provided for students through official media, medical sources/physicians, campaigns, or internet websites. Family-to-student or peer-to-peer awareness campaigns could facilitate the vaccination of students.

Calidad de Vida: a systematic review of quality of life in Latino cancer survivors in the USA

BACKGROUND

Cancer is the leading cause of death among Hispanics/Latinos. Thus, understanding health-related quality of life (HRQOL) needs among this diverse racial/ethnic group is critical. Using Ferrell's multidimensional framework for measuring QOL, we synthesized evidence on HRQOL needs among Hispanic/Latino cancer survivors.

METHODS

We searched MEDLINE/PubMed, EMBASE, CINAHL, and PsycINFO, for English language articles published between 1995 and January 2020, reporting HRQOL among Hispanic/Latino cancer survivors in the USA.

RESULTS

Of the 648 articles reviewed, 176 met inclusion criteria, with 100 of these studies focusing exclusively on breast cancer patients and no studies examining end-of-life HRQOL issues. Compared with other racial/ethnic groups, Hispanics/Latinos reported lower HRQOL and a higher symptom burden across multiple HRQOL domains. Over 80% of studies examining racial/ethnic differences in psychological well-being (n = 45) reported worse outcomes among Hispanics/Latinos compared with other racial/ethnic groups. Hispanic/Latino cancer survivors were also more likely to report suboptimal physical well-being in 60% of studies assessing racial/ethnic differences (n = 27), and Hispanics/Latinos also reported lower social well-being relative to non-Hispanics/Latinos in 78% of studies reporting these outcomes (n = 32). In contrast, reports of spiritual well-being and spirituality-based coping were higher among Hispanics/Latinos cancer survivors in 50% of studies examining racial/ethnic differences (n = 15).

DISCUSSION

Findings from this review point to the need for more systematic and tailored interventions to address HRQOL needs among this growing cancer survivor population. Future HRQOL research on Hispanics/Latinos should evaluate variations in HRQOL needs across cancer types and Hispanic/Latino subgroups and assess HRQOL needs during metastatic and end-of-life disease phases.

An Environmental Scan of Biopsychosocial and Clinical Variables in Cohort Studies of Cancer Survivors

BACKGROUND

An inventory of cancer survivorship cohorts is necessary to identify important gaps in what is being studied among cancer survivors.

METHODS

We conducted an environmental scan of cancer survivor cohorts to determine the scope and scale of information collected on demographic, biopsychosocial, and selected clinical variables from cancer survivors. Cohorts were eligible for inclusion in the environmental scan if the study was conducted in the United States, reported in English, and consisted of data collected from cancer survivors postdiagnosis and followed for at least 1 year.

RESULTS

Out of the 131 cohorts identified, 62 were eligible. There were 23 cancer sites represented, and more than half of the studies included breast cancer survivors (n = 34). The next most commonly included cancers were leukemia (n = 22) and lymphoma (n = 23). The majority (n = 59) collected information on clinical characteristics and basic diagnostic information, patient demographic characteristics (n = 57), patient-reported symptoms (n = 44), lifestyle (n = 45), and psychologic characteristics (n = 42). Half collected biospecimens (n = 35) and biomarkers (n = 35); fewer collected CAM use (n = 19) and social characteristics (n = 27).

CONCLUSIONS

Extensive data are available in cancer cohorts to study important questions relevant to cancer survivors. Cohorts should consider collecting information on social and environmental factors, as well as biospecimen collection and biomarker analyses, and should include survivors from cancer sites less likely to be studied.

IMPACT

This information can assist researchers in understanding the types of information currently being gathered from cancer survivors for further analysis and identify areas where more research is needed.

Exploring the Need of HPV Education Programs in Korean American Communities

Given the significantly higher cervical cancer risks faced by Korea Americans (KA), the aim of this study was to explore cultural influences and barriers affecting human papillomavirus (HPV) vaccination decisions and preferred educational methods to effectively deliver HPV information. Focus groups included 20 KA parents. This study found a lack of knowledge about HPV and the vaccine, along with negative perceptions about the vaccine, affects HPV vaccination decision-making. Ineffective conversations and a lack of HPV vaccine recommendations by health care providers influenced by cultural beliefs were found to be another major barrier. These findings reveal new insights to guide the development of HPV education programs.

Correlates and aetiological factors associated with hedonic well-being among an ageing population of US men and women: secondary data analysis of a national survey

OBJECTIVE

To understand the gender-specific factors that uniquely contribute to successful ageing in a US population of men and women, 57-85 years of age. This was achieved through the examination of the correlates of subjective well-being defined by health-related quality of life (HRQoL), across several biological and psychosocial determinants of health.

DESIGN

Cross-sectional study.

SETTING

The National Social Life, Health and Ageing Project (NSHAP), 2010-2011 a representative sample of the US population.

PARTICIPANTS

3377 adults aged 57-85 (1538 men, 1839 women) from the NSHAP.

MAIN OUTCOME MEASURES

The biopsychosocial factors of biological/physiological function, symptom status, functional status, general health perceptions and HRQoL happiness.

METHOD

HRQoL was measured using the NSHAP wave 2 multistage, stratified area probability sample of US households (n=3377). Variable selection was guided by the Wilson and Cleary model (WCM) that classifies health outcomes at five main levels and characteristics.

RESULTS

Our findings indicate differences in biopsychosocial factors comprised in the WCM and their relative importance and unique impact on HRQoL by gender. Women reported significantly lower HRQoL than men (t=3.5, df=3366). The most significant contributors to HRQoL in women were mental health (B=0.31; 0.22, 0.39), loneliness (B=-0.26; -0.35, -0.17), urinary incontinence (B=-0.22; -0.40, -0.05) and support from spouse/partner (B=0.27; 0.10, 0.43) and family B=0.12; 0.03, 0.20). Men indicated mental health (B=0.21; 0.14, 0.29), physical health (B=0.17; 0.10, 0.23), functional difficulties (B=0.38; 0.10, 0.65), loneliness (B=-0.20; -0.26, -0.12), depression (B=-0.36; -0.58, -0.15) and support from friends (B=0.06; 0.10, 0.11) as significant contributors. Those with greater social support had better HRQoL (F=4.22, df=4). Lack of companionship and reliance on spouse/partner were significant HRQoL contributors in both groups.

CONCLUSION

Our findings offer insight into ageing, gender and subjective well-being. The results provide an opportunity to identify biopsychosocial factors to inform interventions to support successful ageing.

Impact of acculturation on breast cancer treatment and survivorship care among Mexican American patients in Texas

PURPOSE

Given the increasing number and diversity of cancer survivors in the USA and persistent racial/ethnic disparities in breast cancer care, we sought to examine the role of acculturation in adherence to recommended surgical treatment and survivorship care recommendations.

METHODS

Study participants included 343 Mexican American women with stage I to III breast cancer who participated in the Ella Binational Breast Cancer Study and were treated at The University of Texas MD Anderson Cancer Center in Houston, Texas, between March 2007 and June 2011. Participants completed a questionnaire measuring acculturation, and clinical and demographic variables were obtained from an institutional database. Multivariable logistic regression models were constructed to examine differences in surgical procedures received and adherence to long-term survivorship care by acculturation level.

RESULTS

Bilingual (odds ratio [OR] = 1.85; 95% confidence interval [CI] = 0.85-4.02, P = .11) and English-dominant women (OR = 2.39; 95% CI = 1.02-5.61, P = .04) were more likely to receive breast-conserving surgery (versus mastectomy) than were Spanish-dominant women. Among all patients, adherence to surveillance mammography and clinic visits decreased over time; the decline in clinic visit adherence was statistically significant (P = .005). Although no statistically significant association was found between acculturation and adherence to long-term survivorship care, receipt of breast-conserving surgery (versus mastectomy) was significantly associated with higher adherence to surveillance mammograms.

CONCLUSION

Acculturation may play a role in decision-making about surgical management of breast cancer, and further studies with larger samples are needed to explore its role in adherence to survivorship care recommendations. Findings from this study may help identify patients requiring additional support while making decisions pertaining to their cancer treatment and survivorship care.

Exploring the Social Needs and Challenges of Chinese American Immigrant Breast Cancer Survivors: a Qualitative Study Using an Expressive Writing Approach

PURPOSE

Little is known about the psychological well-being and social barriers among immigrant Chinese American breast cancer survivors. The aim of the present study was to explore the social needs and challenges of Chinese American immigrant breast cancer survivors.

METHOD

This study used the expressive writing approach to explore the experiences among 27 Chinese American breast cancer survivors. The participants were recruited through community-based organizations in Southern California, most of whom were diagnosed at stages I and II (33 and 48%, respectively). Participants, on average, had been living in the USA for 19 years. Participants were asked to write three 20-min essays related to their experience with breast cancer (in 3 weeks). Participants' writings were coded with line-by-line analysis, and categories and themes were generated.

RESULTS

Emotion suppression, self-stigma, and perceived stigma about being a breast cancer survivor were reflected in the writings. Interpersonally, participants indicated their reluctance to disclose cancer diagnosis to family and friends and concerns about fulfilling multiple roles. Some of them also mentioned barriers of communicating with their husbands. Related to life in the USA, participants felt unfamiliar with the healthcare system and encountered language barriers.

CONCLUSION

Counseling services addressing concerns about stigma and communication among family members may benefit patients' adjustments. Tailor-made information in Chinese about diagnosis and treatment for breast cancer and health insurance in the USA may also help patients go through the course of recovery.

The Relationship Between Hofstede's Cultural Dimensions, Schwartz's Cultural Values, and Obesity

According to the World Health Organization, obesity is a major public health issue. In 2014, there were more than 600 million obese people around the world. According to the data of the World Health Organization, obesity rates differ among countries. One possible underlying reason of the difference can be culture, more specifically shared cultural values. The strategies and policies regarding obesity were developed; however, the effect of culture is not adequately considered. The aim of the study is to investigate the relationship between obesity rates of countries, Hofstede's cultural dimensions, Schwartz's values, and Gross National Income per capita per country. The data consist of obesity ranking (i.e., the percentage of the population with a body mass index of 30 kg/m² or higher), Gross National Income per capita for each country, and cultural variables (i.e., Hofstede's cultural dimensions for 54 nations and Schwartz's cultural values for 57 nations). Hierarchical regression analysis results revealed that Gross National Income per capita was not a significantly related obesity at the aggregated level. Among Hofstede's dimensions, individualism and uncertainty avoidance were positively associated with obesity, and long-term orientation was negatively associated with obesity. The relationship between Schwartz's cultural values and obesity was not found to be significant. Findings suggest that Hofstede's cultural dimensions should be considered when developing national level strategies and campaigns to decrease obesity.

Predictors of enrollment in individual- and couple-based lifestyle intervention trials for cancer survivors

PURPOSE

To utilize data from lifestyle intervention pilot studies for cancer survivors to elucidate demographic, disease-related, and health behavior factors that might predict enrollment in this type of research. Additionally, factors were differentially compared based on intervention design (i.e., individual versus couple-based).

METHODS

Secondary data analysis was conducted regarding predictors of enrollment into lifestyle intervention studies, including Healthy Moves Weight Loss (individual participants, screened n = 89, enrolled n = 30) and Healthy Moves Couples (survivors and their partners, screened n = 197, enrolled n = 23). Due to small sample sizes, common in pilot studies, random forest analyses were used to maximize information yielded by the data.

RESULTS

Results identified numerous important predictors of enrollment in individual and couple-based lifestyle interventions. Percent energy from fat and physical activity minutes were identified as important predictors for both recruitment methods. Age, cancer site, and marital status were important predictors of enrollment in the individual-based intervention. Weight, fiber consumption, and disease-related symptom severity and interference were important predictors of enrollment in the couple-based intervention.

CONCLUSION

Although there was some overlap in predictors for enrollment between studies, many differential predictors were identified between individual versus couple-based study designs for lifestyle intervention in cancer survivors. Future lifestyle intervention studies for cancer survivors may benefit from targeting different predictors of enrollment based on study design to optimize recruitment. Additionally, understanding predictors may allow certain barriers to enrollment (i.e., symptom burden) to be directly addressed, making lifestyle intervention research more feasible and acceptable to difficult-to-recruit survivors.

The impact of comorbidity on the relationship between life stress and health-related quality of life for Chinese- and Korean-American breast cancer survivors

OBJECTIVE

The current study aimed to (1) identify the occurrence of comorbidities among Chinese- and Korean-American breast cancer survivors (BCS), (2) examine whether health-related quality of life (HRQOL) scores varied with the occurrence of specific comorbidities, and (3) investigate the mediating effect of comorbidities on the relationship between life stress and HRQOL.

DESIGN

Data were drawn from the parent study, a cross-sectional study investigating HRQOL in 86 Chinese- and 71 Korean-American BCS in Southern California. Two comorbidity-related variables, the occurrence of the specific comorbidity and the total number of comorbidities, were used to comprehensively reflect the characteristics of comorbidity.

RESULTS

Approximately 60% of participants had at least one comorbid disease, and osteoporosis was the most prevalent comorbidity. HRQOL differences based on the occurrence of a specific comorbidity were evident for arthritis, eye/vision problems, dental and gum problems, lymphedema, and psychological difficulties. Structural equation modeling demonstrated that the nature of the outcome variable, either physical or mental HRQOL, influenced the overall patterns of the findings. For example, life stress was significantly associated with the total number of comorbidities and in turn influenced physical HRQOL. In terms of mental HRQOL, arthritis, dental and gum problems, chronic pain, heart disease, lymphedema, and psychological difficulties mediated the relationship between life stress and mental HRQOL.

CONCLUSION

The current study adds to the existing literature by examining the mediating effects of comorbidity on the relationship between life stress and HRQOL. The findings support the need for health care professionals to clearly assess physical and psychological comorbidities when providing survivorship care for cancer survivors.

Unmet Needs of Asian American and Pacific Islander Cancer Survivors

In the USA, cancer is the leading cause of death for Asian Americans and Pacific Islanders (AAPIs), but little is known about the unmet needs of AAPI cancer survivors, especially from a national perspective. Using a community-based participatory research approach, we partnered with the Asian and Pacific Islander National Cancer Survivors Network and the Asian American Cancer Support Network to design and conduct a cross-sectional survey to understand the unmet needs of a national sample of AAPI cancer survivors. We assessed unmet needs in 10 domains: day-to-day activities, financial expenses, emotional concerns, medical treatment, cancer information, home care, nutrition, physical concerns, family relationships, and spirituality. We also assessed self-reported measures related to quality of life. This national sample of AAPI cancer survivors included people from 14 states and two territories who had been diagnosed with a broad range of cancers, including cancer of the breast, ovary/uterus/cervix, prostate, blood, and other sites. Over 80 % reported at least one unmet need. Participants reported an average of 8.4 unmet needs, spanning an average of 3.9 domains. Most commonly reported were unmet needs pertaining to physical concerns (66 %), day-to-day activities (52 %), and emotional concerns (52 %). This is the first report of unmet needs in a national sample of AAPI cancer survivors with a range of different cancer types. It describes the areas of greatest need and points to the importance of devoting more resources to identifying and addressing unmet needs for the underserved population of AAPI cancer survivors.

Predictors of psychological outcomes in a longitudinal study of Latina breast cancer survivors

OBJECTIVE

This study sought to investigate the unique contributions of socio-ecological, cultural and cancer treatment-related factors in predicting depressive symptoms and cancer-specific distress among Latinas.

DESIGN

Participants were 140 English or Spanish-speaking Latinas (Mage = 50.6) with non-metastatic breast cancer who were assessed within two years of diagnosis (Time 1) and three months later (Time 2).

MAIN MEASURES

Hierarchical regression analyses identified predictors of depressive symptoms and cancer-specific distress at Time 1 and 2.

RESULTS

Most women scored above the clinical cut-offs for depressive symptoms and cancer-specific distress. After adjusting for socio-ecological factors, greater Latino enculturation, measured by Latino ethnic identity, was significantly associated with greater cancer-specific distress at Time 1 (β = .20, p < .05). A significant interaction (p < .01) revealed that among women high on Latino identity, lower English language use was associated with more cancer-specific distress than higher English language use. After adjusting for socio-ecological factors, greater satisfaction with surgical treatment predicted improved depressive symptoms and cancer-specific distress across time (βs range from -.31 to -.18, ps < .01).

CONCLUSIONS

Findings elucidate the complex relationship between culture and psychological outcomes in the breast cancer context and suggest that treatment satisfaction might be an important intervention target for Latinas.

Unmet needs of non-Hodgkin lymphoma survivors in Korea: prevalence, correlates, and associations with health-related quality of life

OBJECTIVE

We aimed to describe the prevalence and correlates of unmet needs among non-Hodgkin lymphoma (NHL) survivors in Korea and to identify their association with health-related quality of life (HRQOL).

METHODS

Participants were 826 NHL survivors from three hospitals in South Korea diagnosed at least 24 months prior to participating (mean, 6.3 years; range, 2.1-20.9 years). We used self-reported questionnaires, including the Need Scale for Cancer Patients Undergoing Follow-up Care (NS-C) developed in Korea and the EORTC QLQ-C30. We defined an unmet need as a moderate to high level of unmet need in the NS-C response scale.

RESULTS

Among six domains, unmet need prevalence ranged from 1.7% to 38.3%. Most commonly reported domains with unmet needs were 'treatment and prognosis' (38.3%) and 'keeping mind under control' (30.5%). The three most frequently reported individual unmet needs were 'being informed about prevention of recurrence' (50.7%), 'being informed about prevention of metastasis' (49.7%), and 'having self-confidence of overcoming cancer' (42.7%). Multivariate logistic analyses revealed that younger age, being unmarried, and low monthly income were associated with unmet needs of multiple domains. Participants with unmet needs demonstrated significantly poorer HRQOL, and the most clinically meaningful differences were found in social function and emotional function.

CONCLUSIONS

Korean NHL survivors have substantial unmet needs, especially those who are younger, unmarried, and have a lower income. Initiating supportive care programs for meeting unmet needs may enhance their HRQOL. Copyright © 2016 John Wiley & Sons, Ltd.

Cancer survivors' perspectives and experience on western medicine and traditional Chinese medicine treatment and rehabilitation: a qualitative study

BACKGROUND

In the People's Republic of China, both western medicine (WM) and traditional Chinese medicine (TCM) are the main treatment and rehabilitation options for cancer patients. This study aimed to explore cancer survivors' perspectives and experience of treatment and rehabilitation, in order to promote patient-centered activities of treatment and rehabilitation.

METHODS

Using a qualitative research approach, 68 cancer survivors were recruited from eight community cancer rehabilitation organizations in Shanghai, People's Republic of China. Eight focus group interviews were conducted. All these interviews were transcribed verbatim, and the data were analyzed by theme analysis.

RESULTS

WM was the main choice in treatment phase though study participants noted more side effects. TCM was primarily used in the recovery phase. The lack of communication between doctors and cancer patients appears to affect treatment adherence and impair the doctor-patient relationship. WM was expensive for diagnostic procedures and treatment, while the cumulative costs of frequent use of TCM in the long rehabilitation period were also high. Both treatment options created significant perceived economic burden on patients. Conflicting information about dietary supplements tended to make cancer survivors confused.

CONCLUSION

Improving the communication between doctors and cancer patients helps to ameliorate cancer patient adherence and the effect of treatments. It is essential to educate cancer patients about the effect and cost of both WM and traditional TCM. Meanwhile, marketing management and guidance to consumers regarding use of dietary supplements in the cancer rehabilitation field are also necessary.

Knowledge and acceptability of the HPV vaccine among ethnically diverse black women

The purpose of the study was to examine HPV vaccine knowledge and acceptability among ethnically diverse Black women. Forty-four women were interviewed in 6 focus groups (2 African American, 2 English-speaking Caribbean, 1 Haitian, and 1 African). Thematic content analysis was used to generate common concepts and themes and to compare findings across groups. There was varied but limited knowledge and confusion across ethnic groups about the HPV infection and vaccine. African and Haitian women had the least knowledge. Overall, women were generally receptive toward the HPV vaccine for girls but unclear about the need to vaccinate boys. Concerns about the HPV vaccine were mainly related to side effects/safety and vaccinating children at a young age. Healthcare provider's recommendation of the vaccination was important for decision making. Educational interventions with Black women about HPV vaccination should recognize cultural beliefs that vary by ethnic group.

Ethnic disparities in adherence to breast cancer survivorship surveillance care

BACKGROUND

Adherence to guidelines for surveillance mammography and clinic visits is an important component of breast cancer survivorship care. Identifying ethnic disparities in adherence may lead to improved care delivery and outcomes.

METHODS

Records were evaluated for 4535 patients who were treated for stage I, II, or III breast cancer at the University of Texas MD Anderson Cancer Center, Houston, Texas, cancer center between January 1997 and December 2006. Generalized estimating equations and Cox proportional hazards analyses were used to evaluate ethnic differences in missed mammograms and clinic visits up to 4 years of follow-up and the impact of those differences on overall survival.

RESULTS

Nonadherence to guidelines for mammography (P = .0002) and clinic visits (P < .0001) increased over time. Hispanic and black patients were more likely to be nonadherent to guidelines for mammography (odds ratio [OR] = 1.35, 95% confidence interval [CI] = 1.10-1.65; OR = 1.36, 95% CI = 1.11-1.66, respectively) and clinic visits (OR = 1.62, 95% CI = 1.27-2.06; OR = 1.45, 95% CI = 1.13-1.86, respectively) than white patients. There was an interaction between Hispanic ethnicity and endocrine therapy on nonadherence to mammography guidelines (P = .001). Nonadherence to mammography and clinic visit guidelines was not associated with overall survival.

CONCLUSIONS

Withdrawal from breast cancer survivorship care increases over time, and black and Hispanic patients are more likely to be nonadherent. An understanding of the reasons for ethnic disparities in adherence to guidelines for mammography and clinic visits is needed to improve retention in survivorship care.

Breast cancer experience and survivorship among Asian Americans: a systematic review

INTRODUCTION

Breast cancer is the most common cancer in Asian American women, and the number of Asian American breast cancer survivors is rapidly increasing. Although Asian Americans are one of the fastest growing and most heterogeneous ethnic groups in the United States, limited data exist in regard to their breast cancer experience and survivorship.

METHODS

A systematic review of the breast cancer experience literature was conducted and included studies of Asian Americans or their subgroups as a major category of study participants. Of the 125 studies reviewed, 10 qualitative studies, 10 quantitative studies, 5 studies that used a mixed-method approach, and 1 intervention study met the criteria for inclusion.

RESULTS

Qualitatively, Asian Americans reported unmet physical and emotional needs and challenges during survivorship. Quantitative studies consistently found that socioeconomic status, cultural health beliefs, immigration stress, acculturation level, English proficiency, social support, and spirituality associated with Asian American breast cancer patients' health behaviors and health-related quality of life (HRQOL). Studies also revealed significant variation in breast cancer reaction and HRQOL within Asian American subgroups.

CONCLUSIONS

Although research on Asian American breast cancer experience and survivorship is sparse, we concluded that Asian Americans experience disrupted HRQOL following breast cancer diagnosis and treatment, interwoven with their cultural and socio-ecological system, and that programs focused on improving cancer survivorship outcomes among this ethnic minority group are limited. Most studies have concentrated on the West coast population, and there is significant underrepresentation of longitudinal and intervention studies. Implications for study design, measurement, and future research areas are also included.

IMPLICATIONS FOR CANCER SURVIVORS

The results highlight a need to understand ethnic differences and to take into account social, cultural, and linguistic factors in breast cancer survivorship experiences among Asian American subgroups as a means to develop culturally relevant and linguistically appropriate interventions designed to improve HRQOL.

Impact of a bilingual education intervention on the quality of life of Latina breast cancer survivors

PURPOSE/OBJECTIVES

To test the effectiveness of a bilingual education intervention to improve the quality of life (QOL) of Latina breast cancer survivors (BCSs) after completing primary treatment for breast cancer.

DESIGN

A two-group prospective, longitudinal, randomized, controlled trial.

SETTING

An ambulatory-care setting of a designated comprehensive cancer center in southern California.

SAMPLE

52 English- and Spanish-speaking Latina BCSs.

METHODS

Women were randomly assigned to the experimental or attention control group and completed measures of QOL, uncertainty, distress, and acculturation at baseline, and at three and six months postintervention.

MAIN RESEARCH VARIABLES

QOL, uncertainty, and distress.

FINDINGS

After controlling for acculturation, the four dimensions of QOL increased slightly in the groups or remained unchanged without significant group-by-time interaction. The social and psychological well-being subscales had the lowest scores, followed by physical and spiritual well-being. Although the group-by-time interaction was not statistically significant, the post-hoc difference for total QOL between time 2 and time 3 in the experimental group approached significance, with a slight increase in total QOL.

CONCLUSIONS

Latina BCSs have multiple survivorship and QOL concerns that might put them at risk for poor QOL.

IMPLICATIONS FOR NURSING

More culturally congruent intervention studies are needed to address the paucity of intervention research with Latina BCS.

KNOWLEDGE TRANSLATION

Core values must be incorporated in the development of health education programs. Those programs also should be linguistically appropriate and available to non-English-speaking Latinas. In this way, the informational and supportive needs of all BCSs can be met.

Korean Americans' prescription drug information seeking and evaluation and use of different information sources

This study examined Korean Americans' prescription drug information seeking, evaluation and use of different information sources, and communication with physicians, and compared the findings with those from the White American population. The results suggest that although Korean and White Americans were similar in extent of drug information seeking, Korean Americans tended to experience relatively greater difficulty finding information. Regarding perceived source usefulness, Korean Americans were significantly more likely to perceive higher usefulness in mass media and direct-to-consumer advertising sources than were Whites. Korean Americans were also more likely to use fewer sources, and less likely to use mass media and printed materials in drug information seeking. However, the hypothesized in-group source preference by Korean Americans was not found.

Cultural health beliefs and health behaviors in Asian American breast cancer survivors: a mixed-methods approach

PURPOSE/OBJECTIVES

To explore the relationships between cultural health beliefs, acculturation, treatment-related decisions, the doctor-patient relationship, and health behaviors among Asian American breast cancer survivors (AABCS), and the contextual meaning of those relationships among Korean American breast cancer survivors (KABCS) and AABCS.

DESIGN

A mixed-methods triangulation design.

SETTING

Community- and hospital-based support groups and hospital cancer registries in California.

SAMPLE

206 AABCS were included in the quantitative phase, and two focus groups were conducted with KABCS (N = 11) during the qualitative phase.

METHODS

The quantitative phase used secondary data for AABCS. Standardized (i.e., cultural health beliefs, doctor-patient relationship, and acculturation) and newly developed instruments (i.e., health behaviors and treatment-related decisions) were used in the quantitative phase. An exploratory, descriptive, qualitative study of KABCS then was undertaken.

MAIN RESEARCH VARIABLES

Cultural health beliefs, acculturation, treatment-related decisions, the doctor-patient relationship, and health behaviors.

FINDINGS

Inter-intrapersonal health beliefs, doctor-patient relationship, and shared decision making were positively associated with adopting healthy lifestyle practices. Findings from the quantitative phase were explained further by the diverse themes that emerged in the KABCS focus groups.

CONCLUSIONS

This study provides new knowledge about cultural health beliefs and health behaviors among KABCS using a mixed-methods approach.

IMPLICATIONS FOR NURSING

The results highlight the need for greater attention to the cultural contexts of AABCS to promote healthy behaviors and recognition of the significant relationship between health professionals and breast cancer survivors.

The relationship between communication and health-related quality of life in survivorship care for Chinese-American and Korean-American breast cancer survivors

OBJECTIVE

The purpose of this study was (1) to compare family communication, decision support (i.e., supporting the patient in making decisions), self-efficacy in patient-physician communication (i.e., patients' confidence level in communicating with physicians), and health-related quality of life (HRQOL) between Chinese-American and Korean-American breast cancer survivors (BCS) and (2) to investigate how family communication, decision support, and self-efficacy in patient-physician communication influence HRQOL for Chinese-American and Korean-American BCS.

METHODS

A cross-sectional design was used. A total of 157 Chinese-American (n = 86) and Korean-American (n = 71) BCS were recruited from the California Cancer Surveillance Program and area hospitals in Los Angeles County. The chronic care model was utilized.

RESULTS

Chinese-Americans and Korean-Americans showed a significant difference in the decision support only. Self-efficacy in patient-physician communication was directly associated with HRQOL for Chinese-Americans, whereas for Korean-Americans, family communication was related to HRQOL. The mediating effects of decision support and self-efficacy in physician-patient communication in the relationship between family communication and HRQOL were observed for Chinese-Americans only. Multiple group analysis demonstrated that the structural paths varied between Chinese-American and Korean-American BCS.

CONCLUSIONS

Our results provide insight into the survivorship care of Chinese-American and Korean-American BCS, allowing a better understanding of communication among survivors, family, and healthcare providers. Communication skills to manage conflict and attain consensus among them under the cultural contexts are essential to improve HRQOL for BCS.

Through the lens of culture: quality of life among Latina breast cancer survivors

Latinas have lower quality of life than Caucasian cancer survivors but we know little about factors associated with quality of life in this growing population. Bilingual staff conducted interviews with a national cross-sectional sample of 264 Latina breast cancer survivors. Quality of life was measured using the Functional Assessment of Cancer Therapy-Breast (FACT-B). Regression models evaluated associations between culture, social and medical context and overall quality of life and its subdomains. Latina survivors were 1-5 years post-diagnosis and reported a lower mean quality of life score compared to other published reports of non-Latina survivors (M = 105; SD = 19.4 on the FACT-B). Culturally based feelings of breast cancer-related stigma and shame were consistently related to lower overall quality of life and lower well-being in each quality of life domain. Social and medical contextual factors were independently related to quality of life; together cultural, social and medical context factors uniquely accounted for 62 % of the explained model variance of overall quality of life (Adjusted R (2) = 0.53, P < 0.001). Similar relationships were seen for quality of life subdomains in which cultural, social, and medical contextual variables independently contributed to the overall variance of each final model: physical well-being (Adjusted R (2) = 0.23, P < .001), social well-being (Adjusted R (2) = 0.51, P < 0.001), emotional well-being (Adjusted R (2) = 0.28, P < 0.001), functional well-being (Adjusted R (2) = 0.41, P < 0.001), and additional breast concerns (Adjusted R (2) = 0.40, P < 0.001). Efforts to improve Latinas' survivorship experiences should consider cultural, social, and medical contextual factors to close existing quality of life gaps between Latinas and other survivors.

Navigating the advanced cancer experience of underserved Latinas

OBJECTIVE

Previous cancer research does not adequately inform us about the experiences of managing a more serious, life-threatening cancer condition, especially for underserved Latinas. This study was designed to explore the ways in which Latinas navigate through and deal with advanced cancers.

METHODS

A purposive sample of 24 underserved Latina women was selected from a randomized controlled trial. Data were analyzed using a phenomenological approach to explore navigation of the advanced cancer experience.

RESULTS

This study outlines a conceptual framework which denotes the interconnectedness of multiple factors that influence the cancer experience for Latina women. Experiences with advanced cancer were embedded within a social, cultural, and systemic framework described as 1) intrapersonal experiences; 2) interpersonal experiences; 3) provider interactions; and 4) medical system factors.

CONCLUSIONS

This study indicates that underserved Latinas face complex circumstances that interfere with the diagnosis and treatment of cancer. However, women expressed positive attitudes and held beliefs about survival which helped them through their experience with cancer. The implication of these findings is that Latinas have protective attitudes and beliefs that help them to overcome "tragic" circumstances. Providers need to become aware of the complexity of these issues in order to achieve competent, effective, and efficient practice in medical settings with Latinas.

A qualitative exploration of Malaysian cancer patients' perspectives on cancer and its treatment

BACKGROUND

Cancer patients' knowledge about cancer and experiences with its treatment play an important role in long-term adherence in their disease management. This study aimed to explore cancer patients' knowledge about cancer, their perceptions of conventional therapies and the factors that contribute to medication adherence in the Malaysian population.

METHODS

A qualitative research approach was adopted to gain a better understanding of the current perceptions and knowledge held by cancer patients. Twenty patients were interviewed using a semi-structured interview guide. A saturation point was reached after the 18th interview, and no new information emerged with the subsequent 2 interviews. All interviews were transcribed verbatim and analysed by means of a standard content analysis framework.

RESULTS

The majority of patients related the cause of their cancer to be God's will. Participants perceived conventional therapies as effective due to their scientific methods of preparations. A fear of side effects was main reasons given for delay in seeking treatment; however, perceptions were reported to change after receiving treatment when effective management to reduce the risk of side effects had been experienced.

CONCLUSIONS

This study provides basic information about cancer patients' perceptions towards cancer and its treatment. These findings can help in the design of educational programs to enhance awareness and acceptances of cancer screening. Priorities for future research should focus on patients who refused the conventional therapies at any stage.

English proficiency, symptoms, and quality of life in Vietnamese- and Chinese-American breast cancer survivors

CONTEXT

In the United States, limited English proficiency has been shown to have a negative influence on effective functioning in the health care environment. Minority immigrant populations, therefore, may be especially vulnerable to poorer symptom management and quality of life (QOL) during and after cancer treatment, given their limited language skills. Breast cancer is the most prevalent cancer in Asian-American women but little is known about its adverse consequences in this population.

OBJECTIVES

We examined the extent to which English proficiency was associated with symptoms and QOL in Chinese- (n = 72) and Vietnamese-American (n = 25) breast cancer survivors in Houston, Texas.

METHODS

Data were collected through face-to-face interviews. Symptoms and QOL were assessed using the Edmonton Symptom Assessment Scale and the Quality of Life Instrument-Breast Cancer Patient Version (QOL-BC), respectively.

RESULTS

The most commonly reported severe symptoms (≥ 7 on a 0-10 scale) were lack of well-being (38%), fatigue (26%), pain (18%), lack of appetite (14%), anxiety (14%), and feeling depressed (14%). For the QOL-BC, the physical (mean = 6.78; standard deviation [SD] = 1.28) and spiritual subscales (mean = 6.01; SD = 2.18) had the highest and lowest mean scores, respectively. Of the whole sample, 33% reported having the ability to understand, read, speak, and write in English very well. English proficiency was significantly associated with symptom distress (coefficient = -0.257; P = 0.011) and QOL (coefficient = -0.390; P = 0.002).

CONCLUSION

English proficiency has a significant impact on symptom distress and QOL. These findings may help the development of services to meet the unique needs of Vietnamese- and Chinese-American breast cancer survivors.

A contextual approach to understanding breast cancer survivorship among Latinas

OBJECTIVES

The purpose of this review is to describe the empirical literature on the health-related quality of life (HRQOL) in Latina breast cancer survivors by exploring the social determinants of health. In framing the key domains of survivors' quality of life within a ecological-contextual model that evaluates individual and societal contributions to health outcomes, we provide a comprehensive landscape of the diverse factors constituting Latina survivors' lived experiences and their resultant quality of life outcomes.

METHODS

We retrieved 244 studies via search engines and reference lists, of which 37 studies met the inclusion criteria.

RESULTS

Findings document the importance of the social determinants of HRQOL, with studies documenting ecological and contextual factors accounting for significant variance in HRQOL outcomes. Our review identifies a dearth of research examining community-, institutional-, and policy-level factors, such as health care access, legal and immigration factors, physical and built environments, and health care affordability and policies affecting Latina breast cancer survivors' HRQOL.

CONCLUSIONS

Overall research on Latina breast cancer survivorship is sparse, with even greater underrepresentation within longitudinal and intervention studies. Results highlight a need for clear documentation of the comprehensive care needs of underserved cancer survivors and interventions considering integrated systems of care to address the medical and ecological factors known to impact the HRQOL of breast cancer survivors.

Quality of life among Latina breast cancer patients: a systematic review of the literature

INTRODUCTION

The Latino population is the most rapidly growing ethnic minority in the United States and Latinas have higher rates of advanced breast cancer and more rigorous treatments than White women. However, the literature lacks reviews on quality of life among this population of breast cancer patients.

METHODS

A systematic review of the breast cancer quality of life (QOL) literature was conducted among studies that provided a comparison of mental, physical, social, or sexual QOL between Latinas and other racial/ethnic groups. Of the 375 studies reviewed, 20 quantitative studies and two qualitative studies met criteria for inclusion.

RESULTS

Latinas were more likely to report poor mental, physical, and social QOL, relative to non-Latinas. Only four studies assessed sexual QOL, making it difficult to draw any conclusions. Of these four QOL domains, the largest disparity was found in the area of mental health in which Latinas reported poorer QOL compared to non-Latina Whites and Blacks.

DISCUSSION/CONCLUSIONS

Most quantitative studies revealed either that Latinas consistently evidenced significantly lower QOL than non-Latinas on all measures (6 studies) or reported mixed findings in which Latinas generally demonstrated significantly worse QOL on most, but not all, measures (12 studies) included in the study. Explanatory mechanisms including socio-demographic, treatment-related, and culturally-relevant factors are discussed. Implications for research design, measurement, and clinical work are also included.

IMPLICATIONS FOR CANCER SURVIVORS

Although not entirely consistent, data suggest that Latina breast cancer survivors on average experience worse QOL than non-Latina Whites. Understanding ethnic differences in QOL among breast cancer survivors can inform interventions targeted at improving health status for Latinas.

Counternarratives of Mexican-origin women with breast cancer

Little is known about cancer health disparities among undocumented Latino immigrant populations, who represent a rapidly growing sector in the United States. Federal and state legislative reforms to control immigration have increased significantly over the past year. Although the effects of immigration reforms are being documented in housing, education, and public service industries, no data have been found examining the impact on the health of immigrant communities. In this article, we identify the consequences of recent immigration legislation enacted in Arizona, which has created barriers to accessing cancer treatment and continued follow-up care among a sample of Latina breast cancer survivors.