Relationships Between Socio-behavioral Factors and the Symptoms Among Asian American Breast Cancer Survivors: A Structural Equation Modeling

Overview

Journal Cancer Nurs

Specialties Nursing
Oncology

Date 2024 Apr 24

PMID 38656247

Authors

Seo Yun Kim

Heejung Kim

Wonshik Chee

Eun-Ok Im

Affiliations

Soon will be listed here.

Abstract

Background: Despite increased research on breast cancer survivors, little is known about how socio-behavioral factors influence the symptoms among racial/ethnic minority breast cancer survivors, particularly Asian American breast cancer survivors (AABCS).

Objective: This study examined the relationship between multiple socio-behavioral factors in AABCS, including attitudes, perceived barriers, and social influences, and their symptom experiences, with an emphasis on the mediating effect of self-efficacy.

Methods: This secondary analysis used data collected from 195 AABCS women recruited through online and offline communities from January 2017 to June 2020. Study variables were measured using validated instruments such as the Questions on Attitudes, Self-Efficacy, Perceived Barriers, and Social Influences; the Cancer Behavior Inventory; and the Memorial Symptom Assessment Scale-Short Form. For structural equation modeling based on Bandura's self-efficacy theory, mediation analysis was performed using SPSS version 26.0 and AMOS 28.

Results: The overall fitness of the hypothetical model to the data is acceptable (χ2 = 51.36, P < .001; goodness-of-fit index = 0.95, adjusted goodness-of-fit index = 0.89, comparative fit index = 0.96, Tucker-Lewis index = 0.94, normed fit index = 0.94, and root-mean-square error of approximation index = 0.08). Both attitudes and social influences indirectly influenced symptom distress through self-efficacy (β = -0.054, P = .019, and β = -0.053, P = .017, respectively). Perceived barriers had indirect effects through self-efficacy (β = 0.121, P = .024) and significant direct effects (β = 0.605, P = .003) on symptom distress.

Conclusions: Our findings supported that the self-efficacy for coping mediated their symptom experience among AABCS. In addition, there were significant relationships among attitudes, perceived barriers, social influences, and symptom experience.

Implications For Practice: Future theory-driven interventions need to consider self-efficacy and socio-behavioral factors in symptom management among AABCS.

References

Kurt S, Altan Sarikaya N . Correlation of self-efficacy and symptom control in cancer patients. Support Care Cancer. 2022; 30(7):5849-5857. DOI: 10.1007/s00520-022-06972-0. View

Merluzzi T, Nairn R, Hegde K, Martinez Sanchez M, Dunn L . Self-efficacy for coping with cancer: revision of the Cancer Behavior Inventory (version 2.0). Psychooncology. 2001; 10(3):206-17. PMC: 2945365. DOI: 10.1002/pon.511. View

Im E, Yi J, Kim H, Chee W . A technology-based information and coaching/support program and self-efficacy of Asian American breast cancer survivors. Res Nurs Health. 2020; 44(1):37-46. PMC: 9221258. DOI: 10.1002/nur.22059. View

Wen K, Fang C, Ma G . Breast cancer experience and survivorship among Asian Americans: a systematic review. J Cancer Surviv. 2013; 8(1):94-107. PMC: 3945715. DOI: 10.1007/s11764-013-0320-8. View

Ghannadi S, Amouzegar A, Amiri P, Karbalaeifar R, Tahmasebinejad Z, Kazempour-Ardebili S . Evaluating the Effect of Knowledge, Attitude, and Practice on Self-Management in Type 2 Diabetic Patients on Dialysis. J Diabetes Res. 2016; 2016:3730875. PMC: 4958437. DOI: 10.1155/2016/3730875. View

Im E, Kim S, Yang Y, Chee W . The efficacy of a technology-based information and coaching/support program on pain and symptoms in Asian American survivors of breast cancer. Cancer. 2019; 126(3):670-680. PMC: 6980184. DOI: 10.1002/cncr.32579. View

Chen C, Tang S, Chen C . Meta-analysis of cultural differences in Western and Asian patient-perceived barriers to managing cancer pain. Palliat Med. 2011; 26(3):206-21. DOI: 10.1177/0269216311402711. View

Mardanian-Dehkordi L, Kahangi L . The Relationship between Perception of Social Support and Fatigue in Patients with Cancer. Iran J Nurs Midwifery Res. 2018; 23(4):261-266. PMC: 6034531. DOI: 10.4103/ijnmr.IJNMR_63_17. View

Im E, Kim S, Lee C, Chee E, Mao J, Chee W . Decreasing menopausal symptoms of Asian American breast cancer survivors through a technology-based information and coaching/support program. Menopause. 2018; 26(4):373-382. PMC: 6435386. DOI: 10.1097/GME.0000000000001249. View

10.

Karimy M, Koohestani H, Araban M . The association between attitude, self-efficacy, and social support and adherence to diabetes self-care behavior. Diabetol Metab Syndr. 2018; 10:86. PMC: 6260748. DOI: 10.1186/s13098-018-0386-6. View

11.

Moghaddam Tabrizi F, Alizadeh S, Barjasteh S . Managerial Self-Efficacy for Chemotherapy-Related Symptoms and Related Risk Factors in Women with Breast Cancer. Asian Pac J Cancer Prev. 2017; 18(6):1549-1553. PMC: 6373813. DOI: 10.22034/APJCP.2017.18.6.1549. View

12.

Ziner K, Sledge G, Bell C, Johns S, Miller K, Champion V . Predicting fear of breast cancer recurrence and self-efficacy in survivors by age at diagnosis. Oncol Nurs Forum. 2012; 39(3):287-95. PMC: 5018900. DOI: 10.1188/12.ONF.287-295. View

13.

Cook S, Salmon P, Hayes G, Byrne A, Fisher P . Predictors of emotional distress a year or more after diagnosis of cancer: A systematic review of the literature. Psychooncology. 2018; 27(3):791-801. PMC: 5873392. DOI: 10.1002/pon.4601. View

14.

Bandura A . Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977; 84(2):191-215. DOI: 10.1037//0033-295x.84.2.191. View

15.

Tsai W, Nusrath S, Zhu R . Systematic review of depressive, anxiety and post-traumatic stress symptoms among Asian American breast cancer survivors. BMJ Open. 2020; 10(9):e037078. PMC: 7478010. DOI: 10.1136/bmjopen-2020-037078. View

16.

Yeung N, Lu Q . Social constraints and fear of recurrence among Chinese American breast cancer survivors: An exploration of psychosocial mediators. Psychooncology. 2021; 31(1):98-106. DOI: 10.1002/pon.5784. View

17.

Kwok W, Bhuvanakrishna T . The relationship between ethnicity and the pain experience of cancer patients: a systematic review. Indian J Palliat Care. 2014; 20(3):194-200. PMC: 4154166. DOI: 10.4103/0973-1075.138391. View

18.

Im E, Lee S, Liu Y, Lim H, Guevara E, Chee W . A national online forum on ethnic differences in cancer pain experience. Nurs Res. 2009; 58(2):86-94. PMC: 2668932. DOI: 10.1097/NNR.0b013e31818fcea4. View

19.

Fisher H, Winger J, Miller S, Wright A, Plumb Vilardaga J, Majestic C . Relationship between social support, physical symptoms, and depression in women with breast cancer and pain. Support Care Cancer. 2021; 29(9):5513-5521. PMC: 8919209. DOI: 10.1007/s00520-021-06136-6. View

20.

Im E, Chang S, Ko Y, Chee W, Stuifbergen A, Walker L . A national internet survey on midlife women's attitudes toward physical activity. Nurs Res. 2012; 61(5):342-52. DOI: 10.1097/NNR.0b013e31825da85a. View