Social Support Networks and Self-Efficacy of Peruvian Women Diagnosed with Cancer: A Biocultural Analysis of Health Behavior Constructs

Thesis (Ph.D.)--University of Washington, 2016-06

Objectives The primary goal of this dissertation research study was to contextualize health behavior psychological constructs such as self-efficacy and fatalism among cancer patients in Peru, identifying individual, social, cultural and structural factors that are associated with these constructs. The secondary goal was to identify areas for intervention to support women’s self-efficacy when facing a cancer diagnosis. Self-efficacy was considered the primary outcome, a proxy, or at a minimum strong mediator, for treatment continuation and adherence. Methods This study employed a mixed methods approach, including an egocentric social support network survey, cognitive interviews and focus groups. Latent analysis methods were used to explore the key domains of interest – self-efficacy, cancer fatalism, deprivation, social networks and social support. Qualitative analysis was employed to aid interpretation and explanation of survey findings. Results Women undergoing cancer treatment in Peru who participated in the study reported high self-efficacy, high social support, low fatalism and low SES. These findings were unsurprising given that women with cancer in Peru report facing many challenges regarding their illness, and it is likely that those who remain under treatment have found ways to mount sufficient personal and financial resources to overcome these challenges and to address their illness in a clinical setting. Despite the relative homogeneity of the sample, relationships between the main outcome, self-efficacy, and key domains of interest were largely found to be in agreement with the original study hypotheses. Specifically, social support and latent fatalism factors were associated with self-efficacy. Conclusion The findings of this study demonstrated that, in a setting where low-income women have access to cancer treatment, social support interventions may provide useful in supporting their ability to seek and continue with treatment. While family support was identified as critical especially at the moment of diagnosis, women reported a need for support from other patients who understood their experience and could help them achieve a sense of “new normal.” A key limitation to the study was that all participants were women under treatment; women diagnosed with cancer who did not seek, receive or continue treatment were not included in the sample, therefore the findings were not generalizable to the whole population of women with cancer in Peru. It may be that such a population-based sample would show even stronger relationships between the key domains. Furthermore, approaches from this survey may be adapted to design a screening tool for Peru’s cancer institute to help identify and intervene with high vulnerability women who may be at risk of loss-to-follow up even once diagnosed.