A cultural health belief model to understand health behaviors and health-related quality of life between Latina and Asian-American breast cancer survivors

Background and Purpose: Health behaviors and life style changes may be tied to whether or not individuals believe that behavior changes can affect cancer outcomes. Additionally, health behaviors and health-related quality of life (HRQOL) may be influenced by the unique culture, which is a major determinant of how people understand, interpret, and respond to their experiences. However, there is minimal research on how cultural factors including cultural health beliefs influence health behavior changes and HRQOL among BCS, and more specifically among Latina and Asian-American women. The purpose of this study is twofold: (1) to estimate cultural factors influencing health behaviors and health-related quality of life (HRQOL) for Latina and Asian-American BCS; and (2) to compare pathways for predicting health behavior and HRQOL between the two groups.

Methods: Secondary data derived from 389 Latina (N=183) and Asian-American (N=206) who participated in a project examining HRQOL for BCS were used for this study. To identify HRQOL, physical and mental health well-being scores were adapted from a standardized FACT-G measure. Health behaviors (e.g., eating, exercise, complementary/alternative medicine, and stress management), cultural health beliefs, acculturation, doctor-patient relationship, and treatment-related decision were measured using a self-report instrument. The Health Belief Model (HBM) and the Contextual model of HRQOL offer a viable framework for examining these associations and possible predictor models.

Results: Both emotional (t=-3.541; p < 0.001) and physical (t=-3.876; p < 0.001) well-being scores for Asians were better than those for Latinas. Latinas were more likely to have changed their life styles after cancer treatments than Asians (t=2.458; p < 0.05), however, Asians were more likely to indicate increases in their physical activity levels (t=-3.974; p <0.001) and stress management (t=-3.024; p < 0.01) than Latinas. Confirmatory factor analyses demonstrated a factor model of cultural health belief (x2 (7) = 6.044; p = 0.535), indicating the adequacy of two latent factors ‘powerful others' and ‘socio-cultural factors'. Multiple group analysis found the factor model to be equivalent across the two ethnic groups (Äx2 (17) = 13.837; p =0.054). However, the predicted relationships among the variables were not equivalent across the two ethnic groups (Äx2(17) = 89.674; p =0.000), suggesting variations in the structural paths between Latina and Asian-American BCS. For example, for Latinas, the doctor-patient relationship was positively related to exercise, and in turn influenced physical and emotional well-being. For Asian-Americans, treatment decisions and ‘socio-cultural factor' was significantly related to stress management.

Conclusions and Implications: This study benefits the existing literature in that no study has focused on the impact of cultural health beliefs and cultural factors on health behaviors and QOL between Asian and Latina BCS. Evidence that Latinas and Asian Americans in the patterns of cultural factors influencing health behaviors and HRQOL might lead to the development of culturally sensitive breast cancer interventions to promote positive health behavior patterns and ultimately increase HRQOL.