“God Used a Lot of People to Encourage Me”: A Qualitative Exploration of Sources of Social Support in African American Breast Cancer Patients

Background and Purpose:  As the number of breast cancer survivors has grown, increasing attention has been paid to survivorship as an important stage on the cancer control continuum.  Social support is one psychosocial factor shown to provide health benefits among breast cancer survivors.  Less is known, however, about particular sources of social support among African American breast cancer survivors. The purpose of this study was to explore the sources and types of support among African American breast cancer survivors.

Methods:  In-person interviews were conducted with 15 married African American women in one urban area who were recruited from a larger randomized controlled trial of a culturally tailored narrative intervention. Demographic data were collected, and participants responded to questions from a semi-structured interview guide. Interview transcripts were coded independently by two trained coders using a codebook that was created based on the literature and supplemented with inductively derived codes. Both coders then discussed all transcripts and reached consensus on codes. A thematic analysis was conducted by analyzing patterns of codes across transcripts.

Results: At the time of interview, participants’ mean (SD) age was 60.2 (7.4). Participants were a mean 4.2 years (1.0) from enrollment in the parent study (shortly after diagnosis). Eight had early-stage cancer, 11 received breast-conserving surgery, and 7 received chemotherapy.  Participants reported receiving support from a range of sources including their faith and religion; family and friends; health professionals; their work; health communication resources; and other cancer survivors.  Religious support was mentioned by the majority of participants and included talking to church leaders, praying, accepting God’s will, and “believing” or “keeping the faith.”  Family support was also mentioned by a majority of participants; key family members included spouses, siblings (sisters in particular), and adult children.  Emotional support was especially important from family. Friends provided support in forms that included gifts, meals, social outings, and having conversations.  Health professionals such as doctors and nurses were described as providing informational support; strong communication skills were particularly valued from these professionals.  About half the participants reported using the internet to find support or seek information about cancer, and several participants reported their children helped them access such information.  Several people reported feeling supported at work or by coworkers.  Participants also reported receiving support from individual cancer survivors, cancer support groups, and cancer fundraising walks/runs.  In many cases, types of support were intertwined; many participants interpreted tangible support (e.g. help with chores) from family and close friends as emotionally supportive, and several participants felt emotionally supported when they received informational support (e.g. information about side effects) from doctors and other health professionals.

Conclusions and Implications: Social workers and others involved in survivorship care planning should assess African American breast cancer patients’ social context, encourage them to leverage existing sources of support, and provide referrals to resources for patients who are lacking in support. Online resources, support groups, and cancer-survivorship walks/runs may hold promise for providing culturally appropriate support for patients.