An Ecological Study of Quality of Life in Low-Income Women

Institution: University of California, Los Angeles
Investigator(s): Yoshiko Umezawa, Ph.D. -
Award Cycle: 2008 (Cycle 14) Grant #: 14FB-0111 Award: $0
Award Type: Postdoctoral Fellowship
Research Priorities
Community Impact of Breast Cancer>Sociocultural, Behavioral, and Psychological Issues: the human side

Initial Award Abstract (2008)

Completion of treatment may leave breast cancer (BC) survivors with a decreased sense of security away from medical surveillance, as well as fear of recurrence, and physical limitations to deal with on their own. Although BC survivors in general populations are reported to have relatively good long-term health related quality of life (HRQOL), low-income women may have greater risk factors for poorer long-term HRQOL. Misconceptions and fatalism about cancer are highly prevalent among low-income populations, especially among racial/ethnic minorities, which may affect long-term HRQOL directly as well as indirectly through treatment decision-making and care-seeking behaviors. Further, minority low-income women often have suboptimal healthcare experiences due to discrimination, language barriers, and lack of skills to effectively communicate with healthcare providers, which may undermine treatment decision-making, care-seeking, and long-term HRQOL.

Based on an ecological approach, which acknowledges the socio-ecological contexts that affect health, this study will examine the extent to which individual cognitive factors—such as cancer beliefs and knowledge and patient self-efficacy in patient-physician interactions—and systemic barriers, such as institutional discrimination, may directly and indirectly predict HRQOL in a sample of multi-ethnic low-income women with BC. The study also will focus on the role of socio-ecological contexts such as neighborhood environment and community-level health services. To facilitate subsequent intervention planning, we will geographically evaluate the effects of community health services on individual cognitive knowledge and skills, perceptions of institutional discrimination, treatment received, follow-up care, and HRQOL using GIS (geographic information system) mapping technology. I also will conduct interviews with BC survivors, BC advocates, and health educators to explore socioeconomic, cultural, linguistic, and systemic barriers challenging health education in medically underserved communities. Both data sources, GIS analyses and qualitative interviews, will provide a comprehensive empirical foundation to designing effective interventions to betterment of HRQOL in low-income women with BC.

Based on an ecological model, the study addresses multilevel mechanisms that lead to poorer HRQOL in low-income women with BC, including individual cognitive factors (e.g., knowledge and beliefs), medical factors (e.g., treatment choices, follow-up care), neighborhood characteristics (e.g., ethnic segregation, rural residency), healthcare settings (e.g., ethnic and language concordance with providers), and community-level healthcare resources (e.g., cancer education resources). To facilitate translation of the scientific research findings into intervention program planning, the study will geographically identify community characteristics that may have an impact on health knowledge, attitudes, treatment received, receipt of follow-up care, and HRQOL outcomes.