Impact of Social and Religious Support on Health-related Quality of Life in Older Racial/ethnic Minority Women with Breast Cancer

Impact of Social and Religious Support on Health-related Quality of Life in Older Racial/ethnic Minority Women with Breast Cancer
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Published on 2008 by ProQuest

Older Latina and African-American women with breast cancer (BC) face multiple socio-structural disadvantages that may undermine health-related quality of life (HRQOL). This dissertation compared and contrasted the socio-structural and the 'cultural' perspectives to better understand psychosocial pathways to racial/ethnic disparities in HRQOL. According to the socio-structural perspective, disadvantaged groups not only may be more exposed to stressful life events, but also may be more vulnerable to the stressors because their stratified social structure may constrain and overburden their psychosocial resources such as social and religious support and psychological coping skills. On the other hand, the 'cultural' perspective suggests that racial/ethnic groups of color may have developed stronger psychosocial resources, out of necessity in response to negative social pressures, and these resources may be more salient to disadvantaged groups than to advantaged groups. In this dissertation, I compared the extent to which these two perspectives accounted for racial/ethnic differences in HRQOL among older African-American, Latina, and non-Hispanic white women with BC. To 'unpack' the epistemological and empirical complexity involved in the racial/ethnic gap of health outcomes and illuminate the role of agency in individuals within diverse racial/ethnic groups as opposed to structural constraints, this study used an analytical framework that illuminates the impact of racial/ethnic group membership on HRQOL as mediated through psychosocial resources. Statistical analyses controlled for the direct and indirect effects of socio-structural stratification as mediated through psychosocial resources. In this study sample, specific patterns of social and religious support for Latinas and religious support for African Americans were better explained by the 'cultural' thesis, rather than the socio-structural thesis. Compared to non-Hispanic Whites, being Latina had indirect salutary effects on HRQOL mediated through social and religious support and being African American had indirect salutary effect mediated through religious support. In contrast, professional support was explained by the socio-structural perspective and visit-specific social support did not mediate racial/ethnic disparities in professional support. Thus, both the socio-structural perspective and the 'cultural' perspective were necessary to more fully understand the differential impact of social, religious, and professional support on HRQOL in Latina and African-American women with BC. The two perspectives complementarily address the impact of the socio-structural disadvantages and the socio-cultural, active agency in Latina and African-American women. The use of both perspectives would help public-health practitioners develop more effective multi-level interventions that help racial/ethnic groups of color overcome socio-structural disadvantages and maintain their 'cultural' advantages.

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