Mexican-American Breast Cancer Survivors' Challenges with Health Care Disparities: A Mixed Method Study

Purpose: Coping is a challenge for breast cancer survivors and may result in a poor quality of life (QOL) even more than five years after completion of treatment. The primary purpose of this mixed method study was to examine culturally specific health disparities, and the effects of acculturation, optimism, and breast cancer challenges on coping styles and to determine the effect coping styles have on the QOL of Mexican American breast cancer survivors. The secondary purpose was to identify effective strategies to decrease healthcare disparities experienced by Mexican American breast cancer survivors

Methods: A one group ex post facto design with path analysis was used to determine the direct, indirect and total effects of the causal antecedents on coping and QOL. Ninety two subjects participated through a nonprobability, convenience sampling method. Qualitative non-structured interviews were used to gather additional data on Mexican American women’s experiences living with breast cancer and identification of culturally sensitive strategies to overcome barriers. Participant’s responses were recorded verbatim and subjected to content analysis and thematic coding.

Results: Path analysis revealed that women who had lower acculturation, were less optimistic about the future, experienced increased disparities and barriers to care, and had ongoing physical and psychological concerns about breast cancer. Although less optimism was associated with diminished QOL, neither active nor passive coping styles were associated with QOL for survivors. Familismo or the importance of family participation was a major theme in addressing on-going physical and psychological needs of Mexican American breast cancer survivors nine years after treatment.  Qualitative narrative analysis revealed the major domain of Surviving the Fight, with subthemes of Adapting my Lifestyle, Maintaining Hope, and Remaining Vigilant.  

Conclusion: Qualitative data confirmed the quantitative model variables as personal characteristics of acculturation and optimism strongly influencing QOL. Nurses in a variety of healthcare settings can use these findings to identify Mexican American breast cancer survivor’s at risk for reduced QOL and design culturally appropriate interprofessional care plans to coordinate their healthcare needs, increase post diagnostic care, and support efforts towards empowerment and autonomy.