Objective: Describe the role of resourcefulness as a mediator of information linked health disparities among Mexican-American women receiving breast cancer treatment.
Design: A randomized two group (Control and Intervention) by three occasions of measurement over seven months of breast cancer treatment experience (T1, early adjuvant therapy; T2, four months after T1; T3, three months after T2), blocked on age (< 50 years, > 50 years) and language preference (Spanish, English) was used.
Population,Sample,Setting,Years: The 165 Mexican-American women providing data for this analysis are a subset from two larger studies, one (1995-1998) testing the effectiveness of a nurse-delivered oncology support intervention with 300 older Mexican-American, African-American and Anglo women and the other (1996-1999) testing the effectiveness of the same intervention with 300 younger Mexican-American, African-American and Anglo women. North Carolina was the data collection site for younger and older African-American women and for older Anglo women. Arizona was the data collection site for younger and older Mexican-American women and for younger Anglo women.
Concepts,Variables,Intervention,Outcomes: The information linked health disparity variables are: how much women tell MD and tell RN, women’s satisfaction with information provided by RN, reading material provided about condition, level of knowledge necessary to manage condition, level of participation in planning treatment. The intervention strategy-linked proximal outcome is resourcefulness, defined as one’s level of problem-solving and cognitive reframing skills for reaching valued goals despite adversity. The distal outcome variable was help-seeking, defined and measured in terms of the number of health care resources accessed.
Methods: A repeated measures MANOVA was used to assess group (age, language preference) differences over time on the health disparity variables. A repeated measures MANOVA was used to test intervention effectiveness over time for the resourcefulness and help-seeking outcomes.
Findings: Health Disparity – At T1, during early adjuvant therapy and prior to initiation of the nurse-delivered oncology support intervention, Spanish-speaking women as compared to English-speaking women, regardless of age, talked less to their physician (F=12.3,df 1,155, p=.001) and were less satisfied with information received from the clinic nurses (F=9.5, df 1,141, p=.002) with reading materials provided about breast cancer (F=14.1, df 1,150, p=.0001) and with their level of knowledge necessary to manage their condition (F=18.1, df 1,155, p=.0001). However, across the seven months of breast cancer treatment experience these significant differences disappeared. At T1 older women as compared to younger women (F=13.7, df 1,150, p=.0001), regardless of language preference, and Spanish-speaking women as compared to English speaking women (F=12.2, df=1,150, p=.001), regardless of age, less often talked with the clinic nurse. Older women, regardless of language preference, reported less participation in helping to plan treatment (F=4, df1,155, p=.05). However, across the seven months of breast cancer treatment experience significant differences disappeared. Moreover, a significant time effect (F=4.7, df 2/154, p=.01) for all Mexican-American women, regardless of language preference or age was found for increased participation in helping to plan treatment. Intervention Outcomes – Although all Mexican-American women increased in resourcefulness over time, a significant Spanish by Intervention by Time effect (F=3.6, df 2/146, p=.03) demonstrated Spanish-speaking Mexican-American women, regardless of age, who were randomly assigned to the nurse-delivered oncology support intervention, increased the most in resourcefulness over the seven months of breast cancer treatment experience. And, although all Mexican-American women, regardless of age or language preference increased over time in help-seeking, those women randomly assigned to the intervention as compared to women in the Control group over time increased their help-seeking the most (F=5.7, df 2/156, p=.004). Women participating in the intervention added 3 resources over time as compared to less than one resource added over time for women in the control group.
Conclusions: Health disparities linked to information resources may be reduced over time by individuals’ use of problem solving and cognitive reframing resources as experience with an illness is gained over time. Interventions that strengthen individual resourcefulness may facilitate reduction of health disparity through individuals’ identification and use of a wider range of health care resources.
Implications: Health disparities linked to information resources need to be studied over time to allow for description of the role of individual resourcefulness as individuals learn through problem solving and cognitive reframing how to overcome information disparity.
Funding Source: NIH NCI 1RO1 CA64706, NIH NCI/NINR R01 CA57764
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