Among Latina women breast cancer is the most commonly diagnosed cancer and it is the leading cause of cancer-related death. Latinas in the United States with breast cancer are at higher risk of psychological distress than other racial/ethnic groups, reporting higher rates of anxiety and depression, and worse health-related quality of life. These psychosocial health disparities among Latina cancer survivors may be attributable, in part, to the social environment. The social environment includes beliefs, attitudes, culture, relationships, institutions, neighborhood characteristics, and physical structures. The social environment broadly influences psychosocial health and behaviors by shaping social norms, providing resources and opportunities for health enhancing behaviors, and buffering negative psychosocial health outcomes. Latinas’ social environment will affect how they will cope with a breast cancer diagnosis and what resources they will call upon during this stressful event. This dissertation explores the role of the social environment or social context on Spanish-speaking Latinas’ breast cancer survivorship and identifies best practices and strategies to engage community organizations and build on a community’s strengths and resources as a way to sustain a psychosocial intervention created in response to Latina breast cancer survivors’ needs for a culturally-linguistically appropriate psychosocial intervention.
Latina’s lived experiences are cumulative and their response to the social world is cumulative, both of which affect how a cancer diagnosis will affect an individual's psychological distress and utilization of coping resources. Little is known about how coping resources affects health in this population. The first paper examines through an ecological perspective, associations of coping resources with psychological distress among urban newly-diagnosed Spanish-speaking Latinas with breast cancer. Latinas with breast cancer are at higher risk of psychological distress than their White counterparts due to several social and cultural determinants. This paper found that at the intrapersonal-level, self-efficacy for coping with breast cancer treatment was associated inversely with health distress and anxiety, and coping confidence with general problems was associated inversely with health distress. At the interpersonal-level, having a sense of neighborhood cohesion was associated inversely with health distress. No organization/community-level resources were associated with health distress or anxiety.
Psychosocial inequities among Latina cancer survivors are often attributed to upstream factors such as job disruption, financial strain, lower income, worse access to healthcare and cancer treatments, and limited English proficiency. However, the effects of neighborhood cohesion on health-related quality of life among Latinas with breast cancer and whether these effects differ by rural versus urban setting have not been studied. The second paper explores associations between rural and urban residence and health-related quality of life, and whether these associations are moderated by financial strain and by low neighborhood cohesion among Latina breast cancer survivors. Overall, this paper found rural Latina breast cancer survivors reported better emotional, functional, and overall well-being than their urban counterparts. Greater financial strain and less neighborhood cohesion were associated with worse health-related quality of life on most domains regardless of rural/urban context.
Significant disparities exist in access to psychosocial interventions for rural Spanish-speaking Latinas with breast cancer. However, few evidence-based psychosocial interventions exist to promote health equity within this population. Psychosocial interventions are primarily offered in high-resource settings and delivered by trained healthcare providers. However, such interventions are limited in that they are rarely implemented in under-resourced settings. Alternate community settings for intervention delivery and other types of personnel need to be considered to increase access. The third paper uses multi-stakeholder perspectives and mixed methods to evaluate the implementation processes of a 10-week peer-delivered cancer support intervention, Nuevo Amanecer-II, in three rural community-based organizations. This paper demonstrated that using an equity implementation framework and a participatory research process was central to the successful implementation of Nuevo Amanecer-II intervention in three rural community settings with Spanish-speaking Latinas with breast cancer. The co-designed intervention was acceptable to both Spanish-speaking Latinas with breast cancer and practitioners with modest suggestions for improvement. Results from this paper provide best practices and strategies to inform future implementation efforts in rural community settings and improve Latina breast cancer related psychosocial outcomes.
