| Author: | Lar Aung Mar |
| Title: | Understanding self-management behaviours of breast cancer survivors in Myanmar : A mixed-methods study |
| Advisors: | Cheng, Eileen (SN) Ching, Shirley (SN) |
| Degree: | Ph.D. |
| Year: | 2024 |
| Subject: | Breast -- Cancer -- Patients -- Care -- Burma Self-care, Health Hong Kong Polytechnic University -- Dissertations |
| Department: | School of Nursing |
| Pages: | xxii, 286 pages : color illustrations |
| Language: | English |
| Abstract: | Background Despite the increasing recognition of the importance of self-management for breast cancer survivors (BCS), little research has been conducted in developing countries. To date, there is no published study addressing self-management of BCS in Myanmar. In view of unique socio-demographic and healthcare system factors in Myanmar, self-management and associated factors of BCS might be different. Research aim and objectives The aim of this doctoral study was to provide a comprehensive understanding of self-management behaviours and the associated factors among BCS in Myanmar. Specific research objectives includes: Research objectives 1. To examine the self-management behaviour adopted by BCS (quantitative); 2. To identify the relationship of socio-demographics, and self-efficacy, social support, fear of cancer recurrence (FCR), illness perception and self-management behaviours (quantitative); 3. To explore what BCSs do to self-manage, their goals and strategies to adopt to those sets of behaviour and the factor associated with self-management behaviours (qualitative); and 4. To compare quantitative and qualitative data on the self-management behaviours and the associated factors of self-management behaviours that BCSs practiced convergently or divergently from the integration of quantitative and qualitative data (Mixed methods). Methods A convergent mixed methods study design was chosen to address the aim of this study. This study was conducted in the Oncology Centers of four national hospitals in Myanmar, namely; Yangon General Hospital, Mandalay General Hospital, Nay Pyi Taw Hospital, and Taunggyi General Hospital. In this mixed methods study, the quantitative phase involved a cross-sectional survey aiming to investigate self-management behaviours and associated factors in BCS who had completed primary treatments within five years (objective 1 and objective 2). Descriptive statistics including frequency, percentage, mean, and standard deviations were used to describe sociodemographic and clinical characteristics and main study variables of the samples. To investigate correlates of self-management behaviours, univariate and multivariate analyses were adopted. Simultaneously in the qualitative phase of the study, a qualitative descriptive approach with individual in-depth interviews via telephone was employed in selected BCS (objective 3). Interview data was transcribed verbatim in Myanmar (Burmese) and analysed using directed content analysis. After collecting the quantitative and qualitative data concurrently, separate analysis of each data set was conducted. The findings from each dataset were merged and compared in the interpretation phase (objective 4). Results 158 BCS participated in the quantitative phase and the mean age was 49.32 years. The mean number of self-management behaviours among participants was 4.06 (range=2-5). Almost all the participants engaged in self-management behaviours including spiritual/religious practice (99.4%), diet (98.7%), followed by exercise (92.4%) and complementary and alternative medicine (89.2%). Support groups (20.9%) and psychological therapies (5.7%) were the least used. Belief in Buddhism (β =0.19, p=0.01), university or equivalent education (β =0.24, p=0.01), and time since completion of treatment (β = 0.17, p=0.02) are significantly associated with self-management behaviours. Self-efficacy, social support, fear of cancer recurrence, and illness perception were not significant associated factors (p>0.05). For the qualitative phase, 20 BCS completed the telephone interviews and the mean age was 47.40 years. Eight categories of self-management behaviours were emerged from the semistructured interview data of BCS: adjusting healthy diet, following doctors’ prescriptions, devoting to religious practice, engaging regular exercise, symptoms management, maintaining emotional well-being, utilising complementary and alternative medicine for maximising health, and thriving to improve body image. In addition, four categories including power of spirituality, availability of family support, influence of the healthcare system, knowledge and perception of breast cancer were found to be factors associated with self-management. Quantitative and qualitative data confirmed and expanded the understanding of the self-management behaviours and showed BCS frequently engaged in spiritual/religious practices, diet modification, and regular exercise, but less tending to seek psychological therapies. Areas of divergence between two data sets were discovered in support groups and complementary and alternative medicine use. Three self-management behaviours identified only in qualitative interviews included symptom management, coping with body image problems, and following doctors’ prescriptions. Furthermore, side-by-side comparison between quantitative and qualitative data only generated a consistent finding that belief in Buddhism was positively associated with self-management behaviours. Conclusions This mixed-methods study demonstrated that BCS engaged in multiple self-management behaviours, with spiritual/religious practices being the most commonly used one and socio-culturally specific to Myanmar. Furthermore, the study not only confirmed the positive association of belief in Buddhism with self-management behaviour, but also identified an array of influencing factors at the individual, family and healthcare system levels. Having a comprehensive understanding of self-management behaviours and influencing factors among BCS in Myanmar may assist healthcare providers to better prepare women for the survivorship period. The study findings could also enable policymakers to design and implement appropriate self-management support intervention aimed at promoting their quality of life in future. |
| Rights: | All rights reserved |
| Access: | open access |
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