The Influence of Spiritual Well-Being, Self-Esteem, and Perceived Social Support on Post-Traumatic Growth among Breast Cancer Survivors

Eun Young Seo; Suhye Kwon

doi:10.5388/aon.2018.18.4.232

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Seo and Kwon: The Influence of Spiritual Well-Being, Self-Esteem, and Perceived Social Support on Post-Traumatic Growth among Breast Cancer Survivors

Original Article

Asian Oncol Nurs 2018;18(4):232-240.

Published online: 5 December 2018

DOI: https://doi.org/10.5388/aon.2018.18.4.232

The Influence of Spiritual Well-Being, Self-Esteem, and Perceived Social Support on Post-Traumatic Growth among Breast Cancer Survivors

Eun Young Seo¹, Suhye Kwon²

¹Department of Nursing, SAEGYARO Hospital, Busan, Korea

²College of Nursing, Kosin University, Busan, Korea

^∗ This article is a revision of the first author's master's thesis from College of Nursing, Kosin University.

Address reprint requests to: Kwon, Suhye College of Nursing, Kosin University, 262, Gamcheon-ro, Seo-gu, Busan 49267, Korea Tel: +82-51-990-3979 Fax: +82-51-990-3970 E-mail: 113009@kosin.ac.kr

Received 30 Sep 201814 Dec 2018 Accepted 20 Dec 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License (http://creativecommons.org/licenses/by-nd/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Purpose

The purpose of this study was to identify the influence of spiritual well-being, self-esteem, and perceived social support on post-traumatic growth in breast cancer survivors in Korea.

Methods

Data were collected from March 2 to October 31, 2016 using self-reporting questionnaires from 126 breast cancer survivors who had visited outpatient clinics for follow-up in B city. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson's correlation coefficient, and stepwise multiple regression.

Results

Post-traumatic growth was significantly correlated with spiritual well-being (r=.52, p<.001), self-esteem (r=.54, p<.001), and perceived social support (r=.47, p<.001). In a stepwise multiple regression, spiritual well-being (β=.26, p<.001), self-es-teem (β=.23, p<.001), perceived social support (β=.21, p<.001), and presence of spouse (β=.20, p<.001) were associated with post-traumatic growth. These factors attributed to 37.0% of the total variance in post-traumatic growth in breast cancer survivors.

Conclusion

Considering the results of this study, it is necessary to develop and implement effective nursing strategies that can improve spiritual well-being, and to develop a holistic nursing intervention that takes into account self-esteem, perceived social support, and spousal help, when applicable, in order to promote post-traumatic growth in breast cancer survivors in Korea.

Keywords: Spirituality, Self Esteem, Social Support, Post-traumatic Stress Disorders, Breast Neoplasms

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Table 1.

Demographic and Clinical Characteristics of the Participants (N =126)

Characteristics	Categories	n (%) or M ± SD
Age (year)		51.3 ± 9.12
	≤ 40	13 (10.3)
	40~49	42 (33.3)
	50~59	43 (34.2)
	≥ 60	28 (22.2)
Education level	Elementary school	6 (4.8)
	Middle school	14 (11.0)
	High school	70 (55.6)
	≥ College	36 (28.6)
Partner	Yes	95 (75.4)
	No	31 (24.6)
Children (person)	No	13 (10.3)
	1	25 (19.8)
	2	71 (56.4)
	3	17 (13.5)
Religion	Yes	85 (67.5)
	No	41 (32.5)
Occupation	Yes	87 (69.0)
	No	39 (31.0)
Perceived economic	Low	21 (16.7)
condition	Moderate	81 (64.3)
	High	24 (19.0)
Diagnosis (stage)	0	12 (09.5)
	1	46 (36.5)
	2	48 (38.1)
	3	20 (15.9)
Treatment form	Op.	12 (09.5)
	Op.+CT	53 (42.1)
	Op.+R	6 (4.7)
	Op.+CT+R	55 (43.7)
Treatment period		6.8 ± 3.29
(month)	≤ 6	44 (34.9)
	6~11	76 (60.3)
	≥ 12	6 (4.8)
Perceived	Healthy	84 (66.7)
health status	Moderate	36 (28.6)
	Not healthy	6 (4.7)
Self-help group experi-	Yes	26 (20.6)
ence	No	100 (79.4)
Op.= Operation; CT= Chemotherapy; R= Radiation.

Table 2.

Degree of Spiritual well-being, S Self-esteem and Perceiv ved Social Support on Post-traumatic c Growth (N =126)

Variables (Item number)	M ± SD	Min~Max	M ± SD	Skewness	Kurtosis
Spiritual well-being (20)	58.98 ± 10.27	0.35~8.00	2.94 ± 0.51
Existential wellbeing (10)	30.55 ± 4.51	0.19~0.40	3.05 ± 0.45	0.182	-0.652
Religious wellbeing (10)	28.42 _± 6.97	0.15~0.40	2.84 _± 0.69
Self-esteem (10)	38.69 _± 6.10	0.27~0.50	3.86 _± 0.61	0.041	-1.095
Perceived social support (12)	45.23 ± 9.75	0.12~0.60	3.96 ± 0.81
Family support (4)	15.92 ± 3.59	0.04~0.20	3.98 ± 0.89
Friend support (4)	14.88 ± 3.79	0.04~0.20	3.60 ± 0.94	-0.807	0.860
Significant others support (4)	14.88 ± 3.38	0.04~0.20	3.72 ± 0.84
Post-traumatic growth (16)	53.79 ± 14.26	0.15~0.80	3.36 ± 0.89
Changed perception of self (6)	21.24 _± 5.60	0.06~0.30	3.54 _± 0.93
Relating to others (5)	10.17 ± 3.06	0.03~0.15	3.39 ± 1.02	-0.269	-0.652
New possibilities (3)	16.55 ± 4.89	0.02~0.25	3.31 ± 0.97
Spiritual change (2)	5.81 ± 3.00	0.00~0.10	2.90 ± 1.50

Table 3.

Differences of Post-traumatic Growth according to Participants’ Characteristics (N =126

Characteristics	Categories	M ± SD	t or F	p	Scheffé
Age (year)	≤ 40 40~49	50.46 ± 12.52	0.68	.579
	40~49	54.00 ± 14.35
	50~59	52.79 ± 13.47
	≥ 60	56.57 ± 16.19
Education level	Elementary school	54.16 _± 18.49	1.62	.186
	Middle school	51.85 ± 17.61
	High school	51.91 ± 14.03
	≥ College	58.13 ± 12.10
Spousal presence	Yes No	58.16 ± 12.8152.36 14.48	-1.98	.049
	No	52.36 ± 14.48
Children (person)	No ^a 1^b	61.61 ± 12.0653.08 _± 12.82	4.60	.004	c＜ d
	1 ^b ^c	53.08 _± 12.82
	2 ^c ^d	50.69 ± 13.76
	3 ^d	61.82 ± 15.62
Religion	Yes	56.28 ± 13.99	2.90	.004
	No	48.63 ± 13.58
Occupation	Yes No	55.28 ± 14.4653.12 14.21	0.78	.435
	No	53.12 ± 14.21
Perceived	Low	56.42 ± 13.99	3.49	.033	(-)
economic condition	Moderate	51.43 _± 14.96
	High	59.45 ± 9.85
Diagnosis (stage)	0	56.08 ± 13.59	0.59	.620
	1	53.13 ± 12.26
	2	52.52 ± 15.93
	3	57.00 ± 15.12
Treatment type	Operation	51.16 ± 13.57	0.21	.889
	Operation+Chemotherapy Operation+Radiation	54,52 _± 14.9052.00 16.34
	Operation+Radiation Operation+Chemotherapy+Radiation	52.00 ± 16.3453.85 13.87
	Operation+Chemotherapy+Radiation	53.85 ± 13.87
Treatment period	≤ 6	54.47 ± 13.77	0.12	.884
(month)	6~11	53.28 ± 14.50
	≥ 12	55.16 ± 17.08
Perceived	Healthy	54.07 ± 14.12	0.06	.936
health status	Moderate Not healthy	53.41 _± 14.1052.16 19.50
	Not healthy	52.16 ± 19.50
Self-help group experi-	Yes	54.19 ± 14.44	0.15	.874
ence	No	53.69 _± 14.29

Table 4.

Correlations among Spiritual well-being, Self-esteem, Perceived social support, and Post-traumatic growth (N =126)

Variables	Post-traumatic growth
Variables	r (p)
Spiritual well-being	.52 (＜.001)
Self-esteem	.54 (＜.001)
Perceived social support	.47 (＜.001)

Table 5.

Stepwise Multiple Linear Regression of Post-Traumatic Growth (N =126)

Variables	B	SE	^β	t	p	Adj. R²
(Constant)	.16	.44		0.36	.714
Spiritual well-being	.45	.16	.26	2.74	.007	.26
Self-esteem	.33	.15	.23	2.21	.029	.33
Perceived social support	.23	.10	.21	2.18	.031	.34
Spousal presence*	.41	.14	.20	2.76	.007	.37
	Adj.R²=.37, F₌19.86, p＜.001, Tolerance₌.459~.953, VIF₌1.049~2.180, Dubin Watson₌1.996

Dummy variable: Spousal presence (Yes= 1, No= 2).

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