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Zheng, Lee, Zhou, and Li: Effects of Illness Perception and Health Beliefs on the Quality of Life of Breast Cancer Patients in the Yanbian Area of China
Original Article

Asian Oncol Nurs 2019;19(3):135-141.

Published online: 12 September 2019

DOI: https://doi.org/10.5388/aon.2019.19.3.135

Effects of Illness Perception and Health Beliefs on the Quality of Life of Breast Cancer Patients in the Yanbian Area of China

Fenshan Zheng1, Ogcheol Lee2, Jie Zhou, Chunyu Li

1Doctoral Student, Yanbian University, China

2Red Cross College of Nursing, Chung-Ang University, Seoul

3Graduate Student, Yanbian University, China

4School of Nursing, Yanbian University, China

Address reprint requests to: Chunyu Li School of Nursing, Yanbian University, 977, Gongyuan Road, Yenji City, Jilin Province, China Tel: +86-433-2436105 Fax: +86-433-2436105 E-mail: chyli@ybu.edu.cn

Received 1 July 2019       Revised 14 August 2019       Accepted 9 September 2019

Copyright © 2019 Korean Oncology Nursing Society

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

Abstract

Purpose

This study aimed to identify the effects of illness perception and health beliefs on the quality of life (QOL) of breast cancer patients.

Methods

A cross-sectional study was conducted. Data were collected using questionnaires administered to 200 patients admitted for chemotherapy after a partial or total mastectomy at a university hospital in Yanji City. The data were analyzed using t-tests, analysis of variance, Pearson's correlation coefficients, and hierarchical regression analysis.

Results

The QOL of the breast cancer patients was significantly correlated with health beliefs and a subfactor of illness perception. The significant factors influencing QOL were understanding illness and feeling threatened, accounting for 31.7% of the variance in QOL.

Conclusion

Illness perception of breast cancer patients had a negative influence on QOL, whereas health beliefs affected it positively. An implication of this study's findings is that interventions to reduce negative illness perception can improve the QOL among breast cancer patients.

Keywords: Breast neoplasms, Quality of life, Illness perceptions, Beliefs, China

References

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Table 1.
Illness Perception, Health Belief, and Quality of Life of Participants (N= 200)
Variables Range Min Max M ± SD
Illness perception 0∼80 24 69 46.72 ± 6.79
   Cognitive illness representations 0∼50 15 39 27.20 ± 3.98
   Emotional representations 0∼20 4 20 14.94 ± 2.98
   Illness understanding 0∼10 1 10 4.58 ± 2.37
Health belief 48∼240 89 231 187.83 ± 18.75
   Personal health belief 10∼50 17 50 40.46 ± 5.55
   Implementation ability 7∼35 14 35 28.69 ± 3.63
   Control ability 6∼30 7 30 23.58 ± 3.05
   Resource utilization 14∼70 32 70 53.40 ± 6.16
   Feel the threat 11∼55 11 55 41.97 ± 6.80
Quality of life 0∼100 28 63 49.36 ± 6.95
   Physical domain 0∼100 21 92 56.46 ± 12.49
   Psychological domain 0∼100 12 67 40.55 ± 11.94
   Social domain 0∼100 3 96 60.87 ± 17.0
   Common symptom & side-effect domain 0∼100 7 75 45.67 ± 12.39
   Specific domain 0∼100 7 96 41.11 ± 13.31
Table 2.
Differences of Illness Perception, Health Belief, and Quality of Life according to General Characteristics (N= 200)
Characteristics Categories n (%) or M ± SD Illness perception Health belief Quality of life
M ± SD t or F (p) M ± SD t or F (p) M ± SD t or F (p)
Age (yr) ＜40 31 (15.5) 47.55 ± 5.12 0.45 192.10 ± 9.89 a 5.82 52.52 ± 4.47 a 4.85
40∼49 70 (35.0) 46.27 ± 6.97 (.716) 193.51 ± 14.88 b (.001) 50.36 ± 6.53 b (.003)
50∼59 72 (36.0) 46.44 ± 6.98   182.94 ± 20.01 c b＞ a＞ c＞ d 47.76 ± 7.18 c a＞ b＞ c＞ d
≥60 27 (13.5) 47.63 ± 7.66   181.22 ± 26.01 d   47.41 ± 8.21 d  
  49.34 ± 9.01            
Race Han 106 (53.0) 47.40 ± 7.80 1.44 188.09 ± 19.48 0.02 48.09 ± 7.99 a 4.18
Korean 80 (40.0) 46.18 ± 5.65 (.239) 187.54 ± 18.76 (.978) 51.03 ± 5.27 b (.017)
Others 14 (7.0) 44.64 ± 3.41   187.50 ± 13.23   49.43 ± 5.05 c b＞ a
Marital status Married 158 (79.0) 47.13 ± 7.28 2.87 187.54 ± 20.20 0.18 48.68 ± 7.25 8.05
Others 42 (21.0) 45.14 ± 4.22 (.092) 188.93 ± 11.95 (.670) 52.10 ± 4.73 (.005)
Education Elementary 27 (13.5) 45.15 ± 7.19 a 1.97 170.41 ± 33.42 a 11.20 45.33 ± 8.86 a 4.90
Middle school 61 (30.5) 46.82 ± 6.58 b (.020) 187.75 ± 15.77 b (＜.001) 48.90 ± 6.79 b (.003)
High school 83 (41.5) 46.87 ± 5.91 c d d＞ c＞ b＞ a 191.77 ± 9.85 c d d＞ c＞ b＞ a 50.99 ± 5.66 c d c＞ b＞ a
≥ College 29 (14.5) 49.24 ± 8.68 d   192.93 ± 16.70 d   49.41 ± 7.35 d  
Living area City 124 (62.0) 47.60 ± 7.16 5.73 188.60 ± 17.04 0.54 49.93 ± 6.72 2.19
Rural 76 (38.0) 45.26 ± 5.91 (.018) 186.58 ± 21.31 (.461) 48.43 ± 7.26 (.141)
Job Yes 99 (49.5) 46.53 ± 6.56 0.15 191.02 ± 15.11 5.81 50.58 ± 6.36 6.15
No 101 (50.5) 46.90 ± 7.05 (.697) 184.70 ± 21.35 (.017) 48.17 ± 7.32 (.014)
Monthly income (Yuan) ＜1,000 66 (33.0) 47.32 ± 7.67 a b 4.38 185.82 ± 19.95 1.24 47.06 ± 7.81 a b 4.10
1,000∼2,000 65 (32.5) 45.42 ± 5.55 b c (.005) 186.46 ± 21.59 (.296) 50.80 ± 5.65 b c (.008)
2,000∼4,000 49 (24.5) 45.80 ± 4.60 c d d＞ c＞ b＞ a 192.14 ± 11.75   50.65 ± 6.15 c b＞ c
＞4,000 20 (10.0) 51.20 ± 9.77 d   188.35 ± 18.24   49.10 ± 8.03 b＞ a
Family history of breast cancer Yes 65 (32.5) 45.14 ± 3.04 5.30 190.49 ± 12.02 1.95 51.35 ± 5.32 8.21
No 135 (67.5) 47.47 ± 7.90 (.022) 186.55 ± 21.17 (.164) 48.40 ± 7.44 (.005)
Postoperative period (month) ＜1 57 (28.5) 48.82 ± 8.53 2.35 186.88 ± 20.00 a 3.21 46.84 ± 8.96 a 3.71
1∼3 83 (41.5) 46.01 ± 6.07 (.055) 190.41 ± 14.72 b (.014) 50.11 ± 6.10 b (.013)
3∼6 27 (13.5) 46.81 ± 5.37   190.00 ± 17.05 c c＞ a 49.71 ± 7.30 c b＞ a
≥6 33 (16.5) 44.76 ± 5.36   181.21 ± 25.04 d b＞ a 43.00 ± 7.02 d c＞ d
Economic burden Light 78 (39.0) 46.65 ± 6.33 0.01 189.58 ± 14.42 1.11 50.85 ± 6.36 5.99
Heavy 122 (61.0) 46.75 ± 7.10 (.919) 186.71 ± 21.04 (.293) 48.41 ± 7.17 (.015)
Payment method Pocket money 22 (11.0） 44.55 ± 2.50 1.10 193.00 ± 9.12 a 3.13 51.86 ± 4.19 a 4.78
Health insurance 83 (41.5) 47.46 ± 7.77 (.352) 186.67 ± 18.99 b (.027) 49.04 ± 7.43 b (.003)
Rural health services s 68 (34.0) 46.60 ± 6.27   184.41 ± 22.60 c d＞ c 47.62 ± 7.41 c d＞ c
Government subsidy y 27 (13.5) 46.48 ± 7.12   195.78 ± 6.90 d d＞ b 52.70 ± 3.87 d d＞ b
Number of chemotherapy 1∼2 68 (34.0) 47.88 ± 7.85 1.14 188.76 ± 17.87 1.85 48.97 ± 6.59 a 4.21
3∼4 84 (42.0) 45.94 ± 5.92 (.335) 190.17 ± 18.33 (.139) 51.04 ± 6.72 b (.007)
5∼6 30 (15.0) 46.77 ± 5.07   182.63 ± 17.87   47.87 ± 7.49 c b＞ a
≥6 18 (9.0) 45.83 ± 8.57   182.06 ± 23.64   45.50 ± 6.62  
Stage of disease Stage 1 28 (14.0) 48.04 ± 9.16 1.84 191.21 ± 14.09 0.74 47.89 ± 7.45 2.50
Stage 2 89 (44.5) 47.40 ± 7.45 (0.14) 185.81 ± 22.51 (.530) 48.36 ± 7.31 (.060)
Stage 3 62 (31.0) 45.95 ± 5.02   189.06 ± 16.41   50.98 ± 6.38  
Stage 4 21 (10.5) 44.29 ± 3.51   188.24 ± 11.91   50.76 ± 5.5  
Whether to keep breasts or not Yes 30 (15.0) 44.97 ± 4.21 2.35 192.90 ± 9.58 2.60 51.37 ± 5.26 2.97
No 170 (85.0) 47.02 ± 7.11 (0.13) 186.94 ± 19.82 (.108) 49.01 ± 7.16 (.086)
Table 3.
Correlations between Sub-factors of Illness Perception, Health belief, and Quality of Life (N= 200)
Variables 1 1–1 1–2 1–3 2 2–1 2–2 2–3 2–4 2–5 3 3–1 3–2 3–3 3–4 3–5
1. Illness perception 1                              
   1–1. Cognitive illness representation .79** 1                            
   1–2. Emotional representation .76** .36** 1                          
   1–3. Illness understanding .58* .15** .33** 1                        
2. Health belief .25** .21** .23** .06 1                      
   2–1. Personal health belief .17* .14** .13 .07 .82** 1                    
   2–2. Implementation ability .15** .17** .11 .01 .71** .66** 1                  
   2–3. Control ability .08 .01 .06 .14* .60** .45** .50** 1                
   2–4. Resource utilization .04 .02 .06 .00 .74** .47** .44** .41** 1              
   2–5. Feel the threat .34** .27** .43** –.01 .64** .31** .28** .19** .26** 1            
3. Quality of life –.05 .05 .09 –.32** .35** .23** .21** .16* .19** .41** 1          
   3–1. Physical domain –.04 –.06 –.03 .03 .16* .17* .27** .29** .17*- –.04 .35** 1        
   3–2. Psychological domain –.15* .10 .09 –.35** .33** .23** .12 .04 .18* .43** .72** .02 1      
   3–3. Social domain .04 –.08 .18* .01 .18* .13 .14 .19** .22**- –.50- –.01 .01 –.02 1    
   3–4. Common symptom/side effect domain –.12 –.05 –.04 –.20** .13 .08 .07 .07 .06 .10 .59** .04 .49**- –.13 1  
   3–5. Specific domain .05 .10 .13 –.20** .15* .07- –.01 –.02 .01 .36** .71** .02 .40**- –.20** .31** 1

* p＜.05,

** p＜.01.

Table 4.
Variables Influencing on Quality of Life of Participants
Variables Model 1 Model 2 Model 3
β (p) β (p) β (p)
Age –.23 (.012) –.18 (.030) –.16 (.057)
Marital status .18 (.011) .14 (.035) .12 (.063)
Job –.13 (.129) –.15 (.083) –.05 (.554)
Postoperative period –.06 (.409) –.10 (.129) –.01 (.883)
Family history of breast cancer –.10 (.151) –.04 (.564) –.01 (.842)
Emotional representation   .19 (.009) .05 (.542)
Illness understanding   –.38 (＜.001) –.33 (＜.001)
Personal health belief     .05 (.590)
Implementation ability     –.00 (.993)
Control ability     .07 (.388)
Resource utilization     .01 (.848)
Feel the threat     .31 (＜.001)
F (p) 3.51 (＜.001) 5.15 (＜.001) 5.38 (＜.001)
R2 (Adj. R2) .20 (.141) .31 (.251) .39 (.317)
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