Health Promotion International Advance Access published April 15, 2015 Health Promotion International, 2015, 1–10 doi: 10.1093/heapro/dav023
Social support and coping means: the lived experiences of Northeastern Thai women with breast cancer Phensiri Dumrongpanapakorn1 and Pranee Liamputtong2,* 1
*Corresponding author. E-mail: [email protected]
Summary Social support plays a critical role in how women living with breast cancer deal with their diagnosis and treatment. This article discusses the meanings of breast cancer and the experiences of social support among women living with breast cancer in Northeastern Thailand (Isan). In-depth interviews were conducted with 18 women with breast cancer. Data were analysed using the thematic analysis method. Being diagnosed with breast cancer can be a traumatic experience. However, many women with breast cancer managed to deal with their illnesses and treatments and this was based largely on social support they received. Available support from family members, friends, neighbours, religion and health care professionals was essential for them to deal with their breast cancer. Social support was an important component for the provision of good care for these women and women living with breast cancer. Although medical treatments were essential for breast cancer, social support could enhance the effectiveness of the treatments as it helped women to have positive perspectives about their health conditions and to better deal with their illnesses. Our findings are useful for sensitive health promotion for women with breast cancer in Thailand and elsewhere. Social support should be modified to meet the woman’s individual needs. Health professionals are an important source of social support for women with breast cancer. Having an understanding and being sensitive to these women’s experiences and challenges means that health care professionals can provide more individualised support and care to women during their vulnerable period of life. Key words: social support, Northeastern Thai women, family members, religion
INTRODUCTION Being diagnosed with breast cancer often impacts on not only the women, but also their partners, children and extended family (Gass et al., 2007). Additionally, breast cancer diagnosis and treatment process is a ‘demanding’
process to both the women and their significant others [(Salonen et al., 2014), p. 274]. Most have to deal with fear and uncertainty about the outcomes of their treatments. At the same time, due to the conditions of treatment, they
© The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: [email protected]
Downloaded from http://heapro.oxfordjournals.org/ by guest on June 5, 2016
Research and International Relations, Boromarajonani College of Nursing Nakhon Phanom, Nakhon Phanom University, Nakhon Phanom, Thailand, and 2School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC 3086, Australia
2
SOCIAL SUPPORT: THEORETICAL FRAMEWORK This article is situated within social support theory. Generally, social support acts as a ‘buffer’ to diminish distress and strengthen resilience for individuals who experience stressful life events (Zhao et al., 2011; Drageset et al., 2012; Hoban and Liamputtong, 2013). According to Bloom et al., there are two distinct concepts of social support that most researchers have agreed upon (Bloom et al., 2001). First is the ‘structural support’ which refers to ‘the network of relationships’ which occurs between individuals and others including the relatives, friends, neighbours, and so on ( p. 1513). This network connects an individual to his/her group. The important aspect of this network is ‘being part of a system of mutual obligations and reciprocal relationships with individuals who have
common concerns’ ( p. 1514). According to Durkheim, interpersonal relations between individuals are critical for the health of people (Durkheim, 2002). It is also noted that having a larger network of friends and relatives is more important as one grows older (Bloom et al., 2001). The second aspect of social support is the ‘functional support’ and this includes tangible assistance, emotional support and information (Mbekenga et al., 2011). Tangible or instrumental support refers to specific assistances that others provide to the individual, such as financial assistance, household chores, childcare or provision of transport to medical appointments. Emotional support includes message or a clue which signifies that the individual is cared for, loved and valued. It has been suggested that the perception of the availability of tangible and emotional support is more critical than its actual occurrence (Drageset et al., 2012). Informational support conveys the provision of knowledge that is relevant to the situation that the individual is encountering (Bloom et al., 2001). Social support is linked with better health and quality of life in people living with breast cancer (Yoo et al., 2010). Specifically, social support helps to decrease stress associated with the diagnosis of breast cancer among the women, improve their emotional well-being and produces positive changes in their lives (Holland and Holahan, 2003; Bozo et al., 2009; Kim et al., 2010). In contrast, women who have insufficient social support have higher risk of psychosocial distress and depression, as well as cancer progression [(Drageset et al., 2012), p. E40].
METHODOLOGY This article is based on our larger project on the experiences of women living with breast cancer in Northeastern (Isan) Thailand. A qualitative approach is adopted because qualitative researchers accept that, to understand people’s experiences, we must attempt to understand the meanings and interpretations that people give to their experiences. This approach is particularly useful when we have little knowledge of the participants and their worldviews (Liamputtong, 2013). In this study, in-depth interviews were conducted with 18 Northeastern (Isan) Thai women. A purposive sampling technique (Liamputtong, 2013) was adopted; only Thai women living with breast cancer were approached to participate in the study. The participants were recruited through advertising on bulletin boards at hospitals where breast cancer treatments are offered and personal contacts made by the Thai coresearchers, who have carried out a number of research projects in nursing with Isan women. We directly contacted potential participants ourselves only after being introduced by our network or gatekeepers. Because of the
Downloaded from http://heapro.oxfordjournals.org/ by guest on June 5, 2016
become independent on other people (Burke et al., 2012). Thus, social support plays a critical role in how women living with breast cancer deal with their diagnosis and treatment (Kim et al., 2010; Yoo et al., 2010; Drageset et al., 2012). Yoo et al. suggest that the women needed different kinds of support to survive during the periods of diagnosis, treatment and post-treatment (Yoo et al., 2010). Research concerning breast cancer and social support is primarily based on quantitative methods that attempted to measure the relationship between social support and different outcomes including survival, depression and quality of life (Landmark et al., 2002). However, few studies have documented social support from the perspectives of women with breast cancer. Within the Thai context, there have been no studies that address the experience of breast cancer among Thai women living in Northeastern Thailand, particularly the experiences of social support among women with breast cancer. Yet, breast cancer is the most common cancer among Thai women (National Cancer Institute, Ministry of Public Health, 2009). Each year in Thailand ∼190 000 women are diagnosed with breast cancer. Breast cancer has also become a common health issue among Thai women in rural areas (National Cancer Institute, Ministry of Public Health, 2009). In this article, we explore the experiences of social support from other people among women with breast cancer who reside in Northeastern Thailand (Isan). In particular, we aim to contribute to knowledge by discussing the meanings of breast cancer and their experiences of social support during their breast cancer trajectory. Our findings can be useful for sensitive health promotion programmes for women with breast cancer in Thailand and elsewhere.
P. Dumrongpanapakorn and P. Liamputtong
3
Social support and coping means Table 1: Continued
Table 1: Socio-demography of Thai women (n = 18) Characteristics
7 4 5 2
Characteristics
No.
Chemotherapy Radiotherapy Currently being treated Yes No
16 4 16 2
18 13 2 2 1 1 16 1 5 2 1 9 1 1 4 10 3 14 2 2 14 1 3
sensitive nature of this study, we also relied on snowball sampling techniques; that is, our previous participants suggested others who were interested in participating. The number of participants was determined by a theoretical sampling technique, which is to stop recruiting when little new data emerge; this signifies data saturation (Liamputtong, 2013). The socio-demographic characteristics of the women are presented in Table 1. Interviews were conducted by the first author in the Northeastern Thai (Isan) dialect to maintain as much as possible the subtlety, and reveal any hidden meanings, of the participants’ statements (Liamputtong, 2010). Interviews were conducted at a place that the women felt most comfortable; often at their own homes. For this article, we used the following questions to prompt the women to talk with us: 1. 2. 3. 4. 5. 6.
15 3 5 7 1 5 9 8 1
18
Table continued
Please tell us how you felt when you were told that you have breast cancer. Please tell us about support that you have received (or not) during this period. What types of support did you receive, from whom, and in what form? How did you feel about this support? What type of support you felt that you were satisfied with (or not satisfied)? In your opinion, how could this be improved?
These questions were followed by other prompted questions to allow the women to articulate more on the issues. Prior to the commencement of the study, ethical approval was obtained from the Human Ethics Committee of Nakhon Phanom University. Before making an appointment for interviews, the participant’s consent to participate in the study was sought. After a full explanation of the study, the length of interviewing time and the scope of questions, the participants were asked to sign a consent form. Each interview took ∼1 to 2 h. With permission from the participants, interviews were tape-recorded. The tapes were then transcribed verbatim in Thai for data analysis. The transcripts did not contain the real name of our participants; we invented a fictitious
Downloaded from http://heapro.oxfordjournals.org/ by guest on June 5, 2016
Age 40–50 51–60 61–70 >71 Religion Buddhist Marital status Married Divorced Widowed Single mother Education level Lower than primary Primary Secondary Occupation Home duties Casual work Self-employed Farmer Retired government official worker Number of children None 1 2–3 >4 Family income (in baht)
Social support and coping means: the lived experiences of Northeastern Thai women with breast cancer Phensiri Dumrongpanapakorn1 and Pranee Liamputtong2,* 1
*Corresponding author. E-mail: [email protected]
Summary Social support plays a critical role in how women living with breast cancer deal with their diagnosis and treatment. This article discusses the meanings of breast cancer and the experiences of social support among women living with breast cancer in Northeastern Thailand (Isan). In-depth interviews were conducted with 18 women with breast cancer. Data were analysed using the thematic analysis method. Being diagnosed with breast cancer can be a traumatic experience. However, many women with breast cancer managed to deal with their illnesses and treatments and this was based largely on social support they received. Available support from family members, friends, neighbours, religion and health care professionals was essential for them to deal with their breast cancer. Social support was an important component for the provision of good care for these women and women living with breast cancer. Although medical treatments were essential for breast cancer, social support could enhance the effectiveness of the treatments as it helped women to have positive perspectives about their health conditions and to better deal with their illnesses. Our findings are useful for sensitive health promotion for women with breast cancer in Thailand and elsewhere. Social support should be modified to meet the woman’s individual needs. Health professionals are an important source of social support for women with breast cancer. Having an understanding and being sensitive to these women’s experiences and challenges means that health care professionals can provide more individualised support and care to women during their vulnerable period of life. Key words: social support, Northeastern Thai women, family members, religion
INTRODUCTION Being diagnosed with breast cancer often impacts on not only the women, but also their partners, children and extended family (Gass et al., 2007). Additionally, breast cancer diagnosis and treatment process is a ‘demanding’
process to both the women and their significant others [(Salonen et al., 2014), p. 274]. Most have to deal with fear and uncertainty about the outcomes of their treatments. At the same time, due to the conditions of treatment, they
© The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: [email protected]
Downloaded from http://heapro.oxfordjournals.org/ by guest on June 5, 2016
Research and International Relations, Boromarajonani College of Nursing Nakhon Phanom, Nakhon Phanom University, Nakhon Phanom, Thailand, and 2School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC 3086, Australia
2
SOCIAL SUPPORT: THEORETICAL FRAMEWORK This article is situated within social support theory. Generally, social support acts as a ‘buffer’ to diminish distress and strengthen resilience for individuals who experience stressful life events (Zhao et al., 2011; Drageset et al., 2012; Hoban and Liamputtong, 2013). According to Bloom et al., there are two distinct concepts of social support that most researchers have agreed upon (Bloom et al., 2001). First is the ‘structural support’ which refers to ‘the network of relationships’ which occurs between individuals and others including the relatives, friends, neighbours, and so on ( p. 1513). This network connects an individual to his/her group. The important aspect of this network is ‘being part of a system of mutual obligations and reciprocal relationships with individuals who have
common concerns’ ( p. 1514). According to Durkheim, interpersonal relations between individuals are critical for the health of people (Durkheim, 2002). It is also noted that having a larger network of friends and relatives is more important as one grows older (Bloom et al., 2001). The second aspect of social support is the ‘functional support’ and this includes tangible assistance, emotional support and information (Mbekenga et al., 2011). Tangible or instrumental support refers to specific assistances that others provide to the individual, such as financial assistance, household chores, childcare or provision of transport to medical appointments. Emotional support includes message or a clue which signifies that the individual is cared for, loved and valued. It has been suggested that the perception of the availability of tangible and emotional support is more critical than its actual occurrence (Drageset et al., 2012). Informational support conveys the provision of knowledge that is relevant to the situation that the individual is encountering (Bloom et al., 2001). Social support is linked with better health and quality of life in people living with breast cancer (Yoo et al., 2010). Specifically, social support helps to decrease stress associated with the diagnosis of breast cancer among the women, improve their emotional well-being and produces positive changes in their lives (Holland and Holahan, 2003; Bozo et al., 2009; Kim et al., 2010). In contrast, women who have insufficient social support have higher risk of psychosocial distress and depression, as well as cancer progression [(Drageset et al., 2012), p. E40].
METHODOLOGY This article is based on our larger project on the experiences of women living with breast cancer in Northeastern (Isan) Thailand. A qualitative approach is adopted because qualitative researchers accept that, to understand people’s experiences, we must attempt to understand the meanings and interpretations that people give to their experiences. This approach is particularly useful when we have little knowledge of the participants and their worldviews (Liamputtong, 2013). In this study, in-depth interviews were conducted with 18 Northeastern (Isan) Thai women. A purposive sampling technique (Liamputtong, 2013) was adopted; only Thai women living with breast cancer were approached to participate in the study. The participants were recruited through advertising on bulletin boards at hospitals where breast cancer treatments are offered and personal contacts made by the Thai coresearchers, who have carried out a number of research projects in nursing with Isan women. We directly contacted potential participants ourselves only after being introduced by our network or gatekeepers. Because of the
Downloaded from http://heapro.oxfordjournals.org/ by guest on June 5, 2016
become independent on other people (Burke et al., 2012). Thus, social support plays a critical role in how women living with breast cancer deal with their diagnosis and treatment (Kim et al., 2010; Yoo et al., 2010; Drageset et al., 2012). Yoo et al. suggest that the women needed different kinds of support to survive during the periods of diagnosis, treatment and post-treatment (Yoo et al., 2010). Research concerning breast cancer and social support is primarily based on quantitative methods that attempted to measure the relationship between social support and different outcomes including survival, depression and quality of life (Landmark et al., 2002). However, few studies have documented social support from the perspectives of women with breast cancer. Within the Thai context, there have been no studies that address the experience of breast cancer among Thai women living in Northeastern Thailand, particularly the experiences of social support among women with breast cancer. Yet, breast cancer is the most common cancer among Thai women (National Cancer Institute, Ministry of Public Health, 2009). Each year in Thailand ∼190 000 women are diagnosed with breast cancer. Breast cancer has also become a common health issue among Thai women in rural areas (National Cancer Institute, Ministry of Public Health, 2009). In this article, we explore the experiences of social support from other people among women with breast cancer who reside in Northeastern Thailand (Isan). In particular, we aim to contribute to knowledge by discussing the meanings of breast cancer and their experiences of social support during their breast cancer trajectory. Our findings can be useful for sensitive health promotion programmes for women with breast cancer in Thailand and elsewhere.
P. Dumrongpanapakorn and P. Liamputtong
3
Social support and coping means Table 1: Continued
Table 1: Socio-demography of Thai women (n = 18) Characteristics
7 4 5 2
Characteristics
No.
Chemotherapy Radiotherapy Currently being treated Yes No
16 4 16 2
18 13 2 2 1 1 16 1 5 2 1 9 1 1 4 10 3 14 2 2 14 1 3
sensitive nature of this study, we also relied on snowball sampling techniques; that is, our previous participants suggested others who were interested in participating. The number of participants was determined by a theoretical sampling technique, which is to stop recruiting when little new data emerge; this signifies data saturation (Liamputtong, 2013). The socio-demographic characteristics of the women are presented in Table 1. Interviews were conducted by the first author in the Northeastern Thai (Isan) dialect to maintain as much as possible the subtlety, and reveal any hidden meanings, of the participants’ statements (Liamputtong, 2010). Interviews were conducted at a place that the women felt most comfortable; often at their own homes. For this article, we used the following questions to prompt the women to talk with us: 1. 2. 3. 4. 5. 6.
15 3 5 7 1 5 9 8 1
18
Table continued
Please tell us how you felt when you were told that you have breast cancer. Please tell us about support that you have received (or not) during this period. What types of support did you receive, from whom, and in what form? How did you feel about this support? What type of support you felt that you were satisfied with (or not satisfied)? In your opinion, how could this be improved?
These questions were followed by other prompted questions to allow the women to articulate more on the issues. Prior to the commencement of the study, ethical approval was obtained from the Human Ethics Committee of Nakhon Phanom University. Before making an appointment for interviews, the participant’s consent to participate in the study was sought. After a full explanation of the study, the length of interviewing time and the scope of questions, the participants were asked to sign a consent form. Each interview took ∼1 to 2 h. With permission from the participants, interviews were tape-recorded. The tapes were then transcribed verbatim in Thai for data analysis. The transcripts did not contain the real name of our participants; we invented a fictitious
Downloaded from http://heapro.oxfordjournals.org/ by guest on June 5, 2016
Age 40–50 51–60 61–70 >71 Religion Buddhist Marital status Married Divorced Widowed Single mother Education level Lower than primary Primary Secondary Occupation Home duties Casual work Self-employed Farmer Retired government official worker Number of children None 1 2–3 >4 Family income (in baht)
