Hispanic Breast Cancer Survivors’ Perception of Health Affected by English-language Proficiency

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Newswise — SAN DIEGO — Hispanic breast cancer survivors who considered their English-language proficiency as limited were less likely to rate their own health as good, very good or excellent, according to data presented at the Fifth AACR Conference on The Science of Cancer Health Disparities, held here Oct. 27-30, 2012. However, the association between English-language proficiency and self-rated health was not found in women who had higher spiritual well-being, as measured by their sense of peace or meaning.

Self-rated health is a single-item question that asks people to rate their health on a scale of 1 to 5, with 1 being poor and 5 being excellent, according to the researchers.

“Even though it is a single-item question, in large epidemiological studies of mostly non-Hispanic white participants, it has been shown to be highly predictive of morbidity and mortality in chronic disease,” said Maria Garcia-Jimenez, a student at the University of California Berkeley/University of California San Francisco Joint Medical Program.

To examine the association between various acculturation measures, particularly English-language proficiency, and self-rated health, Garcia-Jimenez and colleagues conducted a secondary analysis of data from a telephone survey of 330 breast cancer survivors who identified themselves as Hispanic.

The average age of the women surveyed was 58.3 years. Nearly all of the women had been diagnosed with breast cancer within the past five years. About 40 percent of the women reported speaking English not at all, poorly or fairly well.

About 25 percent of the women self-rated their health as poor or fair. Those women who were proficient in English were more than twice as likely to rank their health as good, very good or excellent compared with women with limited English-language proficiency. The researchers then evaluated whether cancer “self-efficacy,” or an individual’s perception of their ability to manage the repercussions of their disease, attenuated these findings.

“We found that if women had greater cancer self-efficacy, the effect of language on self-rated health was eliminated,” Garcia-Jimenez said. “Regardless of their language ability, having a high cancer self-efficacy was associated with higher self-rated health.”

In addition, researchers examined two elements of spiritual well-being, faith and sense of peace/meaning, and their effects on self-rated health. Data indicated that faith was not associated with English-language proficiency or self-rated health, but the sense of peace/meaning was highly associated with self-rated health, according to Garcia-Jimenez.

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ABSTRACT:The effect of language on the self-rated health of Latina breast cancer survivors: Cancer self-efficacy and spiritual well-being as potential mediators of this association. Maria DeLourdes Garcia-Jimenez1, Jasmine Santoyo-Olsson2, Carmen Ortiz3, Anna M. Napoles2. 1UC Berkeley-UC San Francisco Joint Medical Program, Berkeley, CA, 2University of California San Francisco, San Francisco, CA, 3Circulo de Vida, San Francisco, CA.

Purpose of study: The study aim was to assess associations between various acculturation measures and self-rated health (SRH), as well as potential mediation by spiritual well-being and cancer self-efficacy of any associations.Experimental procedure: Secondary analysis of data from a cross-sectional telephone survey of a population-based registry sample of 330 self-identified Latina breast cancer survivors was conducted. Multivariate logistic regression models assessed relationships between acculturation measures (i.e., the Short Acculturation Scale for Hispanics (SASH), country of birth (foreign or U.S. born), and English proficiency (main predictor)) and SRH (outcome). The role of cancer self-efficacy (measured with a version of the Cancer Behavior Inventory CBI-B) and spiritual well-being subscales (Sense of Peace/Meaning and Faith) of the Functional Assessment of Chronic Illness Therapy as mediators was also assessed in multivariate logistic regression models.New Data: The sample mean age was 58.3 years (range 30-90 years; SD 11.9), about 60% were foreign-born and approximately half were English proficient (EP, speaks English well/very well) vs. limited English proficient (LEP, speaks English not at all/poorly/fairly well). Approximately 70% were of Mexican origin, about 70% had a high school education or less, and two-thirds were privately insured. Almost all were 2-3 years post-diagnosis (283; 85.8%). The mean cancer self-efficacy score was 3.43 (SD 0.59; range 1-4). The mean sense of peace/meaning score was 26.6 (SD 5.31; range 0-32) and the mean faith score was 14.20 (SD 2.99; range 0-16). About one-quarter of the women reported poor or fair SRH. In unadjusted analyses of the acculturation measures, English proficiency demonstrated the strongest association with SRH; women who were EP were more likely than LEP women to rate their health as good/very good/excellent (OR= 2.26 CI= 1.15, 4.45, p<0.000). Country of birth and SASH scores were related to SRH at p<0.15. Greater cancer self-efficacy (OR= 2.24 CI= 1.22, 4.10, p<0.001) and sense of peace/meaning (OR= 3.00 CI= 1.66, 5.44, p<0.001) were associated significantly with better SRH; faith was not. In multivariate models English proficiency was associated significantly with SRH independent of other sociodemographic characteristics (OR=2.26; 95% CI 1.15, 4.45). Adding cancer self-efficacy to the model attenuated the effect of English proficiency on SRH (OR=1.76, 95% CI 0.87, 3.55), and self-efficacy was positively associated with SRH (OR=2.24, 95% CI 1.22, 4.10). In the final model, adding sense of peace/meaning was associated independently with SRH (OR= 2.44, 95% CI 1.30, 4.56) and attenuated the association of self-efficacy and SRH (OR=1.67, 95% CI 0.88, 3.18).Conclusion: The association of English proficiency with SRH was partially mediated by cancer self-efficacy and sense of peace/meaning, with the latter explaining much of the effect. Findings support development of interventions for Latina breast cancer survivors that target modifiable resiliency factors, like sense of peace/meaning or self-efficacy, to address racial disparities in quality of life (QOL) and SRH for Latina breast cancer survivors; particularly for those at risk of poorer QOL and SRH given English proficiency limitations.