Theory Derivation: Adaptation of a Contextual Model of Health Related Quality of Life to Rural Cancer Survivors

Rural Living as Context: A Study of Disparities in Long-Term Cancer Survivors

“…Research showing poorer rural HRQOL than urban HRQOL among cancer survivors (Miles, Proescholdbell, & Puffer, 2011;Wallace et al, 2010;Weeks et al, 2006) leads one to expect that those living in the most rural settings would Aaronson et al, 1993;Rosenberg, 1989;Weinert, 2003. fare worst on HRQOL metrics; the authors' results, however, run counter to this expectation, with those in the most remote area (RUCC 9) reporting better social functioning, fewer symptoms, and fewer financial difficulties than those in RUCCs 7 and 8. The significant difference in HRQOL between RUCCs supports Pedro's (2010) theoretical assumption concerning rurality as a defining factor in HRQOL. The HRQOL differences between RUCCs 7 and 9 likely point to the uniqueness (e.g., tight-knit community networks, limited health resources, vast distances) of rural life on cancer survivorship.…”

“…Rural women culturally rely on family and social activities to feel better (Leipert & Reutter, 2005). Viewing culture as a way of life in a group of people with accompanying beliefs, values, and practices (Kagawa-Singer, 2000) permits consideration of rurality as a culture (Eberhardt & Pamuk, 2004;Leipert & George, 2008) and, therefore, a factor to include in HRQOL outcome evaluation, just as ethnic culture is (Pedro, 2010;Vanderboom & Madigan, 2007). Survivors identify family and social support as important to QOL (John, 2010;Pedro, 2001), which may be particularly relevant for rural survivors, serving as partial explanation for better HRQOL in RUCC 9 survivors compared to those in RUCCs 7 and 8.…”

“…The model was predicated on cancer survivors in general. Three assumptions supported an adaptation of this model for rural cancer survivors: (a) rurality is a defining factor of HRQOL for rural cancer survivors at the macro and micro levels, (b) HRQOL predictors vary across levels of rurality, and (c) rurality as culture must be factored into health outcomes among rural cancer survivors (Pedro, 2010). The current study explored aspects of those theoretical assumptions and HRQOL for rural cancer survivors.…”

“…Survivors in predominantly urban areas report psychological and social HRQOL concerns; they report self-esteem and social support as HRQOL-influencing factors (Pedro, 2001;Wyatt & Friedman, 1996). Selfesteem is reported to influence the cancer adjustment process (Bettencourt, Molix, Talley, & Westgate, 2007;Pedro, 2010;Weinert, Cudney, Comstock, & Bansal, 2011), and social support and self-esteem correlate positively (Dirksen, 2000;Evans, Thompson, Browne, Barr, & Barton, 1993;Pedro, 2010). Research examining the impact of social support and self-esteem on rural survivor HRQOL can extend understanding of these variables in the survivor population.…”

A contextual approach to understanding breast cancer survivorship among Latinas

“…The Contextual Model of HRQOL includes multiple dimensions: socio‐ecological, cultural, demographic, health care system, cancer‐related medical factors, general health and comorbidity, health care practices, and psychological . Although Ashing–Giwa's Contextual Model incorporates both individual (micro) and systemic (macro) levels , McLeroy et al's (1988) Ecological Model enhances specificity by delineating levels of influences (e.g., community, institutional). The Ecological Model is an approach that outlines how multiple levels of influence interact to determine health .…”