Factors Affecting Self-Efficacy in Caregivers of Latina Breast Cancer Survivors

Abstract

Introduction: Informal caregivers provide the bulk of care to individuals with chronic diseases, including cancer. There were 2.8 million informal caregivers of cancer survivors in the United States in 2015. Informal caregivers are vulnerable to poor physical and emotional consequences related to their caregiving role. Caregivers of Latina breast cancer survivors have additional risks related to social determinants of health, which may be attenuated through increased caregiver self-efficacy. Therefore, the purpose of this study is to evaluate a moderating model of self-efficacy in caregivers of Latina breast cancer survivors between acculturation, spiritual well-being, and social support and global health and depression. Conceptual Model: The theoretical framework for this project is grounded in Social Cognitive Theory (SCT) and is informed by Complex Adaptive Systems (CAS). Self-efficacy, from (SCT), is the belief in one’s ability to achieve a desired outcome. It is the anchor of the proposed model for caregivers of Latina breast cancer survivors. CAS provides a framework for this model due to the complexity of caregiver contexts and relationships, particularly those from minority groups. CAS concepts such as interactions, self-organization, and emergence provide a backdrop for the relationships between caregiver factors and health outcomes through the influence of self-efficacy. Methods: Secondary analysis was completed using data from a primary experimental study addressing a psychosocial intervention in Latina breast cancer survivors and their caregivers. Data were analyzed using SPSS for descriptive statistics and frequencies, correlational analysis, moderation analysis, and factor loading. Confirmatory factor analysis and path analysis were completed using AMOS. Results: A total of 233 participants were included in the analysis. Caregivers were primarily women, of Mexican-American or Latino ethnicity, and low-income. There were significant relationships between caregiver Anglo-orientation, informational support, self-efficacy symptom management, self-efficacy cancer knowledge, and health outcomes. In moderation analysis, self-efficacy for symptom management significantly moderated the relationship between informational support and depression. This moderating effect was also noted in path analysis. Additionally, self-efficacy cancer knowledge had a significant moderating effect on the relationship between Anglo-orientation and depression in simple moderating analysis, while self-efficacy symptom management in path analysis had a trend towards a significant moderating effect on the relationship between Anglo-orientation and global health. Conclusions and Implications: Caregivers of Latina breast cancer survivors are a unique caregiving population due to cultural norms that can serve as sources of strength and resilience along with social determinants of health that can contribute to poor health outcomes. Nurses and healthcare providers can support these caregivers more successfully by addressing cultural, spiritual, and informational needs. These factors, along with strategies to foster self-efficacy, may promote better health outcomes in caregivers of Latina breast cancer survivors.