An electronic coping-enhancement programme for bereaved women addressing psychosocial factors in breast-cancer development

Abstract

Conventional breast-cancer prevention strategies tend to focus on the reduction of physical breast-cancer risk factors while neglecting psychosocial factors potentially associated with its development. Yet, there is a wealth of evidence linking psychosocial factors such as the occurrence of and maladaptive coping with bereavement and other stressful life events, certain personality traits, and a lack of social support, to breast-cancer incidence, survival and mortality.This thesis aimed to design, implement and evaluate an electronic Coping-Enhancement Programme for the Bereaved (CEPB), addressing such psychosocial factors. Furthermore, participants’ experiences of the programme were to be explored. An experimental 2x2 independent measures design with triangulation was used, employing qualitative and quantitative methodology. Participants’ experiences were elicited qualitatively through blogs and message boards. The two independent variables were (1) emotional-expression-and-stress-reduction (EESR), and (2) psycho-education. Dependent variables were: (1) maladaptive coping with bereavement, (2) maladaptive coping with stressful life events, (3) social support, and (4) awareness of the connections between psychological and physical health. An additional dependent variable was conformity. A Web site containing message boards and blogs was created. Thirty-one women completed a psychological screening form and were then randomly assigned to one of four conditions (EESR-only, psycho-education-only, EESR-plus-pyscho-education, or the control group who received no intervention). They participated in online exercises designed to aid emotional expression and stress reduction (‘Art and Laughter for Wellbeing’) and/or received psycho-education through the reading of autobiographical accounts of breast-cancer sufferers. Participants were analysed on the dependent variables three times: before the programme to obtain a baseline measurement, after the programme, and at six-week follow-up. Thematic analysis was used to illustrate the process of the CEPB, as well as to confirm or disconfirm quantitative results. Analyses of covariance revealed that after the programme, taking part in ‘Art and Laughter for Wellbeing’ was associated with lower maladaptive coping with bereavement, while reading autobiographical accounts of breast-cancer sufferers was associated with lower maladaptive coping with stressful life events. Participation in both conditions was associated with higher levels of social support, and taking part in either condition was associated with lower levels of conformity. The latter effect persisted at follow-up. Mixed analyses of variance showed changes over time in three dependent variables. The CEPB was generally viewed as useful, helpful and enjoyable by participants. Implications for future research are discussed, and a biopsychosocial model of breast-cancer prevention is proposed.