Relationships Between Socio-behavioral Factors and the Symptoms Among Asian American Breast Cancer Survivors A Structural Equation Modeling

Background: Despite increased research on breast cancer survivors, little is known about how socio-behavioral factors influence the symptoms among racial/ethnic minority breast cancer survivors, particularly Asian American breast cancer survivors (AABCS). Objective: This study examined the relationship between multiple socio-behavioral factors in AABCS, including attitudes, perceived barriers, and social influences, and their symptom experiences, with an emphasis on the mediating effect of self-efficacy. Methods: This secondary analysis used data collected from 195 AABCS women recruited through online and offline communities from January 2017 to June 2020. Study variables were measured using validated instruments such as the Questions on Attitudes, Self-Efficacy, Perceived Barriers, and Social Influences; the Cancer Behavior Inventory; and the Memorial Symptom Assessment Scale-Short Form. For structural equation modeling based on Bandura's self-efficacy theory, mediation analysis was performed using SPSS version 26.0 and AMOS 28. Results: The overall fitness of the hypothetical model to the data is acceptable (chi(2) = 51.36, P < .001; goodness-of-fit index = 0.95, adjusted goodness-of-fit index = 0.89, comparative fit index = 0.96, Tucker-Lewis index = 0.94, normed fit index = 0.94, and root-mean-square error of approximation index = 0.08). Both attitudes and social influences indirectly influenced symptom distress through self-efficacy (beta = -0.054, P = .019, and beta = -0.053, P = .017, respectively). Perceived barriers had indirect effects through self-efficacy (beta = 0.121, P = .024) and significant direct effects (beta = 0.605, P = .003) on symptom distress. Conclusions: Our findings supported that the self-efficacy for coping mediated their symptom experience among AABCS. In addition, there were significant relationships among attitudes, perceived barriers, social influences, and symptom experience. Implications for Practice: Future theory-driven interventions need to consider self-efficacy and socio-behavioral factors in symptom management among AABCS.