Health-related Quality Of Life Model Research Articles

Health-related quality of life in female patients with reumatoid arthritis: a structural equation model.

This study aimed to construct a structural equation model to explain and predict factors affecting the health-related quality of life (QoL) in female rheumatoid arthritis (RA) patients based on the health-related QoL model by Ferrans et al. (2005) and a literature review. Patients (N=243) who were either registered members of an internet cafe composed of patients with RA or rheumatology outpatients at two tertiary general hospitals in Busan, Korea, were recruited via convenience sampling. Data were collected from July 2 to September 9, 2021, and the survey was conducted using a web-based questionnaire. The data were analyzed by SPSS and AMOS 26.0. The goodness-of-fit statistics of the final model exhibited good results (χ2/degree of freedom=2.68, Turker-Lewis index=.94, comparative fit index=.96, standardized root mean-squared residual=.04, root mean- square error of approximation=.08), and 11 out of 14 paths of the model were supported. The squared multiple correlation, which reflected the explanatory power of the environmental characteristics, symptoms, functional status, and perceived health status on health-related QoL, was 80%. In the hypothesis model, 10 paths had significant direct effects, 6 paths had significant indirect effects, and 12 paths had significant total (direct and indirect) effects. Considering that factors directly affecting the health-related QoL of female patients with RA were social support, symptoms (fatigue and depression), resilience, and perceived health status, and that resilience was the most influential factor, clinicians can encourage resilience. Hence, to improve the health-related QoL of female patients with RA, continuing management is necessary, using various intervention methods that focus on enhancing resilience from the early stage to the end of treatment for RA.

Presenting the quality of life model related to the health of patients with type 2 diabetes based on disease perception and demographic characteristics with the mediating role of self-care behaviors

Background and Aim: Type 2 diabetes, which is the most common type of this disease, is caused by the inefficiency of the body regarding the proper use of insulin, and this disease can affect the quality of life of affected patients due to its chronic nature. The present study was conducted with the aim of providing a health-related quality of life model for type 2 diabetes patients based on disease perception and demographic characteristics with the mediating role of self-care behaviors. Methods: The method of this study was correlation type. The statistical population of this study was all patients with type 2 diabetes who had visited the hospitals of Tonkabon and Ramsar cities within a six-month interval. 350 patients were selected by available sampling method. The data were obtained using the health-related quality of life questionnaire (Baroghs et al., 2004), the illness perception questionnaire (Weinman et al., 1996), the self-care behavior questionnaire (Tobert et al., 2000) and the demographic characteristics questionnaire. Came. Data analysis was done by structural equation method and using SmartPLS and SPSS software. Results: The results showed that there is a negative and significant relationship between the perception of the disease and the quality of life related to the patients' health (P<0.01). There is a positive and significant relationship between self-care behaviors and quality of life related to patients' health (P<0.01). There is a significant relationship between demographic characteristics and quality of life related to patients' health (P<0.01). Conclusion: As a result, the quality of life model related to the health of patients with type 2 diabetes based on the perception of the disease and demographic characteristics is suitable for the mediating role of self-care behaviors. Since the quality of life is considered an important health outcome, it is recommended to be considered as a main issue in the care of patients with diabetes.

Presenting the quality of life model related to the health of patients with type 2 diabetes based on disease perception, BMI and demographic characteristics with the mediating role of self-care behaviors

Aim: The aim of this study was to provide a health-related quality of life model for patients with type 2 diabetes based on disease perception, BMI and demographic characteristics with the mediating role of self-care behaviors. Method: The research method was descriptive-correlation type. The statistical population of the research was type 2 diabetes patients who had visited the hospitals of Tankabon and Ramsar. The sample of the study was 350 patients with type 2 diabetes who were selected by available sampling method. Data were collected using health-related quality of life questionnaires (Baroghs et al., 2004), disease perception (Weinman et al., 1996), self-care behaviors (Tobert et al., 2000), body mass index, and demographic characteristics questionnaire. Data analysis was done by structural equation modeling method. Results: The findings showed that the structural model of the health-related quality of life of patients with type 2 diabetes based on disease perception, BMI and demographic characteristics (age, education level, age of disease onset, duration of disease) with the mediating role of self-care behaviors fits with experimental data. Conclusion: Therefore, since the quality of life is considered an important health outcome, it is necessary to consider it as a main issue in the care of different patients, including patients with diabetes.

Model of Factors Influencing Health-Related Quality of Life among Thais with Colorectal Cancer and a Permanent Colostomy

Enhancing health-related quality of life among colorectal cancer survivors with a colostomy has become a significant concern for healthcare professionals. An understanding of factors involved in this condition and treatment, and how these work to affect the health-related quality of life of cancer survivors is a foundation for developing effective interventions. This cross-sectional study aimed to develop and test a health-related quality of life model among people with colorectal cancer and a permanent colostomy. Data were collected from 232 Thais with colorectal cancer and a permanent colostomy from six tertiary hospitals in southern Thailand by using seven instruments, including the Demographic and Health-related Data Form, the Social Support Questionnaire, the Bowel Function Inventory-Colorectal Surgery, the Center for Epidemiologic Studies Depression Scale, the Body Image Scale, the Chula ADL Index, and the Quality of Life Index-Cancer version III. Descriptive statistics and structural equation modeling were used for analyzing the data. The results indicated that the final model fitted with the empirical data and explained 72% of the variance in health-related quality of life. Three factors, carcinoembryonic antigen, gender, and age, had an indirect effect on health-related quality of life through different paths. Six factors, religion, social support, bowel symptoms, depressive symptoms, body image disturbance, and functional status, had both direct and indirect effects on health-related quality of life, with body image disturbance being the strongest effect. Nurses and other health professionals can use the findings of this study to design a comprehensive intervention to improve the quality of life for this group of patients. Such an intervention needs to target all the factors of this study, especially improving body image, functional status, and social support, and managing bowel and depressive symptoms. This intervention should be further tested in clinical practice.

309 Oscillating Between Gratitude and Fear: Lived Experience of Aneurysmal Subarachnoid Hemorrhage Survivors

INTRODUCTION: Aneurysmal subarachnoid hemorrhage (ASAH) is a devastating stroke that affects young adults at a mean age of 55 and mortality rate of 32%. Those who survive are subjected to short- and long-term consequences and the description of self-accounts of experiences are lacking. METHODS: This qualitative study utilized Husserl’s descriptive phenomenology methodology. Participants were recruited from an academic medical center outpatient neurosurgery clinic. A semi-structured interview guide and biodemographic background questionnaire guided data collection. Verbatim texts were analyzed according to Giorgi five-step method. The City of Hope Health-Related Quality of Life Theoretical Model gave structure to open-ended interviews, literature review, and for synthesis of results. RESULTS: Characteristics of the 16 participants included a median age of 56 years, predominantly female (81%), and six weeks to nine years since aneurysm rupture. Three major qualitative themes were uncovered that explained the structure of the general experience. The salient experiences reported by participants included psychological trauma, difficulty of symptom management, uncertainty, change in social relationships, and being unprepared for life after discharge. Other experiences discovered were difficulty in finding resources, fear of recurrence, social support as critical, and spirituality as a protective factor for wellbeing. CONCLUSION: Dimensions of the City of Hope Health-Related Quality of Life Model surfaced as essential, describing life after ASAH, when compared to the study’s conceptual model. The results highlight the need for multidisciplinary comprehensive post discharge support services, programs acknowledging the salience of all dimensions of health-related quality of life, and matching data-based standardized interventions to core sets of patient-reported short- and long-term outcomes.

Testing of a health-related quality of life model in patients with heart failure: A cross-sectional, correlational study

Psychological symptoms, physical symptoms, and behavioral factors can affect health-related quality of life (HRQOL) through different pathways, but the relationships have not been fully tested in prior theoretical models. The purpose of this study was to examine direct and indirect relationships of demographic (age), biological/physiological (comorbidity), psychological (depressive symptoms), social (social support), physical (physical symptoms and functional status), and behavioral (dietary sodium adherence) factors to HRQOL. Data from 358 patients with heart failure were analyzed using structural equation modeling. There was a good model fit: Chi-square = 5.488, p = .241, RMSEA = .032, CFI = .998, TLI = .985, and SRMR = .018. Psychological symptoms, physical symptoms, and demographic factors were directly and indirectly associated, while behavioral and biological/physiological factors were indirectly associated with HRQOL through different pathways. Behavioral factors need to be included, and psychological factors and physical factors need to be separated in theoretical models of HRQOL

Structural Equation Modeling on Quality of Life in Middle-Aged Women with Urinary Incontinence

Purpose: The purpose of this study was to investigate factors affecting the quality of life of middle-aged women with urinary incontinence by using Wilson and Cleary (1995)'s health-related quality of life model and previous studies. This article was done to construct a model for the collection of data on women with urinary incontinence and verifying the suitability of the model and the hypotheses presented in the model.Methods: A total of 209 valid questionnaires which met the criteria of middle-aged women who experienced urinary incontinence was used for final analysis. The exogenous and endogenous variables of the hypothesis model consisted of age, number of delivery, menstrual status, self-esteem, social support, physical symptoms, depression, anxiety, self-care agency and quality of life. The data were analyzed using IBM SPSS/WINdow 25.0 and AMOS 18.0 program.Results: The fitness of the modified model, x<sup>2</sup>/df=1.675, RMR=0.047, RMAEA=0.057, GFI=0.900, AGFI=0.855, NFI=0.923, TLI=0.957, CFI=0.9674. In the modified model, self-esteem showed the strongest total impact including the direct and indirect impacts on the quality of life of women with incontinence. In the result of verification of the modified model, quality of life explained by 58.8% through self-esteem, social support, self-care agency.Conclusion: Efforts are needed to improve self-esteem for middle-aged women with urinary incontinence, alleviate psychological symptoms, and develop self-care agency that they can manage themselves. Various aspects of physical, mental and psychological aspects can be comprehensively assessed and utilized to develop an interactive strategy system through individual programs and social support.

Abstract 13862: Testing of a Health-related Quality of Life Model

Introduction: In patients with heart failure (IHF), health-related quality of life (HRQOL) is as important as longer survival. Deaths are inevitable for all human beings, but clinicians may help patients with HF to maintain or improve HRQOL until almost at the end of their lives. Psychological and physical symptoms can impact HRQOL through different pathways, and behavioral factors can indirectly impact HRQOL, but the relationships have not been tested in prior theoretical models. Hypothesis: Sociodemographic (i.e., age), biological/physiological (i.e., comorbidity), psycho-social (i.e., depressive symptoms and social support), physical (i.e., physical symptoms and functional status), and behavioral factors (i.e., dietary adherence) in Heo-Moser model will be associated with HRQOL directly and indirectly in patients with HF through different pathways. Methods: This is a secondary analysis of baseline data from two observational studies in which baseline data were collected using the same instruments (N = 358 patients with HF, mean age: 60.4 years). Structural equation modeling (SEM) was used to test the hypothesis. Results: In the SEM, the analysis showed desirable model fit: Chi-square = 7.710, p = .260, RMSEA = .028 (95% confidence interval = 0.00, 0.078), CFI = 0.998, TLI = 0.989, and SRMR = 0.023. Age, depressive symptoms, physical symptoms, and functional status were directly associated with HRQOL. Age, comorbidity, depressive symptoms, social support, dietary adherence, and physical symptoms were indirectly associated with HRQOL through different pathways (Figure 1). Conclusions: All the factors in the model were directly and/or indirectly associated with HRQOL through different pathways. The pathways of physical symptoms, depressive symptoms, and dietary adherence differed. This model can be used to develop interventions targeting improvement in HRQOL in patients with chronic diseases.

Psychological functioning, coping styles and their relationship to appraisal of physical limitations following invasive surgical procedures for soft-tissue sarcoma: A qualitative study.

This study explored psychological functioning and coping styles in adult patients with soft-tissue sarcoma who underwent surgical procedures in a single expert sarcoma medical center in Canada. This is a qualitative study with three formats of data collection. The interview guide was based on theoretical health-related quality of life model. We began the investigation with 2 online and 2 in-person focus groups. Four individual semistructured interviews were added to further explore emerging themes. Data were analyzed using inductive thematic networks approach. Twenty-eight adults (13 female, 24-75 years of age) participated. In the domain of psychological functioning we identified three main themes; changes in mood, worry, and body image concerns. In the domain of coping styles, we identified four adaptive coping styles; positive reframing and optimism, finding a purpose, being proactive, and using humor. Among the maladaptive coping styles, we found passive acceptance, and avoidance and denial. Psychological well-being can be contingent on physical functioning and coping styles in adults with soft-tissue sarcoma. Both psychological and physical function impact quality of life. Patients with more physical limitations, psychological distress and maladaptive coping styles should be monitored for their well-being.

AB019. S3B-5. Living well with cancer—a personalized and need-based cancer care

: Cancer is one of the severe health problems globally. Fortunately, the advancements of cancer treatments have made them longer survival time. However, cancer and its related treatments might still cause impacts and distress on patients. In order to decrease cancer patients’ distress and increase their quality of life, a set of cares to support patients living well with cancer is important. In this presentation, the impacts of cancer on patients’ quality of life and the Wilson and Cleary’s Health Related Quality of Life model (HRQOL) will be addressed. Based on the model, patients’ physical, psychological and functional distress will be addressed. A personalized patient centered and need based care program will be discussed. The overall goal is to support cancer patients and their caregivers to develop better quality of life and live well with cancer.

Musculoskeletal Pelvic Pain and Sexual Function in the First Year After Childbirth

ObjectiveTo characterize sexual function in women with and without musculoskeletal pelvic pain during the first year after childbirth. DesignCross-sectional descriptive study. SettingOutpatient women’s health clinic in a Midwestern U.S. academic medical center. ParticipantsWomen who gave birth to singleton infants within the past year. MethodsWomen were recruited from various outpatient settings. We obtained baseline demographic variables and used selected components from the Wilson and Cleary Health-Related Quality of Life model. Participants completed questionnaires related to sexual health, pain symptoms, and general quality of life. They were asked to indicate their pain on a pain diagram and to quantify it with the use of a numeric rating scale (NRS). Examiners used validated examination techniques to assess pelvic floor muscle tenderness, strength, and pelvic girdle pain. Participants who reported pelvic pain and had at least one positive physical examination finding were classified in the pain group. ResultsForty-five participants completed the study, and 20 participants were in the pain group. Most participants with pain had pelvic girdle pain (n = 15) and pelvic floor myofascial pain (n = 20). Participants with pain reported less sexual satisfaction (t[43] = 2.84, p = .007) and reduced quality of life (t[36] = 5.25, p < .001) compared with participants without pain. ConclusionParticipants who experienced musculoskeletal pelvic pain in the first year after childbirth were significantly more likely to report problems with sexual function compared with their counterparts without pain.

Structural Equation Model of Health-Related Quality of Life in School Age Children with Asthma

This study aimed to construct and test a hypothetical model of the quality of life of school-age children with asthma based on the health-related quality of life model by Wilson and Cleary. Data were collected from 205 pairs of pediatric outpatients diagnosed with asthma and their parents in Seoul and Gyeonggi-do from July 2016 to April 2017. The exogenous variables were asthma knowledge, number of accompanying allergic diseases, and social support. The endogenous variables were asthma self-efficacy, asthma symptom control, perceived health status, parental quality of life, and children's quality of life. For data analysis, descriptive statistics, factor analysis, and structural equation modeling were performed. Eighteen of the twenty-four hypotheses selected for the hypothetical model were attentive and supported statistically. Quality of life was explained by asthma self-efficacy, asthma symptom control, perceived health, parental quality of life, and asthma knowledge with 83.5%. Strategies for promoting self-efficacy and enforcing asthma knowledge will be helpful for the improvement of health-related quality of life with school-aged asthmatic children.

A Review of Conceptual Models for Rehabilitation Research and Practice

Background: Since rehabilitation practice focuses on working in multidisciplinary teams to optimize the physical, psychological, and social outcomes of the patient, conceptual models are extremely important in providing a theoretical basis for advancing scientific knowledge and improving professional practice. Aim: Although rehabilitation-related conceptual models have appeared in the literature more than fifty years ago or so, there has been no systematic efforts to review them. The purpose of this paper is to explore the existing rehabilitation models and to link these models to the ICF model of the World Health Organization. Methods: A structured literature search was performed in different databases including Medline and PubMed using terms such as: “rehabilitation” AND “Model” OR “Framework” OR “conceptualization”. 43 citations were identified and further evaluated by two judges according to pre-defined inclusion/exclusion criteria. Results: Six conceptual rehabilitation models were identified in the literature: the Biomedical Model, the Social Model, the Bio-Psycho-Social Model (BPS), the International Classification of Impairments, Disabilities, and Handicaps Model (ICIDH), the Community Based Rehabilitation Model (CBR), and the Health-Related Quality of Life Model (HRQoL). The concepts on which the models are built were linked to the International Classification of Functioning, Disability, and Health (ICF) domains. The strengths and limitations of each model are discussed. The majority of the concepts from the six models could be linked to the ICF model. Conclusion: By applying the conceptual models, an additional perspective can be added by rehabilitation therapists to multidisciplinary teams that use the ICF model. When relationships are highly complex, as they are in rehabilitation processes, it is challenging to develop models that are applied in different contexts. However, it is possible to establish relationships between different variables that are observable.

Breastfeeding attitude, health-related quality of life and maternal obesity among multi-ethnic pregnant women: A multi-group structural equation approach

BackgroundIdentifying the factors influencing breastfeeding attitude is significant for the implementation of effective promotion policies and counselling activities. To our best knowledge, no previous studies have modelled the relationships among breastfeeding attitude, health-related quality of life and maternal obesity among multi-ethnic pregnant women; the current study attempts to fill this research gap. ObjectivesThis study investigated the relationships among maternal characteristics, health-related quality of life and breastfeeding attitude amidst normal weight and overweight/obese pregnant women using a multi-group structural equation modelling approach. DesignExploratory cross-sectional design was used. SettingAntenatal clinics of a university-affiliated hospital ParticipantsPregnant women were invited to participate; 708 (78.8%) agreed to participate in the study. MethodsWe examined a hypothetical model on the basis of integrating the concepts of a breastfeeding decision-making model, theory of planned behaviour-based model for breastfeeding and health-related quality of life model among 708 multi-ethnic pregnant women in Singapore. The Iowa Infant Feeding Attitude Scale and Medical Outcomes Study Short Form Health Survey were used to measure breastfeeding attitude and health-related quality of life, respectively. ResultsTwo structural equation models demonstrated that better health-related quality of life, higher monthly household income, planned pregnancy and previous exclusive breastfeeding experience were significantly associated with positive breastfeeding attitude among normal and overweight/obese pregnant women. Among normal weight pregnant women, those who were older with higher educational level were more likely to have positive breastfeeding attitude. Among overweight/obese pregnant women, Chinese women with confinement nanny plan were less likely to have positive breastfeeding attitude. No significant difference existed between normal weight and overweight/obese pregnant women concerning estimates of health-related quality of life on breastfeeding attitude (Critical Ratio=−0.193). The model satisfactorily fitted the data (Incremental Fit Index=0.924, Tucker–Lewis Index=0.905, Comparative Fit Index=0.921 and Root Means Square Error of Approximation=0.025). Health-related quality of life was found to affect breastfeeding attitude in multi-ethnic pregnant women. ConclusionsThis relationship implied the importance of early culturally specific interventions to enhance health-related quality of life for improving positive breastfeeding attitude among pregnant women across different ethnic groups.

Depressive symptoms impact health-promoting lifestyle behaviors and quality of life in healthy women.

Depressive symptoms are an independent risk factor of cardiovascular disease (CVD). More than 15% of persons with CVD have depressive symptoms, which are twice as likely to occur in women. Depressive symptoms in women being screened for CVD have not been well studied. The relationships between depressive symptoms, health-promoting lifestyle behaviors, heart disease risk awareness, cardiac risk, and quality of life (QOL) in women were investigated. Whether the effect of depressive symptoms on QOL was mediated by cardiac risk and/or health-promoting lifestyle behaviors was also examined. The Wilson-Cleary Health-Related Quality of Life Model guided this descriptive study. A convenience sample of 125 women was recruited from cardiac health screening events. The study measurements were the Center for Epidemiologic Studies Depression Scale; the Framingham risk score; the Ferrans-Powers Quality of Life Index Generic Version-III; the Health-Promoting Lifestyle Profile-II; and questions related to heart disease risk, awareness of heart disease risk, health history, and demographics. Body mass index, percentage of body fat, and lipid profile were also measured. More than one-third (34%) of the women reported significant depressive symptoms. Depressive symptoms were not associated with cardiac risk or risk awareness but were inversely associated with health-promoting lifestyle behaviors (r = -0.37, P < 0.01) and QOL (r = -0.51, P < 0.01). There was a dose-response relationship with health-promoting lifestyle behaviors (odds ratio, 0.92; 95% confidence interval, 0.88-0.97; P < 0.001) and QOL (odds ratio, 0.85; 95% confidence interval, 0.79-0.92; P < 0.001) and depressive symptoms. Health-promoting lifestyle behaviors mediated the association between depressive symptoms and QOL. Depressive symptoms contribute significantly to health-promoting lifestyle behaviors and QOL for women. Early detection and treatment of depressive symptoms are important for participation in healthy lifestyle behaviors, which could result in improved QOL.

Effect of periodontal surgery on oral health‐related quality of life in patients who have completed initial periodontal therapy

Patient-centered assessments are particularly important in periodontal treatment in which their concerns may differ from the traditional clinical endpoints. However, information is limited regarding the influence of periodontal surgery on patients' quality of life (QoL). The aim of the present study was to investigate the impact of surgical periodontal therapy on the oral health-related QoL of patients who have received initial periodontal therapy. A three-center prospective clinical study design was used, with the study participants comprising patients with moderate to severe periodontitis. Following initial periodontal therapy, the participants received either surgical or non-surgical periodontal treatment. The Oral Health-related Quality of Life Model for Dental Hygiene (OHRQL instrument), was used to assess participants' oral health-related QoL at each periodontal assessment interval: baseline (phase I), after initial therapy (phase II) and after surgery or during supportive periodontal therapy (phase III). Seventy-six patients (26 non-surgery, 50 surgery) completed the third phase of OHRQL assessment and were subjected to data analysis. From phase II to III, an improvement was achieved in all clinical parameters (p<0.05-0.001) in the surgery group, whereas no such improvement was observed in the non-surgery group. In both groups, a significant difference in total OHRQL score was noted between phases I and III (p<0.001 for surgery and p<0.05 for non-surgery). The OHRQL domain scores for pain and eating/chewing function showed a significant improvement between these time points. However, no further significant improvement in OHRQL scores was achieved from phase II to III. A significant improvement in oral health-related QoL was noted between phases I and III in the surgery and non-surgery groups. Such improvement was less pronounced in the non-surgery vs. the surgery group. From phase II to III, neither surgery nor non-surgical treatment yielded significant improvement in oral health-related QoL.

Quality of Life in Women Who Use Pessaries for Longer Than 12 Months

Pessaries are an effective treatment for pelvic organ prolapse and urinary incontinence; however, few data exist describing long-term pessary use. Our aim was to describe symptom bother and quality of life (QoL) in women using pessaries for urinary incontinence and/or prolapse for at least 12 months. Consecutive women who met inclusion criteria were approached for this observational cross-sectional study. Wilson and Cleary's Health-Related Quality of Life Model guided the inclusion of biologic, functional, and individual factors that impact the health-related QoL. Consenting participants completed a generalized QoL index, the Center for Epidemiologic Depression Symptoms, Medical Outcomes Study Social Support Survey, and condition-specific measures; the Pelvic Floor Distress Inventory (PFDI-20-SF) and the Pelvic Floor Impact Questionnaire. Fifty-six women, mean age 74.4 years (range, 47-89 years), completed the survey. Mean length of time for pessary use was 4.5 years (1-15 years). Most of the women (n = 31, 55.4%) returned to the clinic for pessary care every 3 months. There was no difference in generalized QoL nor condition-specific total PFDI-20 in women performing self-care versus routine follow-up. Almost one third (29%) of participants reported complications related to pessary use (eg, vaginal erosion), and 41%were considering surgical repair in the near future. Women who were considering surgery had higher PFDI-20 scores relating to more bothersome prolapse symptoms than those not considering surgery (Pelvic Organ Prolapse Distress Inventory 6, 33.91 vs 24.73, P = 0.03). Pessaries can be used to control pelvic floor symptoms for extended periods. Complication rates in this study were lower than previously reported, even in women not doing self-care. Not surprisingly, women considering surgical intervention reported greater symptom bother despite pessary use.

Abstract A33: Engaging stakeholders to improve quality of life in Latina breast cancer survivors and their caregivers: Lessons learned from a community-based organization

Abstract Purpose: In the United States, the lifetime risk for cancer among women of Latino origin is 1 in 3. Evidence indicates that Latina breast cancer survivors have lower quality of life (QOL) compared to non-Latina survivors. Similarly, research demonstrates that Latino caregivers experience increased distress and physical symptoms compared to age- and gender-matched controls. Nueva Vida, a community-based organization (CBO) that supports Latinos and Latinas with cancer and their families, designed a multidimensional intervention for Latina breast cancer survivors and their caregivers that is uniquely formatted to reflect the cultural preferences and values of Latina survivors and their spouses. The unique format involves twice monthly sessions in which survivors and caregivers arrive together, separate into survivor and caregiver groups, and discuss collectively at the end of the session. Observations in the literature indicate a critical need for evaluation of patient-caregiver interventions (PCIs) to improve QOL in underserved groups. Funded by the Patient-Centered Outcomes Research Institute, the purpose of this project is to determine whether the PCI improves QOL, communication, and satisfaction with care more than usual care among Latina breast cancer patients and their caregivers. Procedures: In addition to the dyadic component of the PCI, the project is guided by two conceptual models: the Contextual Model of Health-Related QOL, which specifies individual, cultural and contextual influences as important determinants of QOL; and Social Cognitive Theory, which focuses on confidence in ability to engage in communication and coping as a survivor or caregiver. Latina breast cancer survivors will be eligible for the study if they self-identify as Latina, speak English or Spanish, and can identify at least one primary, adult caregiver that speaks English or Spanish. Interventionists at four CBOs with distinct geographic and ethnic populations will receive training on implementing the PCI using psychosocial interventions with Latina breast cancer patients. Participants complete telephone interviews prior to the PCI, immediately after, and six months later. Interviews are conducted using the Patient-Reported Outcomes Measurement Information System (PROMIS), a rigorously tested instrument tailored to an individual's current level on a particular domain, which will allow us to compare our findings to other cancer and non-cancer cohorts and more precisely estimate QOL outcomes. Unpublished data: This study is innovative in the inclusion of an socioeconomically diverse population of cancer survivors and their caregivers. This study is the first evaluation of a cancer PCI developed by a Latina survivor based on empirical and theoretical evidence. Survivors and caregivers who attend Nueva Vida's PCI reported positive changes in: family life (93%), relationship with one another (50%), work (72%), feeling better with self (100%), activity (93%), and their spiritual life (100%). This study will assess the impact of the inclusion of a caregiver as a part of care across geographic and socioeconomic groups. In addition, through a review of organizational records, Nueva Vida identified significant steps CBOs can take to engage in community-based participatory research. Conclusions: If successful the intervention will improve outcomes for Latina survivors and caregivers. The potential impact of our intervention is large: we can quickly share results through outreach to 150+ local and national groups that provide care and support to thousands of Latino families facing cancer. It will also indicate the distinct impacts the patient-caregiver intervention has with different socioeconomic groups. Citation Format: Margaret LG Darling, Maria Gloria Elliott, Claudia Campos, Kristi D. Graves. Engaging stakeholders to improve quality of life in Latina breast cancer survivors and their caregivers: Lessons learned from a community-based organization. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A33. doi:10.1158/1538-7755.DISP13-A33

Review of electrical stimulation, botulinum toxin, and their combination for spastic drop foot

Traumatic brain injury (TBI) has emerged as a major cause of morbidity among U.S. servicemembers who have served in Iraq and Afghanistan. Even mild TBI (mTBI) can result in cognitive impairments that can affect the community reintegration of Veterans postdeployment. The purpose of this study was to explore the needs and concerns of combat Veterans with mTBI to provide support for an mTBI-specific conceptual model (Conceptual Model in the Context of mTBI) derived from Ferrans et al.'s health-related quality of life model and the TBI literature. Content analysis of qualitative interview data was conducted using a thematic matrix with a predetermined code list. Data saturation was achieved after interviews with eight male Veterans. Six key categories and predominant themes emerged: cognitive impairments, physical symptoms, emotions and behaviors, instrumental activities of daily living, interpersonal interactions, and community reintegration. Findings provide preliminary support for a new, context-specific conceptual model that has the potential to identify areas for future interventions to enhance community reintegration of combat Veterans with mTBI.

Health-related quality of life of african american breast cancer survivors compared with healthy African American women.

The diagnosis and treatment of breast cancer can result in an array of late cancer-specific side effects and changes in general well-being. Research has focused on white samples, limiting our understanding of the unique health-related quality of life outcomes of African American breast cancer survivors (BCSs). Even when African American BCSs have been targeted, research is limited by small samples and failure to include comparisons of peers without a history of breast cancer. The purpose of this study was to compare health-related quality of life of African American female BCSs with that of African American women with no history of breast cancer (control group). A total of 140 women (62 BCSs and 78 controls), 18 years or older and 2 to 10 years postdiagnosis, were recruited from a breast cancer clinic and cancer support groups. Participants provided informed consent and completed a 1-time survey based on the proximal-distal health-related quality of life model of Brenner et al (1995). After adjusting for age, education, income, and body mass index, results show that African American BCSs experienced more fatigue (P = .001), worse hot flashes (P < .001), and worse sleep quality (P < .001) but more social support from their partner (P = .028) and more positive change (P = .001) compared with African American female controls. Our results suggest that African American female BCSs may experience unique health-related outcomes that transcend age, education, socioeconomic status, and body mass index. Findings suggest the importance of understanding the survivorship experience for particular racial and ethnic subgroups to proactively assess difficulties and plan interventions.