Author: Catherine Ruth MacDougall Mackenzie
Mackenzie, Catherine Ruth MacDougall, 2010 Mothers, breast cancer survivorship and physical activity promotion, Flinders University, School of Medicine
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Breast cancer is the most commonly reported cancer in women in Australia, with increasingly high survival rates. Consequently, the health and wellbeing of breast cancer survivors is becoming an important field of cancer survivorship research. Research shows that regular physical activity participation improves important health outcomes for women after a breast cancer diagnosis. In Australia, rising average age of first birth means more women diagnosed with breast cancer in Australia are mothers of dependent children, but little is known about their experience. This thesis explores the experiences and views on physical activity promotion and participation of this significant but scarcely researched group of women. This thesis adopts a critical and feminist lens to ask: how do Australian women who were mothers of dependent children at the time of their breast cancer diagnosis respond to information about health benefits of regular participation in physical activity? To answer this question, the thesis asks five sub-questions; firstly, from what sources do the women gather information about physical activity and health and how do they feel about the information? Secondly, how do they make decisions about acting to support their health in general and physical activity in particular? Thirdly, in what ways do factors such as socioeconomic status, gender or location influence their views on and participation in physical activity? Fourthly, what would it take to enable this group of women to undertake physical activity at a level that is likely to produce health benefit? And lastly, how can evidence from women who have had a breast cancer diagnosis assist in promoting physical activity to women at a broader population level? This thesis answers these research questions principally by analysis of 36 in-depth interviews with rural and metropolitan women living in South Australia and Victoria, who were diagnosed with breast cancer while they were mothers of dependent children. The analysis shows how the women’s responses to health promotion messages were shaped by their embodied experience of their breast cancer journeys in their social contexts. The women responded to health promotion information in ways that suggest that messages based on data from studies of population risk were unhelpful at an individual level. The women’s responses to these types of health promotion messages ranged from resistance to cynicism and/or blaming themselves for their breast cancer diagnosis. Consistent with both feminist and qualitative public health research, the women reported social, structural and individual enablers and constraints to participation in physical activity including level of intimate partner support, their own/partners’ paid work, their everyday/everynight child caring responsibilities, their post-treatment pain and fatigue, their level of priority for physical activity participation, and the pleasure they derived from it. Most of the women spoke of knowing about the biological benefits of participation in physical activity for women after having breast cancer treatment (such as maintaining bone mineral density) whether or not they themselves participated. The thesis supports a theoretical approach to health promotion after breast cancer that includes the concept of embodied expertise in breast cancer which is developed over the breast cancer journey. The thesis concludes that combining feminist and critical research principles is crucial to developing health promotion strategies that attend to gender and embodiment, to enable health promoters to support women’s health after a breast cancer diagnosis.
Keywords: breast cancer,motherhood,survivorship,health promotion,embodiment,public health,women's health,body theory,feminist theory,qualitative research,physical activity
Subject: Medicine thesis
Thesis type: Doctor of Philosophy
School: School of Medicine
Supervisor: Professor Fran Baum