The Impact of Knowing: Causal Attributions and Beliefs about Risk Factors for Breast Cancer

Author: Jo Anne Dumalaon

Dumalaon, Jo Anne, 2017 The Impact of Knowing: Causal Attributions and Beliefs about Risk Factors for Breast Cancer, Flinders University, School of Health Sciences

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This thesis examined how causal attributions among affected (i.e., women with a previous diagnosis of breast cancer) and unaffected women (i.e., women without a previous diagnosis of breast cancer) compare with scientific evidence on risk factors for breast cancer. In addition, attributions between these groups were compared. This thesis also explored whether different causal attributions have a differential impact on measures of psychological sequelae, specifically fear of cancer recurrence (FCR) and well-being, among affected women.

Iin Chapter 2, a systematic review of quantitative and qualitative studies that assessed causal attributions for breast cancer among affected women was reported and compared with scientific evidence on risk factors for breast cancer. Results from 24 studies indicated that affected women consistently attributed the cause of their own breast cancer to factors that can be perceived as non-modifiable. Modifiable lifestyle risk factors were identified less frequently by affected women, despite cancer prevention recommendations. Findings of the systematic review were used to develop the “Beliefs about Breast Cancer Risk Factors" (BBCRF) scale. Affected women (n = 314) rated each risk factor in relation to their own breast cancer as well as in terms of other women’s breast cancer. Unaffected women (n = 160) rated each risk factor in terms of whether the item was a risk factor influencing breast cancer in general. This measure also included open-ended questions which asked women to list factors which they believe may have contributed to the development of their own and other women’s breast cancer.

In Chapter 4, It was investigated if affected women's degree of endorsement of risk factors for breast cancer was influenced by the referent under consideration and compared the degree of endorsement of risk factors for breast cancer between samples. Paired samples t-tests were used to test differences in

personal (self-referent) and general (other-referent) causal attributions among affected women. Results showed that affected women indicated greater endorsement for biological attributions, environmental attributions, reproductive history, breast-feeding, and hormones, lifestyle, and other causal attributions identified but not validated by expert consensus, and smoking when asked to rate the causes of breast cancer in others than when considering their own cancer. Affected women reported a similar degree of endorsement for stress and chance, as a cause of their own condition and breast cancer risk generally, despite the lack of scientific evidence for these attributions.

In Chapter 5, the associations between causal attributions for cancer, FCR and well-being and the possible moderating effect of optimism among affected women were examined. Simultaneous multiple regression analyses were conducted to explore the overall contribution of causal attributions to FCR and well-being separately. Hierarchical multiple regression analyses were also utilized to examine the potential moderating influence of dispositional optimism on the relationship between causal attributions and FCR and well-being. Affected women’s attributions to biological risk factors and stress were associated with greater FCR. Stress as a causal attribution was also negatively associated with well-being. Optimism did not moderate the relationship between causal attributions and FCR or well-being.

Chapter 6 or the concluding chapter discussed the potential theoretical and clinical implications of the results of the thesis as a whole. It was recommended that health promotion programs continue to promote the scientific evidence on breast cancer risks. A dual processing model (Epstein, 1994, 2000) can also be applied to understand how attributions might be constructed and that messages that target both rational and experiential information processing systems might be needed in communicating cancer prevention messages.

Keywords: breast cancer, cancer causal attributions, beliefs, cause, risk, fear of cancer recurrence, psychological well-being, optimism

Subject: Health Sciences thesis

Thesis type: Doctor of Philosophy
Completed: 2017
School: School of Health Sciences
Supervisor: Professor Carlene Wilson