Health Promoting Behavior and Influencing Factors in Iranian Breast Cancer Survivors

  • Tabrizi, Fatemeh Moghaddam (Nursing and Midwifery Department, Reproductive Health Research Center, Urmia University of Medical Sciences)
  • Published : 2015.03.18


Background: The purpose of this study was to investigate the associations among the internal health locus of control, depression, perceived health status, self efficacy, social support, and health-promoting behavior in Iranian breast cancer survivors and to determine influential variables. Materials and Methods: A predictive design was adopted. By convenient sampling the data of 262 breast cancer survivors in Iran were collected by questionnaires during 2014. Data were analyzed applying descriptive statistics, t-tests, one-way ANOVA, Pearson's correlation coefficients, and stepwise multiple regression. Results: The internal health locus of control, depression, perceived health status, self efficacy, social support and undergoing chemotherapy all correlated significantly with the health-promoting lifestyle. Stepwise multiple regression analysis revealed that social internal health locus of control, depression, perceived health status, self efficacy and social support and chemotherapy accounted for about 39.8% of the variance in health promoting lifestyle. The strongest influence was social support, followed by self efficacy, perceived health status, chemotherapy and depression. Conclusions: The results of the study clarifed the seriousness of social support, self efficacy, perceived health status and depression in determining the health-promoting lifestyle among Iranian breast cancer survivors. Health professionals should concentrate on these variables in designing plans to promoting a healthy lifestyle.


Health promotion behavior;internal control;self efficacy;perceived health status social support


Supported by : Urmia University of Medical Sciences


  1. Aleman BM, Moser EC, Nuver J, et al (2014). Cardiovascular disease after cancer therapy. Eur J Cancer Supplements, 12, 18-28.
  2. Armitage CJ, Wright CL, Parfitt G, et al (2014). Self-efficacy for temptations is a better predictor of weight loss than motivation and global self-efficacy: Evidence from two prospective studies among overweight/obese women at high risk of breast cancer. Patient Education Counseling, 95, 254-8.
  3. Ashing K, Rosales M, Lai L, et al (2014). Occurrence of comorbidities among African-American and Latina breast cancer survivors. J Cancer Survivorship, 8, 312-8.
  4. Bahar Z, Beser A, Ozbicakci S, et al (2014). Health promotion behaviors of Turkish women. Dokuz Eylul Universitesi HemsirelikYuksekokulu E Dergisi, 6.
  5. Baheiraei A, Mirghafourvand M, Mohammadi E, et al (2012). Social support for women of reproductive age and its predictors: a population-based study. BMC Women's Health, 12, 30.
  6. Bandura A (1997). Self-efficacy: The exercise of control. New York (NY): W.H. Freeman.
  7. Berglund E, Lytsy P, Westerling R (2014). The influence of locus of control on self-rated health in context of chronic disease: a structural equation modeling approach in a cross sectional study. BMC Public Health, 14, 492.
  8. Chon KK, Choi SC, Uang BC (2001). Integrated adaptation of CES-D in Korea. Korean J Health Psychol, 6, 59-76.
  9. Christian LM, Glaser R, Porter K, et al (2011). Poorer self-rated health is associated with elevated inflammatory markers among older adults. Psychoneuroendocrinol, 36, 1495-504.
  10. Fallowfield L, Jenkins V (2015). Psychosocial/Survivorship issues in breast cancer: are we doing better? J Natl Cancer Inst, 107, 335.
  11. Falzon C, Chalabaev A, Schuft L, et al (2012). Beliefs about physical activity in sedentary cancer patients: an in-depth interview study in France. Asian Pac J Cancer Prev, 13, 6033-8.
  12. Frank-Stromborg M, Pender NJ, Walker SN, et al (1990). Determinants of health-promoting lifestyle in ambulatory cancer patients. Social Science Med, 31, 1159-68.
  13. Gururatana O, Baker SR, Robinson PG (2014). Determinants of children's oral-health-related quality of life over time. Community Dentistry Oral Epidemiol, 42, 206-15.
  14. Hann D, Winter K, Jacobsen P (1999). Measurement of depressive symptoms in cancer patients: evaluation of the Center for Epidemiological Studies Depression Scale (CES-D). Journal Psychosomatic Res, 46, 437-43.
  15. Hashemian M, Aminshokravi F, Hidarnia A, et al (JPMA). Farsi version of the Multidimensional Health Locus of Control and God Locus of Health Control Scales: validity and reliability study among Iranian women with a family history of breast cancer. JPMA, 64, 1057.
  16. Hauken MA, Holsen I, Fismen E, et al (2015). Working toward a good life as a cancer survivor: a longitudinal study on positive health outcomes of a rehabilitation program for young adult cancer survivors. Cancer Nursing, 38, 3.
  17. Hellquist B, Duffy SW, Abdsaleh S, et al (2011). Effectiveness of population-based service screening with mammography for women ages 40 to 49 years. Cancer J, 117, 714-22.
  18. Iskandarsyah A, de Klerk C, Suardi DR, et al (2014). Health locus of control in Indonesian women with breast cancer: a comparison with healthy women. Asian Pac J Cancer Prev, 15, 9191.
  19. Koenig HG, Larson DB, Larson SS (2001). Religion and coping with serious medical illness. Ann Pharmacother, 35, 352-9.
  20. Korpershoek C, Bijl JV (2011). Selfefficacy and its influence on recovery of patients with stroke: A systematic review. J Adv Nurs, 67, 1876-94.
  21. Lagana L, Fobair P, Spiegel D (2014). Targeting the psychosexual challenges faced by couples with breast cancer: can couples group psychotherapy help. J Women's Health Care, 3, 2167-0420.
  22. Lin Y-H, Tsai E-M, Chan T-F, et al (2009). Health Promoting Lifestyles and Related Factors in Pregnant Women. Chang Gung, 32, 650-61.
  23. Mann T, de Ridder D, Fujita K (2013). Self-regulation of health behavior: Social psychological approaches to goal setting and goal striving. Health Psychol, 32, 487.
  24. Meraviglia M, Stuifbergen A (2011). Health promoting behaviors of low income cancer survivors. Clin Nurse Specialist, 25, 118-24.
  25. Mishra SI, Scherer RW, Snyder C, et al (2015). The effectiveness of exercise interventions for improving health-related quality of life from diagnosis through active cancer treatment. oncology nursing forum. Onc Nurs Society, 33-53.
  26. Moon SH, Lee DT, Son Y (2013). Adherence to health-related lifestyle behavior recommendations and association with quality of life among cancer survivors and age-matched controls in Korea. Asian Pac J Cancer Prev, 14, 2949-54.
  27. Mousavi SM, Gouya MM, Ramazani R, et al (2009). Cancer incidence and mortality in Iran. Ann Oncol, 20, 556-63.
  28. Naughton MJ, Weaver KE (2014). Physical and mental health among cancer survivors. Should I get screened?, 75, 283-6.
  29. Nazik E, Nazik H, Ozdemir F, et al (2014). Social support and quality of life in Turkish patients with gynecologic cancer. Asian Pac J Cancer Prev, 15, 3081-6.
  30. Pender NJ, Murdaugh CL (2006). Health promotion in nursing practice. 5th ed. Upper Saddle River (NJ): Pearson Education.
  31. Phillips SM, McAuley E (2015). Associations between selfreported post-diagnosis physical activity changes, body weight changes, and psychosocial well-being in breast cancer survivors. Supportive Care Cancer, 23, 159-67.
  32. Pongthavornkamol K, Wanavarodom P, Sareeso P, et al (2014). Improving health-promoting behaviors and quality of life through breast cancer support groups for Thai women. Pacific Rim Int J Nurs Res, 18, 125-37.
  33. Radloff LS (1977). The CES-D scale a self-report depression scale for research in the general population. Appl Psychol Measurement, 1, 385-401.
  34. Rizalar S, Altay B (2010). Early diagnosis practices for women with breast cancer. J Firat Hlth Services, 5, 73-87.
  35. Rosenstock IM, Strecher VJ, Becker MH (1988). Social learning theory and the health belief model. Health Education Q, 15, 175-83.
  36. Rottenberg Y, Litwin H, Manor O, et al (2014). Prediagnostic self-assessed health and extent of social networks predict survival in older individuals with cancer: A population based cohort study. J Geriatric Oncol, 5, 400-7.
  37. Rugbjerg K, Mellemkjaer L, Boice JD, et al (2014). Cardiovascular disease in survivors of adolescent and young adult cancer: a Danish cohort study, 1943-2009. J Natl Cancer Inst, 106, 110.
  38. Sahin ZA, Tan M, Polat H (2013). Hopelessness, depression and social support with end of life Turkish cancer patients. Asian Pac J Cancer Prev, 14, 2823-8.
  39. Schiavon CC, Vieira FG, Ceccatto V, et al (2015). Nutrition Education Intervention for Women With Breast Cancer: effect on nutritional factors and oxidative stress. J Nutrition Education Behavior, 47, 2-9.
  40. Schytt E, Lindmark G, Waldenstrom U (2005). Physical symptoms after childbirth: prevalence and associations with self-rated health. Br J Obstet Gynaecol, 112, 210-7.
  41. Shaheen Al Ahwal M, Al Zaben F, Khalifa DA, et al (2014). Depression in patients with colorectal cancer in Saudi Arabia. Psycho-Oncol, (Epub ahead of print).
  42. Sotelo JL, Musselman D, Nemeroff C (2014). The biology of depression in cancer and the relationship between depression and cancer progression. Int Review Psychiatry, 26, 16-30.
  43. Stewart S, Pearson S, Luke CG, et al (1998). Effects of a homebased intervention on unplanned readmissions and out-of hospital deaths. J Am Geriatr Soc, 46, 174-80.
  44. Swinney JE (2002). African Americans with cancer: the relationships among self-esteem, locus of control, and health perception. Res Nursing Health, 25, 371-82.
  45. Thaewpia S, Clark MJ, Howland LC, et al (2012). Factors Predicting Health Promoting Behaviors among Older Pregnant Thais. Pacific Rim Int J Nurs Res, 16, 113-23.
  46. Travier N, Fonseca-Nunes A, Javierre C, et al (2014). Effect of a diet and physical activity intervention on body weight and nutritional patterns in overweight and obese breast cancer survivors. Medical Oncol, 31, 1-11.
  47. Walker SN, Sechrist KR, Pender NJ (1987). The healthpromoting lifestyle profile: development and psychometric characteristics. Nursing Res, 36, 76-81.
  48. Wallston KA, Stein MJ, Smith CA (1994). Form C of the MHLC scales: a condition-specific measure of locus of control. J Personality Assessment, 63, 534-53.
  49. Wallston KA, Wallston BS, DeVellis R (1978). Development of the multidimensional health locus of control (MHLC) scales. Health Educ Behavior, 6, 160-70.
  50. Weinert C (1988). Measuring social support: Revision and further development of the Personal Resource Questionnaire. Measurement Nursing Outcomes, 1, 309-27.
  51. White M, Elander G (1992). Translation of an instrument. Scandinavian J Caring Sci, 6, 161-4.
  52. World Health Organization (2014). Breast cancer:prevention and control,WHO 2014.Available at: [Last accessed 2013 January 3].
  53. Yi M, Kim J (2013). Factors influencing health-promoting behaviors in Korean breast cancer survivors. Eur J Oncol Nurs, 17, 138-45.
  54. Yoo MS, Lee H, Yoon JA (2009). Effects of a cognitivebehavioral nursing intervention on anxiety and depression in women with breast cancer undergoing radiotherapy. J Korean Acad Nurs, 39, 157-65.

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