Date of Award

9-5-2024

Thesis Type

PhD

Document Type

Thesis

Divisions

Faculty of Medicine

Department

Department of Social and Preventive Medicine

Institution

Universiti Malaya

Abstract

While improved breast cancer survival rates are commendable, healthcare professionals and stakeholders must acknowledge potential strains on the healthcare system and society if optimal support and survivorship programs are not established. A global shift towards personalized, holistic patient care is crucial. However, implementing such care in a low- and middle-income country like Malaysia faces significant barriers. Positive psychology, which focuses on fostering positive emotions, has shown promise in promoting better health and longevity in healthy populations. However, research on the concept of happiness, both as a predictor of health outcomes and as a patient-reported outcome in cancer settings, remains limited. This study aimed to assess the unmet needs of women living with breast cancer in a multiethnic, middle-income setting and their association with happiness. Specifically, this study sought to validate Subjective Happiness Scale (SHS), Oxford Happiness Questionnaire (OHQ), and Pemberton Happiness Index (PHI), and assess whether social support and religiosity influenced the association between unmet needs and happiness. In Phase 1 (July 2021 - Nov 2021) of the happiness scales (SHS, OHQ, PHI) were validated in 300 women (convenience sampling) recruited from a major public hospital and community-based approach. In this phase, internal consistency and construct validity of the English and Malay versions of SHS, OHQ, and PHI were assessed. Criterion validity was determined. Phase 2 (Mar 2022 - May 2023) assessed needs, happiness, social support, and religiosity in 500 women (purposive sampling) from public, academic, and private hospitals. Cronbach’s alpha for the Malay and English versions of the SHS, OHQ, and PHI ranged from 0.750 to 0.920. In the exploratory factor analysis, a one-factor model was recommended for both versions of the SHS and PHI. A two-factor model was recommended for the English version of the OHQ whereas a three-factor model was extracted for the Malay version. Both versions of the OHQ and SHS revealed a moderately positive correlation with health-related quality of life and a moderately negative correlation with psychological distress. About 74.2 percent and 70.6 percent of participants had unmet needs in hospital appointments and information services domains. More than half participants (55.4 %) reported being very happy. Association between unmet needs and happiness was statistically significant (β = −0.194, p < 0.001, CI = -0.274 to -0.109). The results revealed that social support significantly and partially mediated the association (p = 0.016). However, religiosity did not moderate the association (p = 0.803). In conclusion, present study is expected to facilitate the planning and delivery of optimal supportive and survivorship care in routine clinical practices. Findings are also expected to foster multi-sectoral collaboration in engaging communities to actively play a role in improving various aspects of life, including physical health, mental, emotional well-being, and social connections for patients and their families.

Initial

khm

Additional Information

Thesis (PhD) – Faculty of Medicine, Universiti Malaya, 2024.

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