To Enhance Breast Cancer Survivorship of Asian Americans

Despite few studies on Asian American breast cancer survivors, it is well known that these
women shoulder unnecessary burden of breast cancer because they rarely complain about
symptoms or pain, delay seeking help, and rarely ask or get support due to their cultural
values and beliefs and language barriers. This demonstrates a definite need for support in
this specific population. However, survivorship programs that are increasingly instituted at
cancer centers have serious impediments to providing information and coaching/support because
of the lack of staff time and insurance reimbursement. Furthermore, the pressure of
fast-paced clinical patient-provider interactions leaves little time for health care
providers to provide up-to-date information and coaching or support for these women based on
their cultural attitudes. All these circumstances necessitate an innovative and creative
delivery method of information and coaching/support. A technology- based approach using
computers and mobile devices (smart phones and tablets) promises to meet this necessity with
high flexibility and accessibility, and minimizes the cost of the intervention in busy and
costly health care settings. Also, a technology-based intervention that does not involve
face-to-face interactions could work better for many women from cultures where breast cancer
is still a stigmatizing experience. Therefore, based on Preliminary Studies (PSs), the
research team has developed and pilot-tested a theory-driven technology-based information and
coaching/support program that is culturally tailored to Asian American breast cancer
survivors using multiple features. The purpose of the proposed randomized intervention study
is to test the efficacy of the technology-based information and coaching/support program for
Asian American breast cancer survivors (TICAA) in enhancing the women's breast cancer
survivorship experience. The specific aims are to: a) determine whether the intervention
group will show significantly greater improvements than the control group in primary outcomes
(needs for help, physical and psychological symptoms, and quality of life) from baseline
(pre-test) to Time Points 1 (post 1-month) and 2 (post 3-months); b) identify theory-based
variables (attitudes, self-efficacy, perceived barriers, and social influences related to
breast cancer survivorship) that mediate the intervention effects of the TICAA on the primary
outcomes at the three time points (pre-test, post 1-month and post 3-months); and c)
determine whether the effects of the TICAA on the primary outcomes are moderated by
background characteristics and disease factors. The proposed study will be guided by the
Bandura's Theory of Behavioral Change. This study adopts a randomized repeated measures
pretest/posttest control group design in 330 Asian American breast cancer survivors. The
long-term goals are to: (a) implement the program into various health care settings; (b)
determine if the TICAA will lead to long-term improved health outcomes; and (c) fundamentally
enhance the methodology/paradigm of culturally tailored technology-based interventions for
ethnic minority groups of breast cancer survivors.

Inclusion Criteria:

- Participants will be included in the Internet survey if they (by self-report) are
self-reported Asian American women aged 21 years and older who identify their
sub-ethnicity as Chinese, Korean, or Japanese; have had a breast cancer diagnosis in
the past 5 years

- can read and write English, Mandarin Chinese, Korean or Japanese

- have access to the Internet through computers or mobile devices (smart phones and
tablets).

- Those who are in treatment or not in treatment, but who were diagnosed with breast
cancer within the past 5 years will be included because technology-based programs are
used by those in all stages of treatment and because those who have survived more than
5 years would have different needs from those who have survived less than 5 years. A
specific fatigue level was not set because compared to those who do not have fatigue
or have a low level of fatigue, those with a medium or high levels of fatigue would be
more likely to need support through technology-based programs.

Exclusion Criteria:

- Those under 21 years old are excluded because their cancer experience would be
different from adults'.