Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2017 Lived Experiences of Pre-menopausal African American Women with Advanced Breast Cancer Carmelita Whitfeld Walden University Follow this and additional works at: htps://scholarworks.waldenu.edu/dissertations Part of the Public Health Education and Promotion Commons Tis Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact Walden University College of Health Sciences This is to certify that the doctoral dissertation by Carmelita Whitfield has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Clarence J. Schumaker, Committee Chairperson, Public Health Faculty Dr. Kimberly Dixon-Lawson, Committee Member, Public Health Faculty Dr. Egondu Onyejekwe, University Reviewer, Public Health Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2017 Abstract Lived Experiences of Premenopausal African American Women with Advanced Breast Cancer by Carmelita Yvette Whitfield MA, University of Phoenix, 2008 BS, Alabama A&M University, 1986 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University May 2017 Abstract This qualitative study examined the phenomenology of advanced breast cancer (ABC) among 7 female participants between the ages of 20 and 45. Oral data were collected to extract participants’ interpretations of their spiritual and psychosocial experiences of living with ABC. Findings suggest that these women experienced a dichotomous relationship with regard to their bodies and their relationships with others; this served as a means of making sense of their experiences and as a coping mechanism. Positive psychology and the theory of reasoned action and planned behavior provided the theoretical framework for examining the role of social reinforcements, beliefs, and attitudes and intentions on the health behavior of premenopausal African American women with ABC in Northern and Southern Delaware. Additionally, the theoretical framework provided answers to the overarching questions of how pre-menopausal African American women with advanced breast cancer applied meaning-making and spirituality to find purpose in their diagnosis. Inductive analysis of their narrative data suggested a set of themes: the body as a medical object, the body as a feminine object, honesty in relationships, missed opportunities from healthcare professionals, from wounded to mended, and the joy of purposeful living. The participants reported that an intimate relationship with God helped them feel supported in a way that family and friends could not. The findings in this study support potential spiritual and meaning- making interventions as well as promote a more positive quality of life for premenopausal women living with advanced breast cancer. Lived Experiences of Premenopausal African American Women with Advanced Breast Cancer by Carmelita Yvette Whitfield MA, University of Phoenix, 2008 BS, Alabama A&M University, 1986 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University May 2017 Acknowledgments I want to thank my Dissertation committee: Dr. Clarence “Shuey” Schumaker, Jr., you were my very first professor for my first course on this journey. You’ve made this journey worth taking - Thank you. Dr. Kimberly Dixon-Lawson, your notes made me better a better writer- You ROCK! Finally, Dr. “Ego” Dr. Egondu Onyejekwe, I appreciated your guidance. I especially want to acknowledge two colleagues who I’m grateful to call friends, Dr. Juanita Braxton and Dr. Stacey Pilling. If anyone ever says friendships cannot be forged through online academic engagements, they don’t know us. I love and honor our friendship, through many tears, laughter, lots of wine and Skype you two will forever be etched on my heart. My beautiful and devoted husband Horace Henry Whitfield, Jr., who lost his fight to cancer while I was writing my Dissertation; I continue to feel your gentle arms holding me together, especially when I feel life is unsure and equally unfair. You taught me the meaning of true love, thank you for US. To my parents, Bernard and Mary, you are welcomed for having such an awesome daughter (big lol), kidding aside, I am because of who you are. My siblings Jason and Ivy, God could not have given me a greater gift than to have made me your big sister, I love being your Sissy. My beautiful Kia’Rae, continue to be fearless. To Jacqui my sister in law, and cheerleader, from my heart to yours, love will always live here. Most importantly Thank You Almighty Father for always answering when I called. Table of Contents List of Tables ..................................................................................................................... vi Chapter 1: Introduction to the Study ....................................................................................1 Introduction ....................................................................................................................1 Background to the Problem ...........................................................................................3 Problem Statement .........................................................................................................5 Purpose of the Study ......................................................................................................8 Research Questions ........................................................................................................9 Theoretical Framework ................................................................................................10 Nature of Study ............................................................................................................11 Definitions....................................................................................................................12 Assumptions .................................................................................................................15 Scope and Delimitations ..............................................................................................15 Limitations ...................................................................................................................15 Summary ......................................................................................................................16 Chapter 2: Literature Review .............................................................................................18 Introduction ..................................................................................................................18 Search Strategy ............................................................................................................19 Theoretical Foundation ................................................................................................20 Breast Cancer ...............................................................................................................21 Relationship of Literature to the Problem ....................................................................24 Meaning .......................................................................................................................24 i Research on Meaning ............................................................................................ 26 Meaning as a Concept of Reality .......................................................................... 26 Four Needs of Meaning ........................................................................................ 29 Sense of Coherence and Meaning ......................................................................... 32 Spirituality and Meaning in Cancer Patients ........................................................ 34 Spirituality and African Americans with Breast Cancer ....................................... 35 Meaning and Suffering ......................................................................................... 37 Spiritual Meaning Scale ........................................................................................ 39 Functional Assessment of Chronic Illness Therapy: Spiritual Well-Being Scale .......................................................................................................... 39 The Role of Narrative in Personal Meaning ......................................................... 40 Qualitative Paradigm of Narrative Analysis ......................................................... 41 Coping and Support .............................................................................................. 42 Summary ......................................................................................................................43 Chapter 3: Methodology ....................................................................................................45 Introduction ..................................................................................................................45 Research Methodology ................................................................................................45 Research Questions ......................................................................................................46 Qualitative Interviews ..................................................................................................47 Participant Selection ....................................................................................................48 Role of the Researcher .................................................................................................51 Data Collection ............................................................................................................53 ii Data Management and Analysis ..................................................................................55 Issues of Trustworthiness .............................................................................................55 Validity ................................................................................................................. 55 Reliability .............................................................................................................. 56 Summary ......................................................................................................................56 Chapter 4: Results ..............................................................................................................58 Introduction ..................................................................................................................58 Study Setting ................................................................................................................59 Coding Analysis ...........................................................................................................60 Data Verification ..........................................................................................................61 Description of Participants ...........................................................................................61 Themes Identified ........................................................................................................65 Theme 1: Life Before Cancer ............................................................................... 66 Theme 2: Missed Opportunities with Healthcare Professionals When Communicating with Newly Diagnosed Patients ..................................... 70 Theme 3: The Tension Between the Perception of Body as a Medical Object and Body as a Feminine Object ..................................................... 74 Theme 4: Honest and Accepting Versus Alienating Relationships ...................... 79 Theme 5: The Joy of Purposeful and Living ........................................................ 82 Theme 6: Wounded to Mended............................................................................. 86 Data Collection ............................................................................................................88 Evidence of Quality .....................................................................................................88 iii Process for Credibility .......................................................................................... 89 Process for Confirmability .................................................................................... 89 Process for Dependability ..................................................................................... 89 Summary ......................................................................................................................90 Chapter 5: Discussion ........................................................................................................92 Introduction ..................................................................................................................92 Summary of Findings ...................................................................................................94 Emergent Themes ........................................................................................................95 Theme 1: Life Before Cancer ............................................................................... 95 Theme 2: Missed Opportunities With Healthcare Professionals When Communicating With Newly Diagnosed .................................................. 96 Theme 3: The Tension Between the Perception of Body as a Medical Object and Body as a Feminine Object ..................................................... 96 Theme 4: Honest and Accepting Versus Alienating Relationships ...................... 97 Theme 5: The Joy of Purposeful and Living ........................................................ 98 Theme 6: Wounded to Mended............................................................................. 98 Interpretation of the Findings.......................................................................................99 Implications of the Findings ......................................................................................101 Theory and Research..................................................................................................103 Limitations of the Study.............................................................................................103 Recommendations for Future Research .....................................................................105 Summary and Conclusions ........................................................................................106 iv