Online Exclusive Article
Open Access Article

A Test of the Self-Help Model and Use of Complementary and Alternative Medicine Among Hispanic Women During Treatment for Breast Cancer

Barbara Owens

self-care, complementary and alternative therapies, women, Hispanic Americans
ONF 2007, 34(4), E42-E50. DOI: 10.1188/07.ONF.E42-E50

Purpose/Objectives: To describe the relationships in Braden's Self-Help Model of side-effect burden to uncertainty, complementary and alternative medicine (CAM), self-care, and quality of life (QOL) in Hispanic women during breast cancer treatment.

Design: Descriptive, correlational; convenience sample; cross-sectional design.

Setting: An outpatient oncology clinic in a public setting of a metropolitan community in southern Texas.

Sample: 137 Hispanic women receiving or completing treatment for breast cancer.

Methods: Participants completed a comprehensive set of instruments. Analyses included a correlation of variables and multiple regressions to examine variables for potential theoretical relationships.

Main Research Variables: CAM use, uncertainty, and enabling skills.

Findings: CAM use as a resource to reduce uncertainty for Hispanic women during breast cancer treatment was not supported. As a type of self-care, CAM was minimally effective in improving QOL. The greater the side-effect burden that Hispanic women experienced, the more uncertainty and depression and lower QOL scores were found. In contrast, women who were involved in CAM self-care had higher QOL scores.

Conclusions: The study results provide valuable information about understanding CAM's role during breast cancer therapy among Hispanic women. The model-testing findings indicated strong support for a predicted pattern in Braden's Self-Help Model with a slight trend for CAM as a special type of self-care.

Implications for Nursing: The findings further inform the concept development of CAM and model building. Additional research with a longitudinal design is needed to understand how CAM is used throughout the breast cancer treatment trajectory and will contribute to knowledge guiding nurses in facilitating self-care interventions for Hispanic women.

Jump to a section


    Aaronson, N.K. (1990). Quality-of-life research in cancer clinical trials: A need for common rules and language. Oncology, 4, 59-66.
    Adler, S.R. (1999). Complementary and alternative medicine use among women with breast cancer. Medical Anthropology Quarterly, 13, 214-222.
    Bennett, M., & Lengacher, C. (1998). Design and testing of the complementary therapy rating scale. Alternative Health Care Practitioner, 4, 179-198.
    Braden, C. (1986). Self-help as a learned response to chronic illness experience: A test of four alternative theories. Dissertation Abstracts International, 47(09), 3704. (UMI No. 8623869)
    Braden, C. (1990). A test of the Self-Help Model: Learned response to chronic illness experience. Nursing Research, 39, 42-47.
    Braden, C., Mishel, M., & Longman, A. (1993, November). Quality of life in treatment for breast cancer. Paper presented at the American Nurses Association Council of Nurse Researchers, Washington, DC.
    Braden, C.J. (1993). Final report: Learned self-help response to chronic illness experience. Bethesda, MD: National Institute of Nursing.
    Braden, C.J. (2002). Final report: Breast cancer management in younger minority women. "Promoting self-help: Underserved women with breast cancer" (1 Rol CA64706). Bethesda, MD: National Institutes of Health, National Cancer Institute.
    Braden, C.J., Mishel, M.H., & Longman, A.J. (1998). Self-Help Intervention Project: Women receiving breast cancer treatment. Cancer Practice, 6, 87-98.
    Burstein, H.J., Gelber, S., Guadagnoli, E., & Weeks, J.C. (1999). Use of alternative medicine by women with early-stage breast cancer. New England Journal of Medicine, 340, 1733-1739.
    Campbell, A. (1976). Subjective measures of well-being. American Psychologist, 31, 117-124.
    Cantril, H. (1965). The patterns of human concerns. New Brunswick, NJ: Rutgers University Press.
    Cassileth, B.R. (1999). Complementary therapies: Overview and state of the art. Cancer Nursing, 22, 85-90.
    Cassileth, B.R., & Vickers, A.J. (2005). High prevalence of complementary and alternative medicine use among cancer patients: Implications for research and clinical care. Journal of Clinical Oncology, 23, 2590-2592.
    Chou, J.C., Horng, P., Tolmos, J., & Vargus, H.I. (2000). Alternative therapy use by breast cancer patients. Medicine of the Americas, 1(1), 26-30.
    Derogatis, L.R. (1986). The Psychosocial Adjustment to Illness Scale (PAIS). Journal of Psychosomatic Research, 30, 77-91.
    DiGianni, L.M., Garber, J.E., & Winer, E.P. (2002). Complementary and alternative medicine use among women with breast cancer. Journal of Clinical Oncology, 20(18, Suppl.), 34S-38S.
    Dirksen, S.R. (2000). Predicting well-being among breast cancer survivors. Journal of Advanced Nursing, 32, 937-943.
    Eisenberg, D.M., Davis, R.B., Ettner, S.L., Appel, S., Wilkey, S., Van Rompay, M., et al. (1998). Trends in alternative medicine use in the United States, 1990-1997: Results of a follow-up national survey. JAMA, 280, 1569-1575.
    Gray, R.E., Fitch, M., Goel, V., Franssen, E., & Labrecque, M. (2003). Utilization of complementary/alternative services by women with breast cancer. Journal of Health and Social Policy, 16(4), 75-84.
    Hann, D., Baker, F., Denniston, M., & Entrekin, N.M. (2005). Long-term breast cancer survivors' use of complementary therapies: Perceived impact on recovery and prevention of recurrence. Integrative Cancer Therapies, 4, 14-20.
    Henderson, J.W., & Donatelle, R.J. (2004). Complementary and alternative medicine use by women after completion of allopathic treatment for breast cancer. Alternative Therapies in Health and Medicine, 10(1), 52-57.
    Lee, M.M., Lin, S.S., Wrensch, M.R., Adler, S.R., & Eisenberg, D. (2000). Alternative therapies used by women with breast cancer in four ethnic populations. Journal of the National Cancer Institute, 9, 42-47.
    LeFort, S.M. (2000). A test of Braden's Self-Help Model in adults with chronic pain. Journal of Nursing Scholarship, 32, 153-160.
    Lengacher, C., Bennett, M., Kip, K., Gonzalez, L., Jacobsen, P., & Cox, C. (2006). Relief of symptoms, side effects, and psychological distress through use of complementary and alternative medicine in women with breast cancer. Oncology Nursing Forum, 33, 97-104.
    Lengacher, C.A., Bennett, M.P., Kip, K.E., Berarducci, A., & Cox, C.E. (2003). Design and testing of the use of a complementary and alternative therapies survey in women with breast cancer. Oncology Nursing Forum, 30, 811-821.
    Longman, A.J., Braden, C.J., & Mishel, M.H. (1996). Side effects burden in women with breast cancer. Cancer Practice: A Multidisciplinary Journal of Cancer Care, 4, 274-280.
    Longman, A.J., Braden, C.J., & Mishel, M.H. (1997). Pattern of association over time of side-effects burden, self-help, and self-care in women with breast cancer. Oncology Nursing Forum, 24, 1555-1560.
    Longman, A.J., Braden, C.J., & Mishel, M.H. (1999). Side-effects burden, psychological adjustment, and life quality in women with breast cancer: Pattern of association over time. Oncology Nursing Forum, 26, 909-915.
    Marin, B., & Marin, G. (1991). Research with Hispanic populations. Thousand Oaks, CA: Sage.
    Maskarinec, G. (2000). Breast cancer—Interaction between ethnicity and environment. In Vivo, 14, 115-123
    Mishel, M. (1983). Adjusting the fit: Development of uncertainty scales for specific clinical populations. Western Journal of Nursing Research, 5, 355-370.
    Mishel, M.H. (1981). The measurement of uncertainty in illness. Nursing Research, 30, 258-263.
    Morris, K.T., Johnson, N., Homer, L., & Walts, D. (2000). A comparison of complementary therapy use between breast cancer patients and patients with other primary tumor sites. American Journal of Surgery, 179, 407-411.
    National Center for Complementary and Alternative Medicine. (2006). What is complementary and alternative medicine? Retrieved June 12, 2006, from
    O'Brien, K. (2004). Complementary and alternative medicine: The move into mainstream health care. Clinical and Experimental Optometry, 87, 110-120.
    Orley, J. (1996). The WHO program on mental health behavioral science learning modules. International Journal of Psychiatry in Medicine, 26, 107-108.
    Owens, B. (2002). Pilot study: Self-care and complementary therapies used by women experiencing side effects of breast cancer treatment. San Antonio, TX: Wellness Center of Cancer Therapy and Research Center.
    Pardine, P., Napoli, A., & Dytell, R. (1983, August). Health behavior change mediating the stress-illness relationship. Paper presented at the 91st Annual Conference of the American Psychological Association, Anaheim, CA.
    Radloff, L.S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401.
    Rees, C.E., & Bath, P.A. (2000). Exploring the information flow: Partners of women with breast cancer, patients, and healthcare professionals. Oncology Nursing Forum, 27, 1267-1275.
    Rogers, J.L., Howard, K.I., & Vessey, J.T. (1993). Using significance tests to evaluate equivalence between two experimental groups. Psychological Bulletin, 113, 553-565.
    Rosenbaum, M. (1980). A schedule for assessing self-control behaviors: Preliminary findings. Behavior Therapy, 11, 109-121.
    Rosenbaum, M., & Jaffe, Y. (1983). Learned helplessness: The role of individual differences in learned resourcefulness. British Journal of Social Psychology, 22(Pt. 3), 215-225.
    Sollner, W., Maislinger, S., DeVries, A., Steixner, E., Rumpold, G., & Lukas, P. (2000). Use of complementary and alternative medicine by cancer patients is not associated with perceived distress or poor compliance with standard treatment but with active coping behavior. Cancer, 89, 873-880.
    Sparber, A., Bauer, L., Curt, G., Eisenberg, D., Levin, T., Parks, S., et al. (2000). Use of complementary medicine by adult patients participating in cancer clinical trials. Oncology Nursing Forum, 27, 623-630.
    Tindle, H.A., Davis, R.B., Phillips, R.S., & Eisenberg, D.M. (2005). Trends in use of complementary and alternative medicine by U.S. adults: 1997-2002. Alternative Therapies in Health and Medicine, 11(1), 42-49.