Clinical care for sexual assault survivors multimedia training: a mixed-methods study of effect on healthcare providers’ attitudes,knowledge, confidence,and practice in humanitarian settings

Background

Sexual assault is a threat to public health in refugee and conflict affected settings, placing survivors at risk for unintended pregnancy, unsafe abortion, STIs, HIV, psychological trauma, and social stigma. In response, the International Rescue Committee developed a multimedia training tool to encourage competent, compassionate, and confidential clinical care for sexual assault survivors in low-resource settings. This study evaluated the effect of the training on healthcare providers’ attitudes, knowledge, confidence, and practices in four countries.

Methods

Using a mixed-methods approach, we surveyed a purposive sample of 106 healthcare providers before and 3 months after training to measure attitudes, knowledge, and confidence. In-depth interviews with 40 providers elaborated on survey findings. Medical record audits were conducted in 35 health facilities before and 3 months after the intervention to measure healthcare providers’ practice. Quantitative and qualitative data underwent statistical and thematic analysis.

Results

While negative attitudes, including blaming and disbelieving women who report sexual assault, did not significantly decrease among healthcare providers after training, respect for patient rights to self-determination and non-discrimination increased from 76% to 91% (p?<?.01) and 74% to 81% (p?<?.05) respectively. Healthcare providers’ knowledge and confidence in clinical care for sexual assault survivors increased from 49% to 62% (p?<?.001) and 58% to 73% (p?<?.001) respectively following training. Provider practice improved following training as demonstrated by a documented increase in eligible survivors receiving emergency contraception from 50% to 82% (p?<?.01), HIV post-exposure prophylaxis from 42% to 92% (p?<?.001), and STI prophylaxis and treatment from 45% to 96% (p?<?.01).

Conclusions

Although beliefs about sexual assault are hard to change, training can improve healthcare providers’ respect for patient rights and knowledge and confidence in direct patient care, resulting in more competent and compassionate clinical care for sexual assault survivors.

     

Patients' and clinicians' views of comparing the performance of providers of surgery: a qualitative study

Objectives

Comparison of providers'' outcomes is intended to encourage patient choice and stimulate clinicians to improve the quality of their services. Given that success will depend on how patients and clinicians respond, our aim was to explore their views of using outcome data to compare providers.

Method

Qualitative data from six focus groups with patients (n = 45) and seven meetings with surgical clinicians (n = 107) were collected during autumn 2010. Discussions audio‐taped, transcribed and a thematic analysis carried out.

Results

Patients and clinicians confirmed the value of making comparisons of the outcomes of providers publicly available. However, both groups harboured three principal concerns: the validity of the data; fears that the data would be misinterpreted by the media, politicians and commissioners, and the focus should not just be on providers but also on the performance of individual surgeons. In addition, patients felt that information on providers'' outcomes would only ever have a limited impact on their choice because there were other important factors to be taken into account: accessibility, waiting time, the size of the provider and the quality of other aspects such as cleanliness and nursing. Also patients acknowledged the importance of friends'' and relatives'' experiences and that they would seek their GP''s advice.

Conclusions

While comparisons of providers'' outcomes should be available to patients to stimulate improvements in performance, information should be directed principally to hospital clinicians and to GPs. Impact may be enhanced by providing data on individual clinicians rather than providers. The extent to which these findings are generalizable to other areas of health care is uncertain.     

Comparing the preferences of health professionals and members of the public for setting healthcare priorities

Introduction

This article reports on a priority-setting exercise involving members of the general public and health professionals. The aim is to compare the healthcare priorities of these two groups, as well as their attitudes towards public involvement in priority setting.

Methods

A convenience sample of 373 members of the public attending two central Sydney, Australia, medical clinics were asked to complete a structured, interviewer-administered questionnaire. Forty-four purposively sampled healthcare professionals working in central Sydney completed the same questionnaire. Both groups were asked whether the preferences of the public should inform priority-setting decisions. They then had to allocate an additional (but fixed) amount of healthcare resources across competing programmes, medical procedures and population groups and their preferences were compared.

Results

The health professionals and members of the public strongly supported using public preferences to inform priorities in healthcare. Both groups expressed a slightly stronger preference for using public preferences to inform priorities across healthcare programmes and population groups than for medical interventions.

Discussion/conclusion

Considerable uniformity of preferences was revealed between the health professionals and the members of the public. However, it is argued that, even where the preferences of health professionals are consistent with and representative of those of the wider community, public involvement is important in terms of procedural justice, as it helps to legitimise both the process and the resultant priorities.     

Mainstreaming of Emergency Contraception Pill in India: Challenges and Opportunities

Background:

Emergency Contraception Pill (ECP) is an essential intervention to prevent unwanted pregnancies. However, its use has remained low due to various barriers including reservations among medical fraternity.

Materials and Methods:

This paper presents findings on barriers to ECP''s easy access for potential users from (i) a cross-sectional survey of providers'' attitudes, beliefs, and practices and interviews with key opinion leaders, (ii) three consultations organized by Population Council with policymakers and public health experts, and (iii) evidence from scientific literature.

Results:

The major barriers to easy access of ECP include misconceptions and reservations of providers (disapproval of ECP provision by CHWs, opposition to its being an OTC product, and myths, misconceptions, and moral judgments about its users) including influential gynecologists.

Conclusion:

For mainstreaming ECP, the paper recommends educational campaign focusing on gynecologists and CHWs, relaxing restrictive policy on advertisement of ECP, involving press media and strengthening supply chain to ensure its regular supply to ASHA (CHW).     

Attitudes and beliefs about musculoskeletal pain and its association with pain neuroscience knowledge among physiotherapy students in Israel

Background

Physiotherapy has a vital role in helping patients manage and overcome musculoskeletal pain. Healthcare providers’ beliefs about pain are associated with the beliefs of their patients. This study evaluated the attitudes, beliefs and level of pain neuroscience knowledge among Israeli Bachelor-level physiotherapy students.

Methods

First-year (n?=?29, before pain course), second-year (n?=?28, immediately after pain course and before clinical placements), and fourth-year (n?=?28, post-clinical placements) physiotherapy students completed the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS, range 15–105, lower scores indicate a more positive attitude) to assess pain attitudes and beliefs. The Neurophysiology of Pain Questionnaire (NPQ, range 0–19, higher scores indicate more pain-related knowledge) was also completed to measure pain neuroscience knowledge. Two separate one-way ANOVAs with post hoc analyses were used to compare HC-PAIRS and NPQ results between the three groups of students. Pearson correlations were determined between HC-PAIRS and NPQ.

Results

HC-PAIRS scores of the first-year students were significantly higher than those of second- and fourth-year students (p?=?0.011, p?<?0.001, respectively), with no difference between second- and fourth-year students; indicating that first-year students had less-positive attitudes toward the ability of individuals with musculoskeletal pain to function. Similarly, NPQ scores showed that first-year students differed from second- and fourth-year students (p?<?0.001, p?<?0.001, respectively). The HC-PAIRS and NPQ correlation among the fourth-year students yielded a moderately negative association (r?=???0.462, p?=?0.01), indicating that pain neuroscience knowledge was associated with less belief that chronic pain justifies disability.

Conclusions

A specific curriculum about pain during physiotherapy undergraduate education contributes to a more positive evidenced-based attitude to musculoskeletal pain and patient function. The association between pain neuroscience knowledge and positive attitudes and beliefs regarding pain were enhanced after clinical placements, demonstrating that learning improves when integrated into practice. Due to the impact of pain training and the expected benefits to patient care, health policy decision makers and educators should verify that the pain curriculum is current with the best research evidence. Future studies with larger samples that include students from other healthcare disciplines, including medicine are warranted.

     

The Role of Beliefs About the Importance of Social Skills in Elementary Children’s Social Behaviors and School Attitudes

Background

Positive attitudes toward school have been suggested as a meaningful indicator of school engagement among elementary children. The current study was guided by a social cognitive developmental perspective which suggests that social cognitions, including beliefs, play an important role in children’s adjustment outcomes.

Objective

The present study examined the hypothesis that children’s beliefs about the importance of social skills contribute to school attitudes through their effect on social behavior (i.e., social skills and aggression). The effect of gender was also examined as related to the mean levels of and associations among study constructs.

Methods

Participants were third through fifth-grade students (N = 342) and their teachers (N = 22) from Midwestern rural communities of the United States. Child self-reports, peer nominations, and teacher ratings were gathered.

Results

Children’s beliefs about the importance of social skills were positively associated with social skills and positive school attitudes and were negatively associated with aggression. Beliefs about the importance of social skills were indirectly related to positive school attitudes via social behaviors (i.e., social skills, aggression). Gender differences were detected in the mean levels of study constructs but not in the associations among them.

Conclusions

Findings suggest that children’s beliefs about social skills are an important aspect of social cognition that has significant implications for children’s social behavior and school adjustment. Specific ways in which the findings can inform educators and parents in supporting the development of children’s beliefs about the importance of social skills are discussed.     

Social support needs for equity in health and social care: a thematic analysis of experiences of people with chronic fatigue syndrome/myalgic encephalomyelitis

Background

Needs-based resource allocation is fundamental to equitable care provision, which can meet the often-complex, fluctuating needs of people with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME). This has posed challenges both for those providing and those seeking support providers, in building shared understanding of the condition and of actions to address it. This qualitative study reports on needs for equity in health and social care expressed by adults living with CFS/ME.

Methods

The participants were 35 adults with CFS/ME in England, purposively selected to provide variation in clinical presentations, social backgrounds and illness experiences. Accounts of experienced needs and needs-related encounters with health and social services were obtained through a focus group (n = 6) and semi-structured interviews (n = 35). These were transcribed and needs related topics identified through data-led thematic analysis.

Findings

Participants emphasised needs for personalised, timely and sustained support to alleviate CFS/ME impacts and regain life control, in three thematic areas: (1) Illness symptoms, functional limitations and illness management; (2) practical support and social care; (3) financial support. Access of people with CFS/ME to support from health and social services was seen to be constrained by barriers stemming from social, cultural, organisational and professional norms and practices, further heightened for disadvantaged groups including some ethnic minorities. These reduced opportunities for their illness to be explained or associated functional limitations and social disadvantages to be addressed through social support. Participants sought more understanding of bio-psycho-social aspects of CFS/ME, of felt needs of people with CFS/ME and of human rights and disability rights, for providing person-centred, equitable care.

Conclusions

Changes in attitudes of health practitioners, policy makers and general public and more flexibly organised health and social care provision are needed to address equity issues in support needs expressed by people with CFS/ME, to be underpinned by research-based knowledge and communication, for public and professional education. Policy development should include shared decision-making and coordinated action across organizations working for people with CFS/ME, human rights and disadvantaged groups. Experiences of people with CFS/ME can usefully inform an understanding of equity in their health and social care.     

Ursachen von Übergewicht

Background

Obesity is an increasing problem in Germany. This underlines the importance of preventive activities as part of primary health care. In this study we analysed patients’ beliefs about the causes of obesity, which were identified in behaviour-change counselling interviews with general practitioners.

Methods

Twelve physicians audiotaped check-up dialogues with 52 overweight patients (BMI≥25 kg/m^²). After the interviews were transcribed, a content analysis was performed using the method of Mayring.

Results

Patients attributed their overweight to both behavioural and non-behaviour-related causes during counselling interviews with physicians. Among the behavioural causes, we found different statements of self-responsibility. Patients identified metabolic factors or other predispositions as non-behaviour-related causes.

Conclusions

Patients have complex concepts about their beliefs about overweight; these offer physicians valuable access to patients’ perspectives. In terms of counselling about overweight, physicians should use this knowledge to strengthen their prevention activities.     

Potential impact of a pilot training program on smoking cessation intervention for tuberculosis DOTS providers in Malaysia

Background

The association between tuberculosis (TB) and tobacco smoking is becoming increasingly important. Smoking cessation may yield substantial positive effects on TB treatment outcomes, relapse, and future lung disease. Thus, TB directly observed therapy, short-course (TB DOTS) providers are uniquely positioned to intervene with those TB patients who are smokers. Unfortunately, most health care professionals are inadequately trained to provide such service.

Aim

This study aimed to determine the feasibility of developing and implementing a customized training program related to the delivery of an integrated smoking cessation intervention (SCI) for TB DOTS providers and to evaluate its potential impact on their knowledge, attitudes, and perceived competence.

Method

We developed and delivered a structured training program and materials about treating tobacco use and dependence in TB settings. The training was offered to DOTS providers from six chest clinics in Penang and Wilayah Persekutuan Kuala Lumpur health districts, Malaysia, who were planned to be involved in a larger project, known as the SCIDOTS Project. A pretest-posttest survey of a single group was conducted. Changes in scores before and after the training program in knowledge and attitude were measured.

Results

Ten DOTS providers participated in the program and completed both the pretest and posttest survey questionnaire. The trainees’ median scores in knowledge of health risks of tobacco and tobacco-related diseases, the association between TB and tobacco, and overall knowledge significantly increased compared to the baseline (p?<?0.05). Upon completion of the program, the majority of the trainees (70–100%) believed that they were competent and confident in performing most SCI activities.

Conclusion

This preliminary study suggests that a customized in-service training program on SCI designed for and delivered to TB DOTS providers could significantly improve their knowledge, attitude, and practice related to SCI. It has also highlighted the gap related to SCI in nursing education and calls for urgent curricula reforms.     

Scrambling for access: availability,accessibility, acceptability and quality of healthcare for lesbian,gay, bisexual and transgender people in South Africa

Background

Sexual orientation and gender identity are social determinants of health for people identifying as lesbian, gay, bisexual and transgender (LGBT), and health disparities among sexual and gender minority populations are increasingly well understood. Although the South African constitution guarantees sexual and gender minority people the right to non-discrimination and the right to access to healthcare, homo- and transphobia in society abound. Little is known about LGBT people’s healthcare experiences in South Africa, but anecdotal evidence suggests significant barriers to accessing care. Using the framework of the UN International Covenant on Economic, Social and Cultural Rights General Comment 14, this study analyses the experiences of LGBT health service users using South African public sector healthcare, including access to HIV counselling, testing and treatment.

Methods

A qualitative study comprised of 16 semi-structured interviews and two focus group discussions with LGBT health service users, and 14 individual interviews with representatives of LGBT organisations. Data were thematically analysed within the framework of the UN International Covenant on Economic, Social and Cultural Rights General Comment 14, focusing on availability, accessibility, acceptability and quality of care.

Results

All interviewees reported experiences of discrimination by healthcare providers based on their sexual orientation and/or gender identity. Participants recounted violations of all four elements of the UN General Comment 14: 1) Availability: Lack of public health facilities and services, both for general and LGBT-specific concerns; 2) Accessibility: Healthcare providers' refusal to provide care to LGBT patients; 3) Acceptability: Articulation of moral judgment and disapproval of LGBT patients’ identity, and forced subjection of patients to religious practices; 4) Quality: Lack of knowledge about LGBT identities and health needs, leading to poor-quality care. Participants had delayed or avoided seeking healthcare in the past, and none had sought out accountability or complaint mechanisms within the health system.

Conclusion

Sexual orientation and gender identity are important categories of analysis for health equity, and lead to disparities in all four dimensions of healthcare access as defined by General Comment 14. Discriminatory and prejudicial attitudes by healthcare providers, combined with a lack of competency and knowledge are key reasons for these disparities in South Africa.

     

Knowledge,Practice Behaviors,and Perceived Barriers to Fertility Care Among Providers of Transgender Healthcare

Purpose

Transgender individuals may experience impaired fertility due to gender-affirming hormonal interventions (e.g., pubertal suppression treatment and/or exogenous hormones). Clinical practice guidelines recommend providers discuss fertility implications and options for fertility preservation. The goal of this study was to examine fertility knowledge, practice behaviors, and perceived barriers to fertility care among multidisciplinary providers who care for transgender pediatric and/or adult patients.

Healthcare Providers' Beliefs and Attitudes About Electronic Cigarettes and Preventive Counseling for Adolescent Patients

PurposeElectronic cigarettes (e-cigarettes) are battery-powered nicotine delivery systems that may serve as a “gateway” to tobacco use by adolescents. Use of e-cigarettes by U.S. adolescents rose from 3% in 2011 to 7% in 2012. We sought to describe healthcare providers' awareness of e-cigarettes and to assess their comfort with and attitudes toward discussing e-cigarettes with adolescent patients and their parents.MethodsA statewide sample (n = 561) of Minnesota healthcare providers (46% family medicine physicians, 20% pediatricians, and 34% nurse practitioners) who treat adolescents completed an online survey in April 2013.ResultsNearly all providers (92%) were aware of e-cigarettes, and 11% reported having treated an adolescent patient who had used them. The most frequently cited sources of information about e-cigarettes were patients, news stories, and advertisements, rather than professional sources. Providers expressed considerable concern that e-cigarettes could be a gateway to tobacco use but had moderately low levels of knowledge about and comfort discussing e-cigarettes with adolescent patients and their parents. Compared with pediatricians and nurse practitioners, family medicine physicians reported knowing more about e-cigarettes and being more comfortable discussing them with patients (both p < .05). Nearly all respondents (92%) wanted to learn more about e-cigarettes.ConclusionsHealthcare providers who treat adolescents may need to incorporate screening and counseling about e-cigarettes into routine preventive services, particularly if the prevalence of use continues to increase in this population. Education about e-cigarettes could help providers deliver comprehensive preventive services to adolescents at risk of tobacco use.     

Knowledge,attitudes and behavior of physicians regarding predictive genetic tests for breast and colorectal cancer

Background

Genetic testing for cancer susceptibility is an emerging technology in medicine. This study assessed the knowledge, attitudes and professional behavior of Italian physicians regarding the use of predictive genetic tests for breast and colorectal cancer, including the BRCA1/2 and APC tests.

Methods

A cross-sectional survey of a random sample of Italian physicians was performed in 2010 through a self-administered questionnaire.

Results

A response rate of 69.6% (1079 questionnaires) was achieved. A significant lack of knowledge was detected, particularly for APC testing. Less than half of the physicians agreed on the importance of efficacy and cost-effectiveness evidence in the selection of predictive genetic tests to be offered to the patients. Multiple logistic regression analyses showed that education had a positive influence on knowledge, attitudes and, to a lesser extent, professional use. The factor most strongly related to the physicians' use of genetic testing was patients requests for breast (odds ratio = 12.65; 95% confidence interval 7.77–20.59) or colorectal cancer tests (odds ratio = 7.02; 95% confidence interval 3.61–13.64). A high level of interest for specific training was reported by almost all physicians surveyed.

Conclusions

Targeted educational programs are needed to improve the expertise of physicians, and, ultimately, to enhance the appropriate use of genetic tests in clinical practice.     

A systematic review of measures used in studies of human papillomavirus (HPV) vaccine acceptability

Background

The recent proliferation of studies describing factors associated with HPV vaccine acceptability could inform health care providers in improving vaccine coverage and support future research. This review examined measures of HPV and HPV-vaccine knowledge, attitudes, beliefs and acceptability, described psychometric characteristics, and provided recommendations about their use.

Methods

A systematic search of Medline, CINAHL, PsychoInfo, and ERIC through May 2008 for English language reports of quantitative data from parents, young adults or adolescents yielded 79 studies.

Results

The majority of studies were cross-sectional surveys (87%), self-administered (67%), conducted before prophylactic vaccines were publicly available (67%) and utilized convenience samples (65%). Most measured knowledge (80%), general attitudes about HPV vaccination (40%), and willingness to vaccinate one's daughter (26%). Two-thirds did not report reliability or validity of measures. The majority did not specify a theoretical framework.

Conclusions

Use of a theoretical framework, consistent labeling of constructs, more rigorous validation of measures, and testing of measures in more diverse samples are needed to yield measurement instruments that will produce findings to guide practitioners in developing successful community and clinical interventions.     

Association of vaccine-related attitudes and beliefs between parents and health care providers

Objectives

Health care providers influence parental vaccination decisions. Over 90% of parents report receiving vaccine information from their child's health care provider. The majority of parents of vaccinated children and children exempt from school immunization requirements report their child's primary provider is a good source for vaccine information. The role of health care providers in influencing parents who refuse vaccines has not been fully explored. The objective of the study was to determine the association between vaccine-related attitudes and beliefs of health care providers and parents.

Methods

We surveyed parents and primary care providers of vaccinated and unvaccinated school age children in four states in 2002–2003 and 2005. We measured key immunization beliefs including perceived risks and benefits of vaccination. Odds ratios for associations between parental and provider responses were calculated using logistic regression.

Results

Surveys were completed by 1367 parents (56.1% response rate) and 551 providers (84.3% response rate). Parents with high confidence in vaccine safety were more likely to have providers with similar beliefs, however viewpoints regarding disease susceptibility and severity and vaccine efficacy were not associated. Parents whose providers believed that children get more immunizations than are good for them had 4.6 higher odds of holding that same belief compared to parents whose providers did not have that belief.

Conclusions

The beliefs of children's health care providers and parents, including those regarding vaccine safety, are similar. Provider beliefs may contribute to parental decisions to accept, delay or forgo vaccinations. Parents may selectively choose providers who have similar beliefs to their own.     

Shifts in doctor-patient communication between 1986 and 2002: a study of videotaped General Practice consultations with hypertension patients

Background

Somatisation is particularly challenging in multicultural contexts where patients and physicians often differ in terms of their illness-related beliefs and practices and health care expectations. This paper reports on a exploratory study aimed at better understanding how asylum seeker and refugee patients from the former country of Yugoslavia who were identified by their physicians as somatising make sense of their suffering.

Methods

We conducted semi-structured interviews with 26 asylum seeker and refugee patients from the former country of Yugoslavia who attended the general medicine outpatient clinic of a Swiss teaching Hospital and were identified as presenting with somatisation. Interviews explored patients' illness perspectives and health care expectations. Interviews were audio taped, transcribed verbatim and analyzed to identify key themes in patients' narratives.

Results

Patients attributed the onset of symptoms to past traumatic experiences and tended to attribute their persistence to current living conditions and uncertain legal status. Patients formulated their suffering in both medical and social/legal terms, and sought help from physicians for both types of problems.

Conclusion

Awareness of how asylum seeker and refugee patients make sense of their suffering can help physicians to better understand patients' expectations of the clinical encounter, and the particular nature and constraints of the patient-provider relationship in the context of asylum.     

Implementation challenges of maternal health care in Ghana: the case of health care providers in the Tamale Metropolis

Background

Knowledge regarding the best approaches to improving the quality of healthcare and their implementation is lacking in many resource-limited settings. The Medical Department of Kamuzu Central Hospital in Malawi set out to improve the quality of care provided to its patients and establish itself as a recognized centre in teaching, operations research and supervision of district hospitals. Efforts in the past to achieve these objectives were short-lived, and largely unsuccessful. Against this background, a situational analysis was performed to aid the Medical Department to define and prioritize its quality improvement activities.

Methods

A mix of quantitative and qualitative methods was applied using checklists for observed practice, review of registers, key informant interviews and structured patient interviews. The mixed methods comprised triangulation by including the perspectives of the clients, healthcare providers from within and outside the department, and the field researcher’s perspectives by means of document review and participatory observation.

Results

Human resource shortages, staff attitudes and shortage of equipment were identified as major constraints to patient care, and the running of the Medical Department. Processes, including documentation in registers and files and communication within and across cadres of staff were also found to be insufficient and thus undermining the effort of staff and management in establishing a sustained high quality culture. Depending on their past experience and knowledge, the stakeholder interviewees revealed different perspectives and expectations of quality healthcare and the intended quality improvement process.

Conclusions

Establishing a quality improvement process in resource-limited settings is an enormous task, considering the host of challenges that these facilities face. The steps towards changing the status quo for improved quality care require critical self-assessment, the willingness to change as well as determined commitment and contributions from clients, staff and management.     

“We both just trusted and leaned on the Lord”: a qualitative study of religiousness and spirituality among African American breast cancer survivors and their caregivers

Purpose

Most breast cancer (BC) survivorship research focuses on the general population of survivors. Scant research investigates the potentially unique experiences of minorities, especially during and after the difficult transition from primary treatment to post-treatment. This qualitative study explored African American BC survivors’ and caregivers’ quality-of-life in the post-treatment period with a focus on social and spiritual well-being.

Methods

Participants included a convenience sample of African American women with stage I–III BC (N = 23) who completed treatment 6–24 months before enrollment. Primary caregivers (N = 22) included friends, spouses and other family members (21 complete dyads). Participants completed separate semi-structured telephone interviews. Template analysis was used to evaluate themes related to religiousness and spirituality, both across and within dyads.

Results

After treatment, religiousness and spirituality played a major role in both survivors’ and caregivers’ lives by: (1) providing global guidance, (2) guiding illness management efforts and (3) facilitating recovery. Participants described a spiritual connectedness with God and others in their social networks. Dyad members shared the goal of keeping a positive attitude and described positive growth from cancer. Few future concerns were expressed due to the belief that survivors were healed and “done” with cancer. Beyond practical and emotional support, provision of spiritual assistance was common.

Conclusions

Results highlight the principal, positive role of religiousness and spirituality for African American BC survivors and caregivers after treatment. Findings emphasize the need to assess the importance of religious and spiritual beliefs and practices, and if appropriate, to provide resources that promote spiritual well-being.