Writing to Heal: A Culturally Based Brief Expressive Writing Intervention for Chinese Immigrant Breast Cancer Survivors

项目总结/摘要 中国移民乳腺癌幸存者缺乏文化上合格的精神卫生保健 未满足的心理需求是中国移民经历的健康差异的特征 乳腺癌幸存者乳腺癌是中国人发病率最高的癌症 中国移民乳腺癌幸存者的生活质量低于非中国人， 西班牙裔白色人。然而，其中缺乏改善生活质量的干预措施。 移民人口。表达性书写干预使用书写提示，通过促进 情感和认知过程以西方和东方理论为指导， 为了显示表达性写作在中国移民中的好处，本研究建议测试中国移民的健康状况， 一项创新的简短写作干预对中国移民乳腺癌幸存者的影响 采用随机对照试验和混合方法设计。中国移民乳腺癌幸存者 （N=240）将被随机分配到一个控制条件下写关于中性主题或两个之一 干预条件：自我调节和自我培养，其目的都是促进适应性认知 不同的过程，但在如何实现这一目标。自律干预包括传统的 西方的表达性写作范式，而自我培养干预则融入了亚洲文化 价值观所有三个条件的参与者将被要求在每周三次的30分钟内用中文写作 sessions.主要结果将是生活质量，次要结果将是感知压力， 生物标志物和癌症相关疾病的医疗预约。自我报告的健康结果（QOL 和感知压力）将在基线和6个月和12个月随访时进行评估。应激生物标志物 （唾液皮质醇和α-淀粉酶）将在基线和6周随访时进行评估， 在6周随访时也将自我报告压力。12个月随访前的医疗预约 将自行记录并通过病历进行验证。我们假设这两个干预条件将 改善生活质量，减少压力和癌症相关疾病的医疗预约， 使压力生物标志物正常化。很少有研究在有色人种社区测试基于证据的项目， 更少的人测试了基于文化的干预措施，这些干预措施采用了 服务不足的社区。我们期望所提出的研究，以理论，实践和方法为指导， 并为服务不足的人群量身定制，将激发新的研究方向，以解决这些问题 健康差距研究的科学和实际需要。

Project Summary/Abstract The unavailability of culturally competent mental health care for Chinese immigrant breast cancer survivors and their unmet psychological needs characterize the health disparity experienced by Chinese immigrant breast cancer survivors. Breast cancer is the cancer with the highest incidence rate among the Chinese population and Chinese immigrant breast cancer survivors have lower quality of life compared to their non- Hispanic white counterpart. However, interventions to improve quality of life are lacking among this immigrant population. Expressive writing intervention uses writing prompts to promote health by facilitating emotional and cognitive processes. Guided by Western and Eastern theories and preliminary studies showing the benefits of expressive writing among Chinese immigrants, this study proposes to test the health effects of an innovative and brief writing intervention among Chinese immigrant breast cancer survivors using a randomized controlled trial and mixed methods design. Chinese immigrant breast cancer survivors (N=240) will be randomly assigned either to a control condition to write about neutral topics or to one of two intervention conditions, self-regulation and self-cultivation, which both aim to promote adaptive cognitive processes but differ in how they achieve this goal. The self-regulation intervention incorporates a traditional Western expressive writing paradigm, whereas the self-cultivation intervention incorporates Asian cultural values. Participants in all three conditions will be asked to write in Chinese during three weekly 30-minute sessions. The primary outcome will be QOL, and the secondary outcomes will be perceived stress, stress biomarkers, and medical appointments for cancer-related morbidities. Self-reported health outcomes (QOL and perceived stress) will be assessed at baseline and 6- and 12-month follow-ups. Stress biomarkers (salivary cortisol and alpha-amylase) will be assessed at baseline and 6-week follow-up, and perceived stress will also be self-reported at the 6-week follow-up. Medical appointments up to the 12-month follow-up will be self-recorded and verified by medical record. We hypothesize that the two intervention conditions will improve quality of life, reduce perceived stress and medical appointments for cancer-related morbidities, and normalize stress biomarkers. Few studies have tested evidence-based programs in communities of color, and even fewer have tested culturally based interventions that adopted the cultural values of the underserved communities. We expect that the proposed study, guided by theory, practices, and methods and tailored for an underserved population, will inspire new directions in research to address these scientific and practical needs in health disparities research.