Assessment of Anxiety and Depression Among Breast Cancer Patients Undergoing Treatment in

164 Pages·2017·1.36 MB·English

Walden University
ScholarWorks
Walden Dissertations and Doctoral Studies
Walden Dissertations and Doctoral Studies
Collection
2017
Assessment of Anxiety and Depression Among
Breast Cancer Patients Undergoing Treatment in
Ghana
Kofi Adesi Kyei
Walden University
Follow this and additional works at:https://scholarworks.waldenu.edu/dissertations
Part of thePublic Health Education and Promotion Commons
This 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
[email protected].
Walden University

College of Health Sciences

This is to certify that the doctoral dissertation by

Kofi Adesi Kyei

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. John Oswald, Committee Chairperson, Public Health Faculty
Dr. Anuli Njoku, Committee Member, Public Health Faculty
Dr. Patrick Tschida, University Reviewer, Public Health Faculty

Chief Academic Officer
Eric Riedel, Ph.D.

Walden University
2017
Abstract
Assessment of Anxiety and Depression Among Breast Cancer Patients Undergoing
Treatment in Ghana
by
Kofi Adesi Kyei

MPhil, Cape Peninsula University of Technology, 2010
BSc (Hons), University of Ghana, 2006

Dissertation Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
Public Health

Walden University
November 2017
Abstract
Breast cancer patients undergoing radiotherapy often experience severe levels of anxiety
and depression. There is a gap in the research literature from Africa, particularly from
Ghana, with few studies focusing on the assessment of anxiety and depression among
breast cancer patients undergoing radiation treatment. A better understanding was
essential to promote efforts to help breast cancer patients cope with their diagnosis and
treatment and increase their overall quality of life. This mixed method study examined
breast cancer patients in Ghana undergoing radiotherapy and their responses related to
anxiety and depression through a concurrent triangulation involving an interview with
selected professional participants and a detailed patient survey. Patients completed 2
modified scales, the Patient Health Questionnaire and Depression Anxiety Stress Scale.
The sample consisted of 100 patients between the ages of 20-89. Individual interviews
were held with 6 professionals with a minimum of 5 years of work experience. Themes
were generated through open coding of the interview data, while multiple regression was
performed to determine the relationship between depression and anxiety with the
independent variables . Findings of this study indicated the need intervene through
counseling and education on behalf of patients in Ghana as they undergo breast cancer
treatment. Age and monthly income of patients were statistically significant in predicting
the anxiety and depression among the patients. The study’s implications will lead to
positive change when all stakeholders take on the responsibility of implementing
measures to promote coping strategies for breast cancer patients in Ghana.
Assessment of Anxiety and Depression Among Breast Cancer Patients Undergoing
Treatment in Ghana
by
Kofi Adesi Kyei

MPhil, Cape Peninsula University of Technology, 2010
BSc (Hons), University of Ghana, 2006

Dissertation Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
Public Health

Walden University
November 2017
Dedication
I dedicate this dissertation to my charming wife, Justina Baaba Kyei, and my
lovely children, Penelope, Carina and Bennett Kyei. Penelope and Carina, it seems like a
dream, but you all grew up during the period of my dissertation. Justina, your strength,
and confidence in me kept me going through this whole time and you never failed to help
me keep on, even when I felt. It is such an honor to be my wife and the mother of my
children. With all the sacrifices you made for me, and the continuous love you have
shown me, I will surely look forward to seeing you forge ahead for your dreams. I
appreciate all that you have done for me and all the others you did without me because I
was busily writing or studying or traveling for my Residencies. I pray that God will
reward you with a satisfying life, and your life becomes pleasant all the days ahead. The
God of our Spiritual Father, Bishop Gideon Titi-Ofei, bless you abundantly.
Acknowledgement
There are numerous of people who have tremendously gone all out to support,
believe and assisted me throughout this journey with Walden University, and much more
importantly, writing this dissertation. The first person, Dr. John Wieland Oswald, my
committee chair, and a father: I appreciate the support, corrections, encouragement, and
kindness you gave me over the past years as you guided me to a distinction without
letting me compromise my work even when the situation was desperate. You will always
be in my heart. The second person, my committee member, Dr. Anuli Uzoaru Njoku:
thank you for love, the time spent on my work and the step by step corrections and
directions. Thank you, Dr. Patrick Tschida, for your assistance and Dr. Nancy Rea for
your time on my work. Dr. Leilani Endicott: thank you for your time and directions
during all my Residencies. Prof. Penelope Engel-Hills: thank you for your expert editing,
but mostly for your encouragement and interest in my topic, you knew this right from the
onset, and you believed in me. Dr. Verna Vanderpuye, you were always there for me,
reviewed the work severally, and acted as local supervisor in Ghana. Dr. Joel Yarney,
you gave permission to use the study site, God richly bless you. Dr. William Antwi, you
were always there for me, the book was quite helpful. Dr. Samuel Yaw Opoku, you
supported all my residency trips with letters. Mr. Andrew Donkor, you took the time to
read through my work, amid your busy schedule on campus in Switzerland, Mr. Michael
Kwabeng Addo, Frederick Yakanu and Kwabena Anarfi, I appreciate the time you took
in reviewing my work. Above all, I want to thank Jesus, for seeing me through this
through the continuous prayer of my Pleasant Bishop Gideon Titi-Ofei.
Table of Contents
List of Tables ..................................................................................................................... vi
List of Figures ................................................................................................................... vii
Chapter 1: Introduction to the Study ....................................................................................1
Introduction ....................................................................................................................1
Background of the Study ...............................................................................................2
Problem Statement .........................................................................................................4
Purpose of the Study ......................................................................................................6
Research Questions and Hypothesis ..............................................................................6
Theoretical Framework ..................................................................................................7
Nature of the Study ........................................................................................................8
Assumptions ...................................................................................................................8
Scope and Delimitations ................................................................................................9
Limitations .....................................................................................................................9
Significance of the Study .............................................................................................10
Summary ......................................................................................................................11
Chapter 2: Literature Review .............................................................................................12
Introduction ..................................................................................................................12
Search Criteria/Description of Literature Search .........................................................13
Gap in the Literature ............................................................................................. 13
Social Implications of the Study ........................................................................... 14
Theoretical Framework ................................................................................................16
i
Theories................................................................................................................. 16
Health Action Process Approach .......................................................................... 16
Influence of the Health Action Process Approach on the Study .......................... 17
Alignment of the Health Action Process Approach With the Study .................... 18
Breast Cancer in Ghana ...............................................................................................19
Patients Flow and Staff ......................................................................................... 20
Culture Against Breast Cancer .............................................................................. 21
Contributing Factors to Breast Cancer and Their Impact on the Study ................ 22
Cost of Breast Cancer in Ghana ............................................................................ 24
Anxiety and Depression as Risk Factors for Breast Cancer ........................................26
Diagnosis of Anxiety and Depression Among Breast Cancer .....................................27
Anxiety and Depression Among Breast Cancer Patients .............................................28
Causes of Anxiety and Depression Among Breast Cancer Patients ..................... 28
Prevalence of Anxiety and Depression in Breast Cancer Patients ........................ 29
Symptoms of Anxiety and Depression in Breast Cancer Patients ........................ 30
Interventions and Treatment of Anxiety and Depression ..................................... 30
Validity of Anxiety and Depression Symptoms Scales ...............................................35
Summary ......................................................................................................................35
Chapter 3: Methodology ....................................................................................................37
Introduction ..................................................................................................................37
Research Methodology ................................................................................................37
Setting and Sample ......................................................................................................38
ii
Qualitative Interviews and Quantitative Survey ..........................................................40
Participant Selection ....................................................................................................41
Role of the Researcher .................................................................................................42
Data Collection ............................................................................................................42
Data Management and Analysis ..................................................................................43
Validity and Reliability ................................................................................................44
Ethical Review .............................................................................................................44
Respect for Autonomy .......................................................................................... 45
Respect for Privacy and Confidentiality ............................................................... 45
The Need to Consider Risk of Harm..................................................................... 46
The Need to Avoid Deceit and Exploitation ......................................................... 46
Summary ......................................................................................................................47
Introduction ..................................................................................................................48
Data Collection and Management ................................................................................49
Coding Analysis .................................................................................................... 49
Themes .................................................................................................................. 50
Research Findings ................................................................................................. 50
Qualitative Data ...........................................................................................................51
Descriptive Statistics for the Interviews ............................................................... 51
Research Question ................................................................................................ 52
Formation of Themes ............................................................................................ 52
Interventions Prescribed for Patients .................................................................... 59
iii