JURNAL INTERNASIONAL KEBIDANAN 2020-2023 UNIVERSITAS KEDOKTERAN GUILAN VOLUME 31 ISSUE 4.
JOURNAL OF HOLISTIC NURSING OF MIDWIFERY.
Investigation of Structural Relationships of Factors Affecting Posttraumatic Growth in Women With Breast Cancer

JURNAL INTERNASIONAL KEBIDANAN 2020-2023 UNIVERSITAS KEDOKTERAN GUILAN VOLUME 31 ISSUE 4.
JOURNAL OF HOLISTIC NURSING OF MIDWIFERY.
Investigation of Structural Relationships of Factors Affecting Posttraumatic Growth in Women With Breast Cancer

Posttraumatic growth, Positive Re-evaluation, Re-evaluation, Spirituality, Religion, Rumination

Introduction: It is necessary to identify the factors affecting the posttraumatic growth of
cancer patients to minimize the consequences of its psychological trauma.
Objective: This study aimed to determine the structural relationships of coping styles, the
collapse of core beliefs, social support, spirituality/religious coping with posttraumatic growth
variables, and the mediating role of positive reassessment and deliberate mental rumination
within a causal pattern.
Materials and Methods: This cross-sectional study was performed using path analysis and
structural equation modeling (SEM) by convenience sampling method on 213 patients with
breast cancer in Mashhad, Iran, in 2019. The pattern of variables relationships was tested
in a conceptual model by SEM and used the partial least squares regression method to test
the measurement pattern and research hypotheses. In the measurement model section,
three convergent validity indices, i.e., Average Variance Extracted (AVE), Composite Reliability
(CR), and the Cronbach α, and in the structural model section, two indicators of coefficient of
determination (R2

) and Stone-Geisser coefficient (Q2).

Results: The Mean±SD age of the patients was 52±16 years. The standardized coefficients
of the overall effect of core beliefs pathways, positive religious coping, search for meaning,
presence of meaning, deliberate rumination over positive re-evaluation were 0.953, 0.386,
-0.250, 0.248, and 0.238, respectively (P=0.001). The direct coefficient of the positive
reassessment path to posttraumatic growth was 0.085 (P=0.01). Also, the coefficient of
collapse path of core beliefs to intrusive rumination was 0.687, which was significant at the
level of P=0.0001. Finally, the standardized coefficients of the overall effect of all paths for
negative religious coping, the collapse of core beliefs, presence of meaning, problem-based
coping style, search for meaning, deliberate rumination, social support, positive religious
coping, emotion-based coping, intrusive rumination over posttraumatic growth were -0.481,
0.227, 0.182, 0.146, -0.136, 0.066, 0.060, 0.059, 0.056, and -0.043, respectively (P=0.0001).
Conclusion: The results of the present study showed that in addition to confirming the
direct paths of independent variables to the posttraumatic growth, positive reassessment
had a mediating role between pathways of the presence and search of meaning, conscious
rumination, religious coping, and the collapse of core beliefs in posttraumatic growth.

Azam Hashemian Moghadam , Hamid Reza Aghamohammadian Sharbaf , Mohammad Saeid AbdeKhodaei , Hossein Kareshki , Mona Joudi

October 2021, Volume 31, Number 4

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