Quality of Life Research

, Volume 19, Issue 6, pp 789-802

First online:

Predicting physical quality of life among a multiethnic sample of breast cancer survivors

  • Kimlin T. Ashing-GiwaAffiliated withDivision of Population Sciences, Center of Community Alliance for Research and Education (CCARE), City of Hope National Medical Center Email author 
  • , Jung-Won LimAffiliated withDivision of Population Sciences, Center of Community Alliance for Research and Education (CCARE), City of Hope National Medical Center

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This study aims to test the utility and applicability of the physical quality of life (PQOL) model based on the Contextual Model of Health-Related Quality of Life (HRQOL). Specifically, this study focuses on investigating the different patterns in the structural model of PQOL according to four major U.S. ethnic groups and the mediating effects of psychological well-being between the systemic-level constructs and PQOL.


Secondary data were used to investigate PQOL among 703 European-, African-, Latina-, and Asian-American women diagnosed with breast cancer. A cross-sectional design with mixed sampling methods was used. The study methodology was guided by the Contextual Model of HRQOL.


Multiple group analyses demonstrated that the predicted relationships among the variables were not equivalent across ethnic groups at a P < 0.05 level. Specifically, the relationships between the socio-ecological factor and health care system variables varied across all ethnic groups. However, the direct impacts of life burden and psychological well-being on PQOL were consistent among all ethnic groups. The systemic-level constructs such as life burden and patient–doctor relationship indirectly influenced PQOL through psychological well-being for the specific ethnic groups.


Our findings revealed ethnic variability in the associations among the individual- and systemic-level contexts influencing PQOL based on the Contextual Model of HRQOL. HRQOL research including studies examining physical outcomes can utilize a comprehensive and integrated conceptual approach that includes psychological, socio-ecological, and cultural aspects to deepen our understanding and advance the translational utility of the research into clinical practice.


Physical quality of life Psychological well-being Health care system Socio-ecological characteristics Breast cancer survivorship