Exploration of the Role Self-Management in Improving Chemotherapy Compliance: Theory of Planned Behavior
Abstract
Introduction: Chemotherapy compliance in breast cancer patients is crucial, as side effects often lead to non-compliance, worsening the disease. Current self-management lacks a behavioral approach, highlighting the need for a self-management model based on the theory of planned behavior to enhance compliance. This study aimed to explore chemotherapy compliance in breast cancer patients by examining individual factors, specific conditions, and self-management strategies grounded in the theory of planned behavior.
Methods: A cross-sectional design and purposive sampling were conducted on 208 respondents, consisting of chemotherapy patients with breast cancer. The variables of this study were the individual factors, specific conditions, theory of planned behavior (TPB)-based self-management, and chemotherapy adherence. The data was collected using questionnaires in August–September 2024 at Islamic Hospital in Central Java, Indonesia, and processed using Smart Partial Least Square (SmartPLS) analysis.
Results: Individual and condition-specific factors explained 96.3% of the variation in TPB-based self-management, and TPB-based self-management explained 91.4% of chemotherapy adherence. This model showed strong predictive relevance. There was a significant relationship between self-management and adherence (p < 0.001; β = 0.465). The interactions between individual and self-management factors and condition-specific and self-management factors also contributed significantly to adherence (p = 0.019; β = 0.298 and p < 0.001; β = 0.717). These findings confirm the important role of self-management as a mediator in chemotherapy adherence.
Conclusion: TBP-based self-management is a major factor improving chemotherapy compliance. It is a mediator of individual factors and specific conditions that play an important role in improving chemotherapy compliance.
References
1. Lestari NKY, Lestari AAD. Gambaran Kepatuhan Pasien Kanker Payudara Yang Menjalani Kemoterapi Di Ruang Kemoterapi Sanjiwani Rsup Sanglah Denpasar. Pros Semin Nas. 2019;(Kepatuhan Pasien Kanker Payudara Terhadap Kemoterapi):145.
2. Darmawan ARF, Adriani M. Status Gizi, Asupan Energi dan Zat Gizi Makro Pasien Kanker yang Menjalani Kemoterapi di RUMKITAL Dr. Ramelan Surabaya. Amerta Nutr. 2019;3(3):149–57.
3. Williams ALM, Khan CP, Heckler CE, Barton DL, Ontko M, Geer J, et al. Fatigue, anxiety, and quality of life in breast cancer patients compared to non-cancer controls: a nationwide longitudinal analysis. Breast Cancer Res Treat [Internet]. 2021;187(1):275–85. Available from: https://doi.org/10.1007/s10549-020-06067-6
4. Ministry of Health Republic Indonesia. Kanker Payudara Paling Banyak di Indonesia, Kemenkes Targetkan Pemerataan Layanan Kesehatan [Internet]. Jakarta; 2022. Available from: https://www.kemkes.go.id/article/view/22020400002/kanker-payudaya-paling-banyak-di-indonesia-kemenkes-targetkan-pemerataan-layanan-kesehatan.html
5. Yao S, Zhu Q, Zhang Q, Cai Y, Liu S, Pang L, et al. Managing Cancer and Living Meaningfully (CALM) alleviates chemotherapy related cognitive impairment (CRCI) in breast cancer survivors: A pilot study based on resting-state fMRI. Cancer Med. 2023;12(15):16231–42.
6. Suarilah I, Nihayati HE, Wahyudi AS, Asmoro CP, Felipe-Dimog EB. Treatment decision-making experience among Indonesian women with obstetrics and gynecology-related cancer. Med Palliat [Internet]. 2023;22(2):68–76. Available from: https://doi.org/10.1016/j.medpal.2022.08.004
7. Lv D, Lan B, Zhang L, Sun X, Yang M, Ma F. Association between depression and anxiety status of breast cancer patients before adjuvant chemotherapy and chemotherapy-induced adverse events. Cancer Med. 2022;(February 2022):4794–800.
8. Csuka SI, Désfalvi J, Thege BK, Sallay V, Martos T. Relationship satisfaction and self ‑ esteem in patients with breast cancer and healthy women : the role of expected and actual personal projects support from the partner. BMC Womens Health [Internet]. 2023;23(42):1–11. Available from: https://doi.org/10.1186/s12905-023-02555-1
9. Kemenkes RI. Kanker Payudara Paling Banyak di Indonesia, Kemenkes Targetkan Pemerataan Layanan Kesehatan [Internet]. Jakarta; 2022. Available from: https://www.kemkes.go.id/article/view/22020400002/kanker-payudaya-paling-banyak-di-indonesia-kemenkes-targetkan-pemerataan-layanan-kesehatan.html
10. Badan Pusat Statistik Jawa Tengah. Profil Kesehatan Jawa Tengah 2013 [Internet]. Semarang; 2013. Available from: https://jateng.bps.go.id/publication/2014/12/09/d894bfaf589f804c7d3f5c1a/profil-kesehatan-jawa-tengah-2013.html
11. Adam R, Haileselassie W, Solomon N, Desalegn Y, Tigeneh W, Suga Y, et al. Nutritional status and quality of life among breast Cancer patients undergoing treatment in Addis Ababa, Ethiopia. BMC Womens Health [Internet]. 2023;23(1):428. Available from: https://www.ncbi.nlm.nih.gov/pubmed/37568125%0Ahttps://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC10422709
12. Susilawati S, Syabaniah RN, Riniawati R. Pengaruh Asupan Makanan dan Stress terhadap Kondisi Kesehatan Pasien Kemoterapi. J Sains dan Kesehat. 2021;3(3):470–7.
13. Gernier F, Grellard JM, Dupont C, Castel H, Fernette M, Lahaye F, et al. Impact of web application support versus standard management on adherence with adjuvant hormone therapy in patients treated for breast cancer: the WEBAPPAC study. BMC Cancer. 2023;23(1):736.
14. Ali EE, Cheung KL, Lee CP, Leow JL, Yap KY, Chew L. Prevalence and determinants of adherence to oral adjuvant endocrine therapy among breast cancer patients in Singapore. Asia-Pacific J Oncol Nurs [Internet]. 2023;4(4):283–9. Available from: https://dx.doi.org/10.4103/2347-5625.212864
15. Martina I, Cahyono HD. Faktor - Faktor yang Mempengaruhi Kepatuhan Kemoterapi pada Pasien dengan Kanker. Nurs Updat J Ilmu Keperawatan. 2023;14(2):215–20.
16. Jia L, Hu Y. Self-Management About Adjuvant Therapy in Breast Cancer Survivors: A Qualitative Study. Patient Prefer Adherence. 2022;16:2663–81.
17. Moon Z, Moss-morris R, Hunter MS, Hughes LD. Development of a self-management intervention to improve tamoxifen adherence in breast cancer survivors using an Intervention Mapping framework. Support Care Cancer. 2021;29(1):3329–38.
18. Luo X, Chen Y, Chen J, Zhang Y, Li M, Xiong C, et al. Effectiveness of mobile health ‑ based self ‑ management interventions in breast cancer patients : a meta ‑ analysis. Support Care Cancer [Internet]. 2022;2853–76. Available from: https://doi.org/10.1007/s00520-021-06568-0
19. Grady PA, Gough LL. Self-management: A comprehensive approach to management of chronic conditions. Am J Public Health. 2014;108(8):S430–6.
20. Bing Z, Zheng Z, Zhang J. Risk factors influencing chemotherapy compliance and survival of elderly patients with non-small cell lung cancer. Afr Health Sci. 2023;23(3):291–300.
21. Freeman JQ, Sheade J, Zhao F, Olopade OI, Nanda R. Demographic and Clinical Characteristics Associated With Familiarity , Interest , and Use of Integrative Therapies Among Patients With Breast. Integr Cancer Ther. 2023;22(1):1–11.
22. Rimmer B, Brown MC, Sotire T, Beyer F, Bolnykh I, Balla M, et al. Characteristics and Components of Self-Management Interventions for Improving Quality of Life in Cancer Survivors: A Systematic Review. Cancers (Basel). 2024;16(1).
23. Ryan P, Sawin KJ. The Individual and Family Self-Management Theory: Background and perspectives on context, process, and outcomes. Nurs Outlook. 2009;57(4):217–25.
24. Rias YA, Rosa EM. Pengembangan Model Konservasi Discharge Planning Terstruktur Terhadap Individual And Family Self Management Diabetic Foot Ulcer. Psisula Pros Berk Psikol 1. 2020;1(1):1–27.
25. Ajzen I. The theory of planned behavior: Frequently asked questions. Hum Behav Emerg Technol. 2020;2(4):314–24.
26. Pan L, Zhang X, Wang S, Zhao N, Zhao R, Ding B, et al. Determinants associated with self-management behavior among type 2 diabetes patients in China: A structural equation model based on the theory of planned behavior. Int J Clin Heal Psychol [Internet]. 2023;23(1):100332. Available from: https://doi.org/10.1016/j.ijchp.2022.100332
27. Ghozali I. Partial Least Square Konsep, Teknik Dan Aplikasi Menggunakan Program SmartPLS 3.2.9 Untuk Penelitian Empiri. Edisi 3. Semarang: Badan Penerbit Universitas Diponegoro; 2021.
28. Hair JF, Brunsveld N. Essentials of business research methods. Essentials of Business Research Methods. New York: Routledge; 2019. 1–507 p.
29. Ministry of Health of the Republic of Indonesia. Regulation of the Minister of Health of the Republic of Indonesia No. 25 of 2016 [Internet]. Ministry of Health of the Republic of Indonesia. Jakarta; 2016. Available from: https://scioteca.caf.com/bitstream/handle/123456789/1091/RED2017-Eng-8ene.pdf?sequence=12&isAllowed=y%0Ahttps://dx.doi.org/10.1016/j.regsciurbeco.2008.06.005%0Ahttps://www.researchgate.net/publication/305320484_SISTEM_PEMBETUNGAN_TERPUSAT_STRATEGI_MELESTARI
30. Ardian I, Nursalam, Ahsan, Haiya N, Azizah IR. Investigating the complex relationships between nurses ’ work factors , Sharia -based nursing care , and patient satisfaction in an Islamic hospital : A PLS-SEM approach. Belitung Nurs J. 2023;9(6):530–8.
31. Anggraeni FD, Sukartini T, Nihayati HE. Quality of life of breast cancer patients. Pediomaternal Nurs J. 2023;9(1):31–5.
32. Mayasari, Indah D, Widjajanto E, Supriati L. Pengaruh Logoterapi Terhadap Kecemasan Pada Pasien Kanker Payudara Yang Menjalani Kemoterapi Di Rumah Sakit Dr. Soepraoen Malang. J Penelit Keperawatan [Internet]. 2017;3(2):79–87. Available from: https://download.garuda.kemdikbud.go.id/article.php?article=898328&val=14123&title=PENGARUH LOGOTERAPI TERHADAP KECEMASAN PADA PASIEN KANKER PAYUDARA YANG MENJALANI KEMOTERAPI DI RUMAH SAKIT DR SOEPRAOEN MALANG
33. Nira AW, Triharini M, Nastiti AA. Factors Associated with The Resilience of Breast Cancer Patients Undergoing Chemotherapy. Pediomaternal Nurs J. 2020;6(2):89.
34. Norman P, Hoyle S. The Theory of Planned Behavior and Breast Self-Examination : Distinguishing Between Perceived Control and Self-Efficacy. J Appl Soc Psychol. 2004;34(4):694–708.
35. Hunter MS, Grunfeld EA, Ramirez AJ. Help-seeking intentions for breast-cancer symptoms: A comparison of the self-regulation model and the theory of planned behaviour. Br J Health Psychol. 2003;8(3):319–33.
36. Iskandar, Rizka A, Akramah S. Analisis Hubungan Tingkat Pendidikan dan Pengetahuan Terhadap Kepatuhan Kemoterapi Pada Pasien Kanker Payudara di Rumah Sakit Umum Cut Meutia Aceh Utara. J Ilm Mns Dan Kesehat. 2023;6(1):69–77.
37. Afthanorhan A, Awang Z, Majid NA, Foziah H, Ismail I, Halbusi H Al, et al. Gain More Insight from Common Latent Factor in Structural Equation Modeling. J Phys Conf Ser. 2021;1793(1).
38. Mansor M, Ibrahim RM, Afthanorhan A, Salleh AMM. The mechanism of anger and negative affectivity on the occurrence of deviant workplace behavior: An empirical evidence among Malaysian nurses in public hospitals. Belitung Nurs J. 2022;8(2):115–23.
39. Vassilev I, Lin SX, Calman L, Turner J, Frankland J, Wright D, et al. The role of social networks in the self-management support for young women recently diagnosed with breast cancer. PLoS One [Internet]. 2023;18(4 April):1–21. Available from: https://dx.doi.org/10.1371/journal.pone.0282183
40. Shi N, Ching Wong AK, Yuet Wong FK, Zhang N, Zhu W, Shen K, et al. Feasibility of a mobile health app-based self-management program for Chinese patients with breast cancer receiving chemotherapy: A randomized controlled pilot study. Digit Heal. 2024;10(1):1–17.
41. González GMC, Parra LRC, Forero JEG. Cancer nursing; symptom management. Ann Oncol [Internet]. 2024;35(1):S1194. Available from: https://doi.org/10.1016/j.annonc.2024.08.487
42. Been-Dahmen JMJ, van der Stege H, Oldenmenger WH, Braat C, van der Lans MCM, Scheper M, et al. What factors contribute to cancer survivors’ self-management skills? A cross-sectional observational study. Eur J Oncol Nurs [Internet]. 2024;69(September 2023):102539. Available from: https://doi.org/10.1016/j.ejon.2024.102539
43. Vallis M, Ryan H, Berard L, Cosson E, Kristensen FB, Levrat-Guillen F, et al. How Continuous Glucose Monitoring Can Motivate Self-management: Can Motivation Follow Behaviour? Can J Diabetes [Internet]. 2023;47(5):435–44. Available from: https://doi.org/10.1016/j.jcjd.2023.04.001
44. Zhu M, Doo MY. The relationship among motivation, self-monitoring, self-management, and learning strategies of MOOC learners. J Comput High Educ [Internet]. 2022;34(2):321–42. Available from: https://doi.org/10.1007/s12528-021-09301-2
45. Wu R, Feng S, Quan H, Zhang Y, Fu R, Li H. Effect of Self-Determination Theory on Knowledge, Treatment Adherence, and Self-Management of Patients with Maintenance Hemodialysis. Contrast Media Mol Imaging. 2022;2022.
46. Shin DS, Kim S, Jo HS. Understanding facilitators and barriers of online cancer information utilization among cancer survivors and their families: Focus on the theory of planned behavior. Asian Pacific J Cancer Prev. 2020;21(5):1357–62.
47. Vainauskienė V, Vaitkienė R. Enablers of patient knowledge empowerment for self-management of chronic disease: An integrative review. Int J Environ Res Public Health. 2021;18(5):1–24.
48. Papadakos J, Barnsley J, Berta W, Rowlands G, Samoil D, Howell D. The association of self-efficacy and health literacy to chemotherapy self-management behaviors and health service utilization. Support Care Cancer [Internet]. 2022;30(1):603–13. Available from: https://doi.org/10.1007/s00520-021-06466-5
49. Shi N, Wong AKC, Wong FKY, Zhang N, Lai X, Gan L. A Nurse-Led mHealth Self-Management Program (mChemotherapy) for Breast Cancer Patients Undergoing Chemotherapy: Study Protocol of a Randomized Controlled Pilot Study. Cancer Control. 2022;29:1–11.
50. Lawless MT, Tieu M, Feo R, Kitson AL. Theories of self-care and self-management of long-term conditions by community-dwelling older adults: A systematic review and meta-ethnography. Soc Sci Med [Internet]. 2021;287(September):114393. Available from: https://doi.org/10.1016/j.socscimed.2021.114393
51. Shen A, Wu P, Qiang W, Fu X, Wang F, Zhu F, et al. Predicting lymphedema self-management behaviours in breast cancer patients: A structural equation model with the Integrated Theory of Health Behaviour Change. J Adv Nurs. 2023 Dec;79(12):4778–90.
52. Pourmand G, Doshmangir L, Ahmadi A, Noori M, Rezaeifar A, Mashhadi R, et al. An application of the theory of planned behavior to self-care in patients with hypertension. BMC Public Health. 2020;20(1290):1–8.
53. Jalali Javaran E, Sharifi H, Hasani M, Borhaninejad V, Iranpour A. Effectiveness of a Theory of Planned Behavior-Based Intervention for Promoting Medication Adherence among Rural Elderly Hypertensive Patients in Iran. Elder Heal J. 2020;6(1):9–15.
54. Jiang Y, Sun X, Jiang M, Min H, Wang J, Fu X, et al. Impact of a mobile health intervention based on multi-theory model of health behavior change on self-management in patients with differentiated thyroid cancer: protocol for a randomized controlled trial. Front Public Heal. 2024;12(January):1–15.
Authors
Copyright (c) 2025 Intan Rismatul Azizah, Tintin Sukartini, Ira Suarilah, Ni Nyoman Elfiyunai, Iwan Ardian, Nutrisia Nu’im Haiya, Maria Silveira de Jesus
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
