Predicting Health-related Quality of Life: Testing the Contextual Model Using Structural Equation Modeling

This study aims to investigate the utility of the Contextual Model of Health-Related Quality of Life (HRQOL) to explain the relationship among the domains of HRQOL with a diverse, population-based sample of breast cancer survivors (BCS). We employed a cross-sectional design to investigate HRQOL among 703 multiethnic, population-based BCS. The study methodology was guided by the Contextual Model of HRQOL. Structural Equation Modeling (SEM) was conducted to assess the hypothesized model. SEM identified significant relationships among the bio-psychological domain (general health status, cancer-related factors, and psychological factors), the cultural-socio-ecological domain (health care satisfaction, socio-ecological factor, and socio-economic status), and HRQOL. The best fitting model indicates direct pathways from ‘general health status’, ‘years since diagnosis’, ‘health care satisfaction’ and ‘socio-ecological factor’ to ‘HRQOL’ variables. Additionally, ‘socio-ecological factor’ and ‘socio-economic status’ variables were indirectly associated with HRQOL through ‘general health status’. Findings suggest that the Contextual Model of HRQOL adds valid factors to explain overall HRQOL and increases our understanding of the socio-ecological dimensions predicting HRQOL outcomes. The revelation of inter-relations among the dimensions of HRQOL may inform the translational and clinical utility of the HRQOL construct.

Jung-Won Lim (Corresponding author)Email:

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Dr. Kimlin T. Ashing-Giwa   is professor and director of the Center of Community Alliance for Research and Education (CCARE) at City of Hope. She received her doctorate in clinical psychology from the University of Colorado-Boulder. Her scholarship and life work is to understand and investigate how culture, ethnicity, ecological and systemic context influence health outcomes. Currently, she is developing and implementing community participatory interventions to reduce the risk and burden of chronic illness, in particular cancer. Dr. Jung-won Lim    is a research fellow of the CCARE at City of Hope. She received her doctorate from the University of Southern California, School of Social Work. Her research focuses on adjustment and quality of life among patients with chronic physical illness and their family. She is currently conducting studies related to health beliefs, health behaviors, and quality of life among breast cancer survivors.