Latent Classes Of Social Participation And Its Associated Factors In Rehabilitative Breast Cancer Patients

Objectives:The purpose of this study was to explore the latent classes of social participation in rehabilitative breast cancer patients,and based on the ICF model,to explore the relationship of health status,individual factors,environmental factors and its mediating effects with the latent classes of social participation.This study would provide evidence for improvement of social participation rehabilitation in rehabilitative breast cancer patients.Methods:Using convenient sampling method,a total of 310 rehabilitative breast cancer patients was enrolled in 8 Grade A general hospitals and oncology hospitals in Shandong Province.The survey tools included General information Questionnaire,Social Dysfunction Screening Scale(SDSS),Cancer Fatigue Scale(CFS),Connor-Davidson Resilience Scale(CD-RISC-10)and Lubben Social Network Scale 6(LSNS-6).SPSS25.0,Mplus8.3 and R4.2.2 were used for statistical analysis,and the main statistical methods included univariate analysis,latent class analysis,multinomial logistic regression and meditation analysis.Results:1.The status and latent classes of social participation in rehabilitative breast cancer patientsThe average score of social participation in rehabilitative breast cancer patients was(5.36±4.15).The results of the latent class analysis showed that the social participation of rehabilitative breast cancer patients could be divided into three categories(AIC=4178.81,BIC=4335,75,aBIC=4202.54,Entropy=0.909):low social participation type(C1),family participation type(C2)and high participation type(C3),accounted for 28.4%,28.4%,and 43.2%.2.Relationship between latent classes of social participation and related factors in rehabilitative breast cancer patientsChi-square test and one-way analysis of variance showed significant differences in the classes of social participation in demographic variables(age,place of residence,education,and family economy)and disease variables(whether chemotherapy had been used)(Ps<0.05).Univariate analysis of variance showed that there were significant differences in the scores of fatigue and its sub-dimensions(physical fatigue,cognitive fatigue and emotional fatigue),resilience scores,the scores of social network and its sub-dimensions(family network and friend network)in classes of social participation categories(Ps<0.01).LSD showed that the total score of fatigue and its sub-dimensions(physical fatigue,cognitive fatigue and emotional fatigue)in group Cl were significantly higher than those in group C2 and group C3,the scores of resilience in group C2 and group C3 were significantly higher than those in group C1,and the scores of social network and its sub-dimensions(family network and friend network)in group C3 were significantly higher than those in group C1 and group C2.3.Multicategorical logistic regression analysis of latent classes of social participation and related factors in rehabilitative breast cancer patientsMulticategorical logistic regression analysis was conducted with the classes of social participation as dependent variables and fatigue,resilience and social network as independent variables.The results showed that,with C3 group as reference,individuals with higher score of fatigue were more likely to enter C1 group(OR=1.17)and C2 group(OR=1.07).Individuals with higher social network scores were less likely to enter the C2 group(OR=0.89)(Ps<0.01).4.The mediating effects of latent classes of social participation and related factors in rehabilitative breast cancer patientsThe "RMediation" package of R software was used to test the mediation effect of categorical variables,with the classes of social participation as the dependent variable,resilience and social network as independent variables,and fatigue as the mediating variable.The results showed that,with the C3 group as the reference,resilience could reduce the likelihood of entering C1 group by relieving fatigue(Za1=-7.11,Zb1=8.00),and the 95%confidence interval of mediating effect was(-0.084,-0.040).Social networks could reduce the likelihood of entering C1 and C2 groups by alleviating fatigue(Za2=-6.95,Zb21=7.00,2b22=2.50).The 95%confidence intervals for mediating effects were(-0.073,-0.033)and(-0.035,-0.004),respectively.The above 95%confidence intervals did not include 0,indicating that the intermediary effect of fatigue was valid.Conclusions:1.The social participation of rehabilitative breast cancer patients could be divided into three latent classes,named low social participation group,deficient family participation group and high social participation group,among which high social participation group accounted for the largest proportion.2.Fatigue,resilience and social network were associated with the classes of social participation in rehabilitative breast cancer patients.Fatigue was a risk factor,while resilience and social network were protective factors for social participation.3.Resilience and social network could reduce the risk of individuals entering low social participation group by relieving fatigue,suggesting that promoting resilience and social network and reducing fatigue may improve social participation.