title: Use of formal and informal mental health resources by cancer survivors: differences between rural and nonrural survivors and a preliminary test of the theory of planned behavior.
abstract: OBJECTIVE
  Previous research has identified rural residence as a risk factor for poorer mental health (MH) outcomes in cancer survivors. This may be due to less use of various MH resources due to poorer access and less favorable attitudes and social norms related to MH resource utilization. The present study sought to examine use of MH resources in rural and nonrural survivors and identify factors associated with MH resource use.
  
  
  METHODS
  Cancer survivors (n=113, 1-5 years postdiagnosis) completed a questionnaire packet and telephone interview. Accessibility and postdiagnosis use of various formal and informal MH resources were assessed along with constructs potentially linked to use of MH resources by the Theory of Planned Behavior (TPB; personal attitude, social norm, perceived behavioral control).
  
  
  RESULTS
  Results indicated no widespread differences between rural and nonrural cancer survivors in MH resource use although some evidence suggested poorer accessibility and less use of mental health professionals and cancer support groups among rural survivors. In general, rural survivors reported less favorable personal attitudes and social norms regarding MH resource use. TPB constructs accounted for a significant portion of variance in use of most MH resources with personal attitudes generally being the strongest predictor of MH resource use.
  
  
  CONCLUSIONS
  Additional research is needed to expand the search for factors, particularly modifiable factors, which might account for disparities in MH outcomes between rural and nonrural survivors.
authors.affiliation: Department of Behavioral Science, University of Kentucky College of Medicine, KY 40536-0086, USA. mandry@uky.edu
authors.forename: Michael A
authors.initials: MA
authors.lastname: Andrykowski
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Burris
mesh_terms: D000328:Adult; D000368:Aged; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D005260:Female; D015438:Health Behavior; D006295:Health Resources / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D007407:Interviews as Topic; D007629:Kentucky; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D011582:Psychological Theory; D012424:Rural Population; D012944:Social Support; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D014505:Urban Population