title: Factors predicting adherence to risk management behaviors of women at increased risk for developing lymphedema.
abstract: OBJECTIVE
  Lymphedema affects 20-30% of women following breast cancer treatment. However, even when women are informed, they do not necessarily adhere to recommended lymphedema self-management regimens. Utilizing the Cognitive-Social Health Information Processing framework, we assessed the cognitive and emotional factors influencing adherence to lymphedema risk management.
  
  
  METHODS
  Women with breast cancer who had undergone breast and lymph node surgery were recruited through the Fox Chase Cancer Center breast clinic. Participants (N = 103) completed measures of lymphedema-related perceived risk, beliefs and expectancies, distress, self-regulatory ability to manage distress, knowledge, and adherence to risk management behaviors. They then received the American Cancer Society publication "Lymphedema: What Every Woman with Breast Cancer Should Know." Cognitive and affective variables were reassessed at 6 and 12 months post-baseline.
  
  
  RESULTS
  Maximum likelihood multilevel model analyses indicated that overall adherence increased over time, with significant differences between baseline and 6- and 12-month assessments. Adherence to wearing gloves was significantly lower than that for all other behaviors except electric razor use. Distress significantly decreased, and knowledge significantly increased, over time. Greater knowledge, higher self-efficacy to enact behaviors, lower distress, and higher self-regulatory ability to manage distress were associated with increased adherence.
  
  
  CONCLUSIONS
  Women who understand lymphedema risk management and feel confident in managing this risk are more likely to adhere to recommended strategies. These factors should be rigorously assessed as part of routine care to ensure that women have the self-efficacy to seek treatment and the self-regulatory skills to manage distress, which may undermine attempts to seek medical assistance.
authors: Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, 2109, Australia, kerry.sherman@mq.edu.au.
authors: Kerry A
authors: KA
authors: Sherman
authors: Suzanne M
authors: SM
authors: Miller
authors: Pagona
authors: P
authors: Roussi
authors: Alan
authors: A
authors: Taylor
mesh_terms: D001940:Breast / Q000601:surgery; D001943:Breast Neoplasms / Q000601:surgery; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008198:Lymph Nodes / Q000601:surgery; D008209:Lymphedema / Q000517:prevention & control*; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D012306:Risk; D012307:Risk Factors; D012648:Self Care / Q000379:methods* / Q000523:psychology; D014481:United States