Directions for the Primary Research Article summary assignment.html
You are to read a primary research article on an aspect of health about women in another country.  (The two links below this one on the content page will help you know what qualifies as a research article).  This is a primary research article- We do have a librarian in the classlist that is more that willing to look at the article you find in your index to make sure you are using a research article.  (This means you should not use newspapers or editorials from the internet.)

 

This article can be anything that affects women’s health and it can be any other country outside the USA.  You must then summarize the article in at least one full page double spaced and write a citation in APA style—see the content page for help with that (yes, put a citation even though you are also including a copy of the article).   Write enough  summary (one page) to let us know what the article discussed in details because these postings will be used for your classmates to choose a topic for their mid-term papers. You do not have to give your thoughts and opinions about the article, just a summary.   

 

Download the article into a pdf file and post with the summary. This is required for the summary to be accepted.  Do not just put the link to the article.  You must put the pdf copy of the actual full text article 

 

Post all of this on the discussion board with the article title in the subject line of your posting.  You will see a heading called Research Article on the discussion board for you to post this under.   

 

Then for your midterm, you will then read your classmates article summaries and pick one of these to use for your topic on your mid term paper.   (See midterm article directions on the content page for more details on the midterm project)

How to Know if it is a Research Article

A research article is a journal article in which a researcher (or a team of researchers) publishes the results of their original, empirical research.  All research articles are scholarly, but not all scholarly articles are research.  Library databases include citations to all sorts of sources. Consequently, it’s important to be able to determine if an article is a research article, or if it’s something else.

How can you tell if it’s a research article?

Confirm that it is a scholarly article.  It should be published in a scholarly journal and not a newspaper or popular magazine. The authors should be experts in the field and not journalists.  The article must have a reference list. If the article does not have these elements it is not scholarly, and it cannot be a research article.

The article should clearly state that the author(s) conducted research, ran surveys, did experiments, collected data, or otherwise gathered material on their own or with a team of researchers.  It must be original research conducted by the authors of the research article, and needs to be identified as such.

A research article is different than a review article, which is a critical evaluation of material that has been previously published. This can be done to assess the state of the literature on a topic (which is a literature review), and to suggest steps for future research.

The abstract often has clues.  Look for a sentence that says something like “this study examines…” or “we did research to find…”  Such statements indicate that the author probably conducted original research

Research article format

Research articles typically follow a particular format, and include specific elements that show how the research was designed, how the data was gathered, how it was analyzed, and what the conclusions are. Sometimes these sections may be labeled a bit differently, but these basic elements are consistent:

Abstract: A brief, comprehensive summary of the article, written by  the author(s) of the article. This abstract must be part of the article, not a  summary in the database.

Introduction: This introduces the problem, tells you why it’s important, and outlines the background, purpose, and hypotheses the authors are trying to test. The introduction comes first, just after the abstract, and is usually not labeled.

Method: Tells the reader describes in details how the research was conducted, and may be subdivided into subsections describing Materials,  Apparatus, Subjects, Design, and Procedures.

Results: Summarizes the data and describes how it was analyzed. It should be sufficiently detailed to justify the conclusions. 

Discussion: The authors explain how the data fits their original hypothesis, state their conclusions, and look at the theoretical and practical implications of their research.

References: Lists the complete bibliography of sources cited in the research article.

HOW TO DISTINGUISH BETWEEN RESEARCH AND
NON-RESEARCH ARTICLES

USAILC.ORG

University of South Alabama
Innovation in Learning Center

This guide will show you how to distinguish between research and non-research articles.

Research Articles

• Research articles should include a hypothesis, a proposed question. Does the article
propose an assumption to be tested? Remember the scientific method.

• Research articles should include a methods section, a description of the subjects,
procedures and tools used. Does the article describe the process of testing the research
question? It should explain who, what, when, where and how the research was
conducted.

• Research articles should include findings, an explanation of conclusions. Does the article
explain what was found after the study?

• Research articles should include suggested further research. Does the article give an
analysis of the implications from the findings?

• Research articles should be peer reviewed. This is a standard preference of most
professors. Research articles should be from a peer reviewed journal.

Non-research Articles

• Research should not be an opinion based document.
• Research articles should not be newspaper articles. Did you find the article in a

newspaper or magazine?
• Research articles should not be editorials. Is the article from the author’s opinion?
• Research articles should not be book or test reviews. Is the evaluation of a book or

measurement tool?
• Research articles should not be columns giving advice. Can you summarize your article

with a statement beginning with “how to”?

*For further assistance, contact the Innovation in Learning Center at (251) 461-1888.

Research Article

Life after cervical cancer: Quality of life among
Chinese womennhs_616 296..302

Ying Chun Zeng, rn, mphil,1 Dingmei Li, rn, bmed2 and Alice Yuen Loke, rn, phd1
1School of Nursing, The Hong Kong Polytechnic University, Hong Kong and 2Department of Nursing, Huaihua Medical
College, Huaihua, China

Abstract This study explored the meaning of “quality of life” among Chinese survivors of cervical cancer and the impact
of cervical cancer survivorship on these women’s quality of life. Written responses were used as the means of
data collection. The qualitative data were analyzed by using a qualitative content analysis. The meaning of
“quality of life”, as perceived by 35 Chinese survivors of cervical cancer, included being free of disease, having
a good standard of living, having a harmonious family atmosphere, and having a harmonious sex life. The
impact of cervical cancer on the Chinese women’s quality of life included physical and psychological sequelae,
family distress, financial burden, and disruptions to their social functioning and sexual life. Nevertheless, there
were positive gains that were reported by these survivors, including changes in their outlook on life, treasuring
their life, and better family relationships. This study revealed that the Chinese survivors of cervical cancer
identified their sexual life as one of the essential indicators of quality of life. It is necessary to raise nurses’
awareness so that women’s sexuality-related concerns are addressed. Health professionals also should provide
relevant supportive care in order to address this target population’s physical and psychosocial needs across the
survivorship continuum.

Key words cancer survivor, cervical cancer, Chinese women, nursing, quality of life, sexuality.

INTRODUCTION

Cervical cancer is one of the most common types of cancer
in developing countries. Due to widespread screening pro-
grams, most cases of cervical cancer are being diagnosed in
the earlier stages and with a good prognosis. Despite better
survival rates, the survivors of cervical cancer might continue
to live with its sequelae (Vistad et al., 2006). Quality of
life (QOL) assessment among cancer survivors can aid in
the detection of these late effects and long-term sequelae
(Victorson et al., 2007).

Quality of life among survivors of cervical cancer

Research on the survivors of cervical cancer has reported
various QOL concerns. The major physical impacts include
the inability to bear children, as well as menopausal, urologic,
and gastrointestinal symptoms (Korfage et al., 2009). The
common sequelae that disrupt the psychological aspects
of life for survivors of cervical cancer include a fear of cancer
recurrence and reduced self-confidence (Ashing-Giwa
et al., 2004; Bradley et al., 2006). The common social sequelae

include social stigma and social isolation, which are linked to
social associations between cervical cancer and unsafe sexual
practices (Lai et al., 2009). The major sexual and reproductive
side-effects of the treatments for cervical cancer include a
reduced sexual desire, diminished lubrication, and a short-
ened vaginal cavity (Jensen et al., 2003; 2004). In summary,
these physical, psychological, social, and sexual sequelae
severely influence women’s QOL.

Measurement of the quality of life of survivors of
cervical cancer

A variety of questionnaires has been used to assess the
QOL of women with cervical cancer. Zeng et al. (2010)
summarized the four types of QOL instruments that have
been used: generic (e.g. Medical Outcome Study: 36-Item
Short Form Survey) (Distefano et al., 2008), cancer-specific
(e.g. European Organization for Research Treatment’s QOL
cancer-specific questionnaire) (Greimel et al., 2009), cancer
site-specific (e.g. Functional Assessment of Cancer Therapy-
Cervix) (Ashing-Giwa, 2008), and cancer survivor-specific
(e.g. Cancer Survivors’ Unmet Needs) (Hodgkinson et al.,
2007). These instruments vary in their length and emphasis,
but it has been reported that none of them is comprehensive
enough to explore all the domains of QOL across the survi-
vorship continuum (Zeng et al., 2010).

Correspondence address: Alice Y. Loke, School of Nursing, The Hong Kong Poly-
technic University, Hung Hom, Kowloon, Hong Kong, China. Email: hsaloke@
inet.polyu.edu.hk
Received 20 January 2011; accepted 6 May 2011.

Nursing and Health Sciences (2011), 13, 296–302

© 2011 Blackwell Publishing Asia Pty Ltd.

doi: 10.1111/j.1442-2018.2011.00616.x

An increasing amount of quantitative evidence on QOL
among Chinese survivors of cervical cancer has become
available in recent years (e.g. Liu et al., 2006; Zhang et al.,
2009). However, there is a lack of qualitative insight into the
impact of cervical cancer and its related treatments on
Chinese women’s survivorship experiences. It is the intention
of this qualitative study to explore the QOL among Chinese
survivors of cervical cancer.

AIMS

The purposes of this study were to explore the meaning of
QOL among Chinese survivors of cervical cancer and the
impacts of cervical cancer survivorship on these women’s
QOL.

METHODS

Design

In order to obtain information on Chinese cervical cancer
survivors’ perceptions of QOL, a descriptive, exploratory
design, using the QOL model of Ferrell et al. (1997) as a
framework for the exploration, was used.

Sample and setting

All the participants were recruited from a tumor hospital in
mainland China. A purposive sampling strategy was used to
select the participants. For the purposes of the study, a “sur-
vivor of cervical cancer” was defined as an individual who
was alive after the initial treatment for cervical cancer. The
inclusion criteria for the sample were: (i) Chinese women
who were at least 18 years old and had a diagnosis of cervical
cancer; (ii) completion of the primary cancer treatment;
and (iii) currently cancer-free. The exclusion criteria for the
sample were: (i) no cancer recurrence or metastasis; (ii) diag-
nosed with secondary cancer; and (iii) lacking basic literacy
so as to not understand and write in Chinese.

Data collection

Method of data collection

Compared with face-to-face interviews, written responses
have the advantage of putting the participants under less
interaction pressure (Salander, 2002). Written qualitative
responses do not require transcription, so this method is
less time-consuming and more cost-effective (Hamilton &
Bowers, 2006). Other advantages are that written responses
might overcome the barrier of dialects, as persons in main-
land China typically speak many different Chinese dialects,
even within the same province, but the written form is under-
standable across these language groups.

The impersonal nature of written responses also might
help the participants to express their feelings or perceptions
that they would not be willing to describe in a face-to-face
interview (Hunt & McHale, 2007). In particular, when survi-
vors of cervical cancer are asked about sensitive issues, such

as sexual health, they are more likely to share their percep-
tions in written form rather than by expressing them verbally.
However, the disadvantages of written responses are the lack
of interaction between the interviewer and interviewee and
the absence of spontaneous responses that are obtained in
face-to-face interviews (Holloway & Wheeler, 2002).

Process of data collection

The data were collected from August to December 2009.
Eligible women were invited to complete a demographic
form and some open-ended questions (Appendix I) about
their perceptions of QOL. The design of this written response
sheet was framed by the QOL model of Ferrell et al. (1997).
All the participants were recruited from the tumor hospital’s
gynecologic outpatient department, which included patients
with gynecologic cancer at their follow-up visits. A gyneco-
logic oncologist helped with the data collection. The women
were asked to return their written responses to the hospital
or by mail.

Data analysis

A qualitative content analysis was adopted to analyze the
qualitative data. The written responses were read by the first
author, who tried to be familiar with the data and to obtain a
general understanding of the data. The first author reread all
the written responses carefully, highlighted sections of the
text, and started to write down as many headings as possible
in order to describe all aspects of QOL among the Chinese
survivors of cervical cancer. Then, the first author cut out the
highlighted sections of the text and grouped all the headings
in a list, with similar headings grouped together and devel-
oped into a temporary list of categories and subcategories.
The temporary list was compared with the raw written
responses and the final list of categories and subcategories
was produced, covering all aspects of the written responses.
The second author worked separately to categorize the state-
ments before meeting to discuss and agree on the categories.

Ethical considerations

Ethical approval was obtained from the Human Subjects
Ethics Application Review System of The Hong Kong Poly-
technic University, Hong Kong, and the hospital’s Human
Subjects Research Review Committee before the start of this
study. Information sheets about the purpose of the study
were provided to all the participants and their participation
was voluntary. After the participants’ consent was obtained,
the researcher further explained the process of data collec-
tion and reassured them that they could withdraw from the
study at any time. A code number for each participant was
used to ensure anonymity. In order to maintain the confiden-
tiality of the research data, the raw data could be accessed
only by the researcher.

Rigor in qualitative studies

Rigor in qualitative studies is assured through achieving
the credibility and confirmability of the results (Speziale &

Quality of life among Chinese women 297

© 2011 Blackwell Publishing Asia Pty Ltd.

Carpenter, 2007). This study recruited participants with expe-
rience that was related to cervical cancer and its impacts on
QOL, which enhanced the true value of the results through
the purposive sampling strategy. In addition, this study
enhanced the credibility of the study’s results by adopting the
“member checking” strategy; that is, checking with the par-
ticipants with regard to the accuracy of the results (Leech &
Onwuegbuzie, 2007). The member check involved two par-
ticipants in the current study, one at an early disease stage
and the other at an advanced disease stage. Both of them
agreed with the interpretations and findings, including the
codes, subcategories, and categories. The confirmability was
achieved by an audit trail: the second author used the the-
matic content analysis on the same set of data independently,
yielding similar results.

RESULTS

Demographic and medical characteristics of the
survivors of cervical cancer

A total of 42 eligible women was accessed and invited to
participate in the study. Thirty-five women responded to the
invitation to provide a narrative account of their experience.
Most of the survivors of cervical cancer were aged in their 30s
(14) or 40s (13). Eighteen had a high school education or
above. Ten were working at the time of the data collection.
Twenty-three had been unemployed since their cancer diag-

nosis. Most were married, but nine divorced after their cancer
diagnosis. Twenty of the survivors of cervical cancer were
diagnosed at an early stage of the disease. Eighteen had
received a combination of cancer treatments (surgery, che-
motherapy, or radiotherapy). Fifteen respondents had
1–2 years of postprimary treatment.

Meaning of “quality of life”

The participants were asked, “Could you please describe
the meaning of ‘quality of life’ in your own words?”, and
they provided the major components of the meaning of
QOL according to their own perception (Table 1). The most
common one was that “QOL” meant being in good health
and free of disease. The second component was women’s
concerns about daily living, such as “normal living” and
having a good living standard. Other issues that were related
to daily living included regular living habits and being easily
satisfied with life.

The third component was related to social and interper-
sonal relationships, such as the quality of the women’s rela-
tionships with family members, colleagues, and society at
large. The fourth component concerned the participants’
financial condition, such as having enough money to afford
the cost of cancer treatment. The fifth component was related
to family issues: having a happy family or having harmonious
family relationships. The sixth component was work-related
issues: being able to work independently and having the

Table 1. Meaning of “quality of life”, as perceived by Chinese women

Component Participant

Health condition
Good health and free of disease CCS3, 9, 15–17, 19, 20, 24, 26, 29, 30–35

Issues related to daily living
Normal living CCS16, 21
Having basic living materials CCS11
Regular living habits, such as eating, sleeping, and entertaining activities CCS18
Living independently and having a good standard of living CCS2, 4, 10, 23, 25, 28
Being happy CCS9, 16, 24, 29
Having hope for the future CCS20, 22
Being easily satisfied with life CCS15

Social relationships
Good social relationships generally and good interpersonal relationships with friends and

colleagues
CCS4, 13, 20, 24

Financial condition
Quality of life depends on the financial condition and having to save as much as possible to

afford the cost of cancer treatments and living expenses
CCS1

Good, with enough money to use CCS12, 13, 15, 27
Family issues

Family harmony, good family relationships, and individuals and things in the family are running
smoothly

CCS7, 9, 13, 17, 18, 25, 28, 34

Work-related issues
Working conditions, being able to independently finish work, good quality of work, and

recognition from colleagues
CCS4, 14, 15, 31

Issues related to sex life
The importance of sexual activity and the existence of harmony in the sexual relationship with

the husband/partner
CCS7, 12, 17, 26, 29

CCS, cervical cancer survivor.

298 Y-C. Zeng et al.

© 2011 Blackwell Publishing Asia Pty Ltd.

quality of one’s work recognized by colleagues. The final one
was related to the participants’ sex life. Some women consid-
ered sexual activity and a harmonious sexual relationship
with their partner as important indicators of their QOL.

Impact of cervical cancer survivorship on the Chinese
women’s quality of life

According to the QOL model of Ferrell et al. (1997), QOL
includes physical, psychological, social, and spiritual well-
being. Sexual health issues also were perceived as important
indicators of QOL by the participants in the current study.
Thus, the analysis of the impact of cervical cancer survi-
vorship on the participants’ QOL was classified into five
domains, as described below. “CCS” in the parentheses after
the quotations refers to “cervical cancer survivor”.

Domain 1: Impacts on physical well-being

Physical health impacts included a loss of appetite, poor sleep
quality, a loss of hair, weight changes, premature menopause
symptoms due to the removal of the ovaries or ovarian
failure, constipation, and dysuria:

I was very sensitive to radiotherapy. After treatment, I
had no appetite and poor quality of sleep. Also, my
immune system was weaker than before, so that I caught
cold easily . . . (CCS3, 36 years old).

. . . leg edema and hyperspasmia, hot flushes, midnight
sweating, and severe constipation . . . (CCS12, 33 years
old; CCS18, 42 years old).

Domain 2: Impacts on psychological well-being

Cervical cancer and its related treatments also can have psy-
chological sequelae: anxiety, depression, becoming irritable,
feeling guilty due to burdening the family, fatigue, and wor-
rying about the disease. A fear of cancer recurrence was one
common negative psychological concern. Other subthemes
included a sense of vulnerability, such as reduced self-esteem
and sense of self:

One year after surgery, my mood was not stable and
I would have significant mood swings. I felt more
irritable, worried about the disease, and afraid of cancer
recurrence . . . (CCS18, 42 years old).

Sometimes, I felt very anxious and worried about the
possible recurrence of cancer, resulting in sleeplessness,
feeling dirty, and having no sense of self (CCS9, 48 years
old; CCS31, 52 years old).

Domain 3: Impacts on social well-being

Changes in daily life and a feeling of social isolation. Al-
though some women perceived no change in their daily life,
more than half perceived cancer as having negative impacts
on their social functioning, including a more limited social
network and a feeling of isolation:

After the cancer diagnosis, I quit my job. Just staying at
home and having nothing to do, I felt isolated (CCS20,
41 years old).

. . . I lost my job due to my disease. My social networks
were narrowed as a consequence . . . (CCS29, 43 years
old).

Changes in roles and responsibilities. Many of the women
stated that the household roles and the responsibility for
daily chores had been taken over by their husband or parents.
These women felt uncomfortable with this situation, as it
rendered them dependent and unable to carry out the duties
that they easily had taken care of previously:

I used to do all the housework, such as cleaning, cooking,
etc. After the disease diagnosis, I had no desire and was
getting too tired to do these things. My family members
did as much as they could to look after me (CCS12,
33 years old).

Being a burden to the family. One aspect that was experi-
enced by the women was placing an emotional burden on
their husband:

. . . worrying about my disease influenced my family
members’ quality of life, especially for my children.
Since getting the disease, I had become more irritable.
Sometimes, I would quarrel with my husband. Now, the
whole family suffered from lots of pressure (CCS15,
32 years old; CCS28, 47 years old).

The other aspect was the financial burden that was placed
on the family, such as having to afford cancer treatment:

In order to come to hospital to undertake systematic
treatment, all my family members have to save as much
as possible in daily living. In order to pay for my treat-
ment, my whole family borrowed a lot of money from
others. Particularly since I haven’t returned to work, I
am under a lot of financial pressure (CCS1, 35 years old).

Coping methods and sources of support. The participants
had numerous sources of support for coping with their
disease. The most common one was caring and psychological
and/or social support from the family. Some women even
perceived that their family members gave them too much
support:

. . . my family members always tell me that my life is not
just belonging to myself. No matter what happens, I have
to live for my family (CCS3, 36 years old).

All family members very [much] emphasized my health
conditions. They did whatever they could for me. But, I
don’t want to get so much caring, it has adverse effects
on me and lets me feel depressed (CCS4, 42 years old).

Also, the women could obtain support and care from their
relatives, friends, and colleagues:

Quality of life among Chinese women 299

© 2011 Blackwell Publishing Asia Pty Ltd.

My neighbor and colleagues’ support and caring let me
come through all those hard times during my treatment
(CCS18, 42 years old; CCS25, 51 years old).

Domain 4: Effects on spiritual well-being

Some of the women tried to find meaning in their disease and
made different deductions about the meaning of life:

We have no need to complain too much about life, as we
will all die some day. This is the natural law. Getting
cancer . . . is fate and we have to face our own fate and
other kinds of suffering in our lives (CCS33, 58 years
old).

Many of the other women perceived certain positive gains
from their cancer experience. These changes included a more
positive outlook on life, such as treasuring life more, appre-
ciating their relationships with others, viewing the cancer
experience as a rebirth, the relationship with their husband
becoming more intimate, and their family relationship
becoming more harmonious:

. . . compared with before I had cancer, now I have a
more positive outlook on life and enjoy it every day
(CCS1, 35 years old).

Compared with before the cancer, my relationship with
my husband has become more intimate, I am more
content with life and more aware of my health, and I
treasure life and feel grateful to be alive (CCS17,
46 years old; CCS20, 41 years old).

Domain 5: Disruptions to sexual life

There were negative changes in the women’s sex life. Since
the diagnosis and treatment of cervical cancer, many of the
survivors (13 out of 35) had not resumed sexual activities. The
reasons included not having a partner, being too tired to have
sex, a fear of sexual activity weakening the potency of the
cancer treatment, and the husband not initiating sexual activ-
ity due to a fear of the disease:

Since the surgery, there has been no sexual activity, as I
am worried that sexual intercourse might influence the
effect of the treatment . . . (CCS1, 35 years old).

Before the surgery, our sex life was really good. Since the
surgery, there has been no sexual activity. My husband
and I sleep in different beds. Relevant factors include
fear of disease, the negative impact of thinking about
sexual intercourse, and the lack of sexual desire (CCS9,
48 years old).

Some of the women reported that they were currently
sexually active but that there was a reduced frequency and/or
quality of their sexual activity because of vaginal dryness,
dyspareunia, and worry about the disease:

The frequency is the same but . . . the quality of our sex
life is not as good. There are lots of factors, including
vaginal dryness, pain during sexual intercourse, and my

husband also being afraid of contracting the disease . . .
(CCS7, 31 years old; CCS29, 43 years old).

DISCUSSION

The results of this study support a growing body of knowl-
edge that is related to the QOL among survivors of cervical
cancer. In this study, most of the Chinese survivors of cervical
cancer defined QOL as being in good health and free of
disease. Other Chinese survivors of cervical cancer perceived
QOL as being happy with the quality of their interpersonal
relationships. The results of the current study are similar to
those of previous studies that took place in Hong Kong:
the Chinese cancer survivors in these studies also viewed
“normal living”, a good working life, happiness, and support
from their family as essential indicators of QOL (Molassiotis
et al., 2000).

In the current study, the Chinese survivors of cervical
cancer perceived numerous physical impairments, such as
poor sleep quality, a loss of appetite, vomiting, and a loss of
fertility, which is similar to the results of other research in
Western countries (Ashing-Giwa et al., 2004; Distefano
et al., 2008; Greimel et al., 2009). The psychological impacts
included depression, a fear of cancer recurrence, feeling
guilty, and reduced self-esteem. The social rejection of survi-
vors of cervical cancer is common in China, as cervical cancer
is viewed as “dirty” and is labeled as a sexually transmitted
disease that is related to early sexual activity and multiple
sexual partners (Lai et al., 2009), which might result in a
negative impact on women’s emotional well-being (Chan
et al., 2001). Therefore, nurses should be developing mecha-
nisms to provide support for women’s fear about the cancer
spreading and their uncertainty about the future.

This study also identified the ongoing challenges in
the women’s personal and social lives. The demographic
data clearly revealed that the impact of cervical cancer and
its subsequent treatments brought about changes in the
women’s marital and employment status. Nine women were
divorced and 23 out of 35 women were unemployed after the
completion of their cancer treatment. This study also found
that some of the women were unable to take care of their
usual daily living activities, such as housework and child care,
which they saw as their duties and responsibilities. Therefore,
cervical cancer was still causing problems in the flow of the
women’s daily life.

Coping strategies are thought to play an important role in
managing the physical and psychological sequelae that are
associated with a cancer diagnosis and treatment (Costanzo
et al., 2006). There are differences between the coping strat-
egies that are used by women in China and those that are
used by women in Western countries. Religious beliefs and
spiritual applications are important in coping with and fight-
ing the disease and increasing the hope for cancer survival in
Western cultures (Ferrell et al., 2002). It was reported in one
study that almost all (95%) of the patients with gynecologic
cancer in Turkey used worship and prayer as disease-control
methods and psychological support mechanisms (Akyuz
et al., 2007). In another study in the USA, praying also was a

300 Y-C. Zeng et al.

© 2011 Blackwell Publishing Asia Pty Ltd.

commonly used coping strategy for the female cancer survi-
vors after treatment (Lauver et al., 2007).

Most of the Chinese survivors of cervical cancer in this
study coped with their disease with the support and caring of
their family. Beliefs and values that are related to the family
are as strong as religious beliefs for Chinese persons (Chen,
2001). This is why most Chinese survivors of cervical cancer
view family support as an essential coping strategy. Chan
et al. (2001) conducted a study to investigate the social
support that was perceived by patients with gynecologic
cancer in Hong Kong and their results showed that the par-
ticipants emphasized the importance of interpersonal rela-
tionships and reported their social support as coming mainly
from family members.

Regarding the effects on spiritual well-being of life after
the diagnosis and treatment of cervical cancer, this study
demonstrated that the Chinese survivors of cervical cancer
perceived a more positive outlook on life and treasured life
more. These results are also consistent with those of studies
that were conducted in Western countries (Hodgkinson et al.,
2007; Akyuz et al., 2008; Clemmens et al., 2008). An additional
positive impact that was identified by survivors of gyneco-
logic cancer in Hong Kong included being sensitive to others’
needs (Molassiotis et al., 2002).

Many studies have indicated that sexual problems often
are related to the treatment for gynecologic cancer (Molas-
siotis et al., 2002). In this study, 13 out of 35 participants
reported the complete cessation of sexual activity after their
cancer treatment or since the diagnosis of cervical cancer and
eight indicated that there were significant changes in their sex
life, including a reduced frequency and quality of sexual
activity. The rate of reduced or no sex life was relatively high
among the Chinese survivors of cervical cancer. This finding
might be related to Chinese culture. Taoist beliefs about the
regulation of sexual activities in order to preserve one’s
health suggest that a Chinese woman and her spouse should
reduce or cease sexual activities after the diagnosis and treat-
ment of cancer in order to facilitate the recovery of the
woman’s health (Tang et al., 1996).

Although sexual issues are not discussed openly and are
viewed as a cultural taboo in Chinese communities (Khoo,
2009), the unexpected finding from this study was that some
Chinese survivors of cervical cancer defined the importance
of their sex life and the harmony of the sexual relationship
with their husband as one of the major indicators of their
QOL. Therefore, cervical cancer survivors’ sexuality issues
should receive as much attention as other aspects of women’s
health.

Recommendations for future research and practice

Further research that provides diverse methods of data col-
lection, such as interviewing rather than written responses, is
needed. In the Chinese culture, sexuality issues are not dis-
cussed openly and are viewed as a cultural taboo. However, in
this study, some of the participants defined the importance of
sexual activity and the harmony of their sex life as a major
indicator of their QOL. Further research is needed to explore
how sexuality-related issues impact Chinese cervical cancer

survivors’ QOL in detail. In clinical practice, nurses and other
healthcare providers in China should address cervical cancer
survivors’ sexuality-related concerns.

Limitations of the study

The present study had a few limitations. There was just one
tumor hospital involved as the research setting, thus making
it difficult to establish the transferability of the study’s results.
Another limitation was the use of written responses as the
only means of data collection. Written responses lack the
interaction and spontaneity of face-to-face interviews,
although the participants might be more likely to share sen-
sitive issues, such as women’s sexual health, via written
responses because there is less interaction pressure. Partici-
pants with a low educational level might have been excluded
from this study.

CONCLUSION

The results of this study revealed that being healthy or free of
disease was a common indicator of QOL among the Chinese
survivors of cervical cancer. Although the women perceived
certain positive gains from their cancer experience, such
as personal growth and better family relationships, their
cancer diagnosis and relevant cancer treatment had ongoing
physical, psychological, social role/responsibility, and sexual
implications for their well-being. In order to improve the
QOL and overall survival outcomes of survivors of cervical
cancer, Chinese nurses and other health professionals should
provide relevant supportive care to address this target popu-
lation’s physical, psychological, social, spiritual, and sexual
needs across the survivorship continuum.

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APPENDIX I

Written response sheet (English translation)
1 In your words, what does “quality of life” mean?
2 How do you perceive the impact of cervical cancer on
your quality of life?

• What do you think about the impact on your physical
health?

• What do you think about the impact on your psycho-
logical health?

• What do you think about the impact on your social
role and function?

• What do you think about the impact on your spiritual
well-being?

• What do you think about the impact on your sexual
health?

302 Y-C. Zeng et al.

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