%0 Journal Article
%@ 2561-326X
%I JMIR Publications
%V 6
%N 5
%P e33262
%T Self-reliance, Social Norms, and Self-stigma as Barriers to Psychosocial Help-Seeking Among Rural Cancer Survivors With Cancer-Related Distress: Qualitative Interview Study
%A DeGuzman,Pamela Baker
%A Vogel,David L
%A Bernacchi,Veronica
%A Scudder,Margaret A
%A Jameson,Mark J
%+ School of Nursing, University of Virginia, PO Box 800782, Charlottesville, VA, 22902, United States, 1 434 466 8327, prb7y@virginia.edu
%K cancer survivorship
%K cancer-related distress
%K rural health
%K self-stigma
%K help-seeking
%K psychosocial referral
%K support networks
%K self-reliance
%D 2022
%7 19.5.2022
%9 Original Paper
%J JMIR Form Res
%G English
%X Background: Even when technology allows rural cancer survivors to connect with supportive care providers from a distance, uptake of psychosocial referrals is low. Fewer than one-third of participants in a telemedicine intervention for identifying rural survivors with high distress and connecting them with care accepted psychosocial referral. Objective: The purpose of this research was to examine the reasons for which rural cancer survivors did not accept a psychosocial referral. Methods: We utilized a qualitative design to address the research purpose. We interviewed participants who had been offered psychosocial referral. Semistructured interviews were conducted 6 weeks later (n=14), and structured interviews were conducted 9 months later (n=6). Data were analyzed descriptively using an inductive approach. Results: Ultimately, none of the rural cancer survivors (0/14, 0%) engaged with a psychosocial care provider, including those who had originally accepted referrals (0/4, 0%) for further psychosocial care. When explaining their decisions, survivors minimized their distress, emphasizing their self-reliance and the need to handle distress on their own. They expressed a preference for dealing with distress via informal support networks, which was often limited to close family members. No survivors endorsed public stigma as a barrier to accepting psychosocial help, but several suggested that self-stigma associated with not being able to handle their own distress was a reason for not seeking care. Conclusions: Rural cancer survivors’ willingness to accept a psychosocial referral may be mediated by the rural cultural norm of self-reliance and by self-stigma. Interventions to address referral uptake may benefit from further illumination of these relationships as well as a strength-based approach that emphasizes positive aspects of the rural community and individual self-affirmation. 
%M 35588367
%R 10.2196/33262
%U https://formative.jmir.org/2022/5/e33262
%U https://doi.org/10.2196/33262
%U http://www.ncbi.nlm.nih.gov/pubmed/35588367