Power in breast cancer survivors: a secondary analysis.
The paper describes a secondary analysis of power in breast cancer
survivors. The researcher examined three new research questions
regarding power intensities, frequency, and form for a sample (n = 104)
of extended stage breast cancer survivors. The theoretical perspective
was Barrett's power theory. After approval by the researcher's
university institutional review board, data were analyzed regarding
power, as measured by Barrett's Power as Knowing Participation in
Change Tool Version II (PKPCT). Data analysis techniques included
descriptive statistics, correlation and regression analyses, and ANOVA
with post hoc analyses. The findings included identification of power
intensity groups, e.g. low (180--266), moderate (267--291), and high
(296--336). The power dimensions (awareness, choices, freedom to act
with intention, involvement in creating change) explained 100% of the
variance in power. Forms varied in the power intensity groups. The
researcher concluded that breast cancer survivors experience a high
capacity for power demonstrated in all power intensity groups. The power
dimensions are integral and together manifest unitary power. Patterns of
dimensional intensities vary in each power intensity group. The study
implications include support for Barrett's power theory, need for
additional research, recommendations for consistent reporting of power
data, and the importance of nurses' and other health care
providers' awareness of power as knowing participation in change
for extended stage breast cancer survivors.
Keywords: Barrett's Power Theory, Secondary Analysis, Power, Breast Cancer Survivors
(Care and treatment)
Breast cancer (Diagnosis)
Breast cancer (Research)
Cancer survivors (Research)
|Author:||Farren, Arlene T.|
|Publication:||Name: Visions: The Journal of Rogerian Nursing Science Publisher: Society of Rogerian Scholars Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2010 Society of Rogerian Scholars ISSN: 1072-4532|
|Issue:||Date: Jan, 2010 Source Volume: 17 Source Issue: 1|
|Topic:||Event Code: 310 Science & research; 200 Management dynamics Computer Subject: Company business management|
|Product:||Product Code: 8043100 Nurses NAICS Code: 621399 Offices of All Other Miscellaneous Health Practitioners|
|Geographic:||Geographic Scope: New York Geographic Code: 1U2NY New York|
Hearing one has a diagnosis of breast cancer may be a shock and
initiate a cascade of life changes that all too many women experience.
More than 25% of the 10 million cancer survivors in the United States
are breast cancer survivors (National Cancer Institute [NCI], 2005).
Breast cancer survivors in the extended stage of survivorship have
completed treatment and are less than 5 years since diagnosis (Mullan,
1985). During this stage of survivorship, it is essential for people to
participate knowingly in their changing life. Women have shared how
important it is to be aware of what is going on with them and what their
options and choices are so they can knowingly participate in making
changes and decisions related to life-style and health in their new
situation (Bilodeau & Degner, 1996; Lally, 2009; Thind, Hoq,
Diamant, & Maly, 2010). Despite evidence of the importance of
awareness, choices, freedom to act with intention, and involvement in
creating change in their lives, power as knowing participation in
change, a middle-range nursing theory addressing these manifestations,
has been examined on a limited basis (Farren, 2010). The purpose of the
paper is to describe a secondary analysis of power in a sample of breast
cancer survivors in the extended stage of survivorship. The findings are
presented and discussed in relation to Barrett's power theory
(Barrett, 2010) and literature. Conclusions and implications for theory,
research, and practice are presented.
Theoretical Framework and Background
Barrett (2010) summarized and updated the power theory, which she developed within Rogers' (1970) science of unitary human beings (SUHB). The definition of power has remained the same as originally published in 1983, power is "the capacity to participate knowingly in the nature of change characterizing the continuous patterning of the human and environmental fields" (Barrett, 1983, 1986, p. 174, 1990, p. 108; Caroselli & Barrett, 1998, p. 9). More recently, Barrett (2010) described two types of power as knowing participation in change, i.e., power-as-freedom and power-as-control. There are four integral manifestations of power, also referred to as factors or dimensions that are observable and measureable, i. e., awareness (A), choices (C), freedom to act with intention (F), and involvement in creating change (I). Barrett has always asserted the integral nature of the four power dimensions and that there is no one sequence or order in which the dimensions occur. While power is inherently value free, types of power (power-as-freedom and power-as-control) may manifest in a variety of forms and may manifest as constructive or destructive (Barrett). Furthermore, Barrett describes power as a unitary process, which manifests in varying intensities, frequencies, and forms.
Barrett's power theory (1986, 1998, 2010) has been identified as a middle range theory developed within Rogers' SUHB (Fawcett, 2005). Middle range theories are described as those with a focus on identified dimensions of reality. Middle range theories are basic, constructed with testable ideas, and as such, are especially suited for research and practice (Fawcett & Garity, 2009; Walker & Avant, 2005). Power theory-based practice has been explicated (Barrett, 1990, 2010; Fawcett, 2005; Malinski, 1994, 2006). The practice includes pattern manifestation knowing and appreciation and voluntary mutual patterning (Barrett, 2010).
Barrett's power theory and/or the Power as Knowing Participation in Change Tool (PKPCT) have been used within the conceptual-theoretical empirical structure for research in more than 50 studies (Kim, 2009). Published literature reviews have illustrated the usefulness of the power theory in research (Caroselli & Barrett, 1998; Kim 2008, 2009). Power has been examined in nurses and nursing students (Caroselli, 1995; Massari-Novak, 2004; Mahoney, 2006; Moulton, 1994); healthy adults (Kim, 2001; Kim, Kim, Park, Park, & Lee, 2008; Kim, Park, & Kim, 2008; Wright, 2004), older adults (Morris, 1991; Rizzo, 1990), those in cardiac rehabilitation (Ackerman, 2006), and those with pain (Lewandowski, 2004; Rapcaz, 1991; Siedliecki & Good, 2006; Wijesinghe, 2007). Researchers have also studied power in the situations of chronic illnesses (Larkin, 2007; Leksell, Johnasson, Wibell, & Wikbland, 2001; Shearer, Cisar, & Greenberg, 2007; Smith, 1993), organ transplant (Stoeckle, 1993), polio survivors (Smith, 1995); lung cancer (Wall, 2000), and those with mental health problems (Malinski, 1997; Rush, 1996; Salerno, 2002).
Studies have been done to explore differences in power for groups that are thought to express higher and lower intensity power (Malinski, 1997; Rapcaz, 1991, Smith, 1995). Whereas Smith found no differences in power for those who were and were not polio survivors, Malinski reported statistically significant differences in power for depressed (n = 200) and non-depressed (n = 200) women using canonical correlations. Data regarding subscale scores or mean scores on the PKPCT were not reported. Malinski performed supplemental analyses, which indicated that choices and involvement in creating change explained 32% of the variance in depression, while awareness and freedom accounted for a non-significant 7% of the variance in the sample of depressed and non-depressed women (Malinski). Likewise, Rapcaz supported differences in power (as measured by the PKPCT) with findings of lower intensity power for those participants with chronic (n = 113) as compared to those without chronic (n = 113) pain.
Barrett and Caroselli (1998) identified a paucity of information regarding normative power scores. Studying power profiles in different situations has been identified as a way to advance the power theory and provide evidence for Rogerian-based health patterning practices (Barrett & Caroselli; Caroselli & Barrett, 1998; Malinski, 1997). Limited information regarding normative power scores or power profiles persists. The researcher conducted the current secondary analysis to identify preliminary data regarding normative ranges of low, moderate, and high intensity power scores, frequency, and form for women in the extended stage of breast cancer survivorship. Conceptual and operational definitions of intensity, frequency, and form used for the current study are outlined in Box 1. Barrett's (2010) definition of power profiles is also offered.
In summary, the conceptual-theoretical-empirical structure of the current study is described within the conceptual model of Rogers' SUHB. Barrett's power theory, a mid-range theory, emerged from the SUHB to address the construct of knowing participation in change, which Barrett conceptualized as power. Empirically, the PKPCT Version II (Barrett, 1998) was used to measure power. Power has been examined in a variety of samples and in association with other variables; however, there is limited research available regarding power in breast cancer. Likewise, there is a paucity of studies addressing power intensity, frequency, or form.
The research is intended to answer three questions. The research questions are: a) What power intensities are present in extended stage breast cancer survivors? b) What power frequencies are present in extended stage breast cancer survivors? c) What forms of power are present in extended stage breast cancer survivors and within power intensity groups?
After approval from the researcher's university institutional review board, a secondary analysis was conducted using data from a parent study of 104 breast cancer survivors in the extended stage of survivorship (Farren, 2010). The parent study had a cross-sectional, correlational design with power as knowing participation in change conceptually defined by Barrett and operationally defined by the Power as Knowing Participation in Change Tool Version II (PKPCT) (Barrett, 1983, 1986, 1998). In the current study, descriptive statistics, comparison of means, multiple regression analyses and ANOVA with post hoc analyses were conducted to answer the research questions. The a priori level of significance was set at .05. Statistical Packages for the Social Sciences (SPSS) version 11 was used to analyze the data. In addition to the PKPCT, the demographic data form results from the parent study were used to describe the sample.
The PKPCT (Barrett, 1983, 1986, 1998) is a 52 item semantic differential scale to measure the individual's capacity to participate knowingly in change. Barrett developed the tool within Rogers' SUHB and to be consistent with Barrett's Power Theory. There are four integral power manifestations (awareness, choices, freedom to act with intention, and involvement in creating change) which are measured by 12 pairs of bipolar adjectives using a 7-point scale. Each dimension contains an additional retest item which is not included in the PKPCT scores. The 12 items are summated to arrive at dimension scores and all are summated to arrive at the PKPCT scores. Higher scores indicate higher power.
Reliability data for the PKPCT has been well established with Cronbach alphas for the total tool ranging from .72 to .98 (Caroselli & Barrett, 1998; Kim, Kim et al., 2008; Lewandowski, 2004; Shearer et al., 2007; Wall, 2000) and dimension alphas most often greater than .85 (Caroselli & Barrett; Kim, Kim et al.; Wall). Barrett (1983, 1986) reported face validity with a group of experts. Construct validity has been supported through results of factor analyses and known groups techniques (Barrett, 1990; Malinski, 1997; Rapcaz, 1991). In the parent study (Farren, 2010), the alpha reliability for the PKPCT was .96 (total) with dimension alphas ranging from .84 (awareness) to .91 (involvement in creating change), providing further support for the internal consistency reliability of the PKPCT and its appropriateness for use with breast cancer survivors.
The preliminary analysis and sample demographics for the parent study sample have been previously reported (Farren, 2010). The results included the handling of missing values. For the PKPCT, only 0.2% of responses were missing on different items across dimensions. Missing data were well below the criterion of 5%, so, it was deemed appropriate to replace missing values with the series means (Tabachnick & Fidell, 2001).
In terms of a summary description of the participants, the majority were recruited from cancer and breast cancer related groups (82%) primarily located on the East Coast, were well educated (more than 50% with baccalaureate or higher degrees), Caucasian (92%), Christian (75%), married (69%), and employed full- or part-time or self-employed (70%). The majority (51%) of women reported household income of $75,000 or less. Participants were all (100%) diagnosed for the first time and had completed treatment (51%) for approximately 1 / years. Participants reported treatment as primarily surgery in combination with adjuvant therapies (chemotherapy and/or radiation therapy). The majority of participants (64%) were receiving hormonal therapy, most of the women (83%) reported taking other medications, and some (30% were using one or more complementary modalities (including massage, spiritual healing, and energy therapies). A small percent (12%) of women reported experiencing lymphedema. The average age of the sample was 53 years with an age range of 28 to 81 years.
The first research question asked, "What power intensities are present in extended stage breast cancer survivors?" Three groups of intensity were identified (low, moderate, and high). Each group had a mutually exclusive range and mean power score (see Table 1). Likewise, means and standard deviations for the power dimensions in each group were calculated (see Table 2). The power intensity groups were identified through an examination of case summaries, frequencies, ranges, means, and standard deviations. The groups were constructed by examining the lower, mid, and upper third of the sample. The lower third of the sample contained 33 participants. The other two groups (mid = 36 and upper = 35) while approximately equal, had a few more participants. This method of forming the power intensity groups allowed for natural breaks in power scores between groups and sufficient group sizes for comparisons (see Table 1). Discriminant analysis estimated 96.2% of the originally grouped cases were correctly classified, which was deemed acceptable. Table 2 contains the mean dimension and total scores for each group and the full sample.
Research question two asked, "What are the power frequencies present in extended stage breast cancer survivors? The dimensional correlations with power were awareness (r = .915, p = .000), choices (r = .941, p = .000), freedom to act with intention (r = .935, p = .000), and involvement in creating change (r = .871, p = .000), all of which were statistically significantly, highly and positively correlated with power. On regression analysis (F = 7.98, Sig. F = .000), standardized coefficients (Beta = .258, .260, .287, and .288, respectively) estimate the strength of the contribution of each power dimension to power. The [R.sup.2] and adjusted [R.sup.2] were 1.00 indicating that 100% of the variance in power is explained by the four power dimensions.
Research question three asked, "What forms of power are present in extended stage breast cancer survivors?" Form was defined as the pattern of intensity in each of the inseparable power dimensions. This was examined for each intensity group and for the total sample. Mean dimension scores were reported for each group (see Table 2). The pattern of dimension intensities demonstrated lower to higher intensity for each group. Table 3 summarizes the forms of power for each group and total sample.
To further understand the forms of power in each power intensity group, ANOVA (see Table 4) and post hoc analyses were conducted. Prior to performing ANOVA, a test of homogeneity of variance was conducted. The Levene statistic for each dimension and total PKPCT, a test of homogeneity of variance, was 3.585, 3.235, 9.940, 3.936, and 7.705, respectively; all of which were statistically significant (p = .031, .043, .000, .023, .001, respectively). The criterion of homogeneity was not met as the variances were not equal. With a normal distribution (Skewness less than 2), and group sizes of at least 30 approximately equal size groups (n = 33, 36, 35, respectively), ANOVA is thought to be robust enough to tolerate the violation of the homogeneity of variance assumption (Weinberg & Abramowitz, 2002).
Post Hoc Tukey HSD indicated statistically significant (p = .000) mean differences in all dimensions for each power intensity group and total power. For example, awareness was different in all intensity groups. Results of ANOVA suggest there are differences in power forms for each power intensity group in this sample of extended stage breast cancer survivors.
The secondary analysis of power in breast cancer survivors yielded preliminary, detailed data about power in the extended stage of survivorship that can be discussed in terms of the power theory and the literature. The results of the first research question, regarding power intensities, indicated three groups (low, moderate, and high) of power intensity identified by power score ranges, means, and standard deviations. Barrett and Caroselli (1998) identified the need to begin to establish PKPCT score norms in different populations. In one masters' thesis (Mercier, 1994) reported in Barrett and Caroselli's review, power was examined in a sample of homeless (n = 65) men and women, which revealed low (48-143), moderate (144-287), and high (288-336) range power scores. Barrett and Caroselli suggested that more should be done to examine norms in specific groups. The ranges of power scores identified by Mercier in relation to the sample of homeless persons were considerably lower and broader than that found in the current study examining power score ranges (see Table 1) in extended stage breast cancer survivors.
Siedliecki and Good (2006) reported mean item scores for power in a study of music and power in adults with chronic non-malignant pain. The researchers classified the scores as low for means of 4 (on a 7-point scale), moderate for means of between 4 and 5, and high for means greater than 5. Generally, summated power scores are reported in the literature, which is consistent with recommendations regarding PKPCT scoring being done as factor or dimension scores and/or summation scores (Barrett & Caroselli, 1998). As low, moderate, and high intensity power groups have not been reported in the literature, only comparisons of mean power scores can be made.
In terms of sample mean power scores, the breast cancer survivors (n = 104) in the current study had a mean of 277 (SD = 33), which approximated mean power scores of a sample of adults (n = 104) with lung cancer (276, SD = 36) at the baseline data collection point in a study of power and an exercise intervention (Wall, 2000). Lower mean power scores ranging from 156 (SD = 15) to 248 (SD = 57)) have been found in adults prior to receiving different interventions for pain (Lewandowski, 2004; Siedliecki & Good, 2006; Wijesinghe, 2007). In a sample of adults with heart failure receiving an intervention to enhance power (n = 42), researchers found mean power scores of 255 (SD = 37) at baseline (Shearer et al., 2007). The comparisons of mean power scores suggest that breast cancer survivors have higher power intensities than adults experiencing pain, heart failure, and homelessness.
Research question two asked, "What power frequencies are present in extended stage breast cancer survivors?" In this sample of breast cancer survivors, there was evidence of high frequency power. The findings supporting high frequency are strong, positive, statistically significant correlations (r = .871 to .941); standardized coefficients that are within a narrow range (.258 to .288) with all making a statistically significant contribution to the explanation of power; and the extent of the explained variance (100%) in power (see Box 1 for definitions). In the current study, the correlational and regression findings support Barrett's (2010) statements about the integral nature of the power dimensions. Exploring the strength of correlations amongst the dimensions and the strength of each dimension's contribution to the variance in power helps to understand the relations amongst the power dimensions in breast cancer survivors.
No studies were found that reported regression of power on the four power dimensions for comparison of the current findings to other situations. However, Malinski (1997) reported that two dimensions (choices and involvement in creating change) explained a statistically significant portion (32%) of the variance in depression, while awareness and freedom to act with intention provided only a small, non-significant portion (7%) of the variance in depression. As the variables are different, specific comparisons between power frequencies in breast cancer survivors and women with depression cannot be made. Malinski's findings do suggest variations in the combination of the power dimensions (forms of power) are present in depression. It seemed reasonable to wonder about the forms of power in other situations.
Research question three asked, "What forms of power are present in extended stage breast cancer survivors?" In the current study, forms of power were defined as the pattern of variations in dimension intensity. Table 2 displays the dimension intensities (means and standard deviations) for the power intensity groups (low, moderate, high) and total sample. As one might expect, the results indicate that the means for each dimension increases from low to high power intensity groups. For example, Awareness (A) dimension means increase across power intensity group (low, moderate, and high).
Within power intensity groups, the dimension means vary in intensity and therefore, form a different sequence or order based on the power intensity group (see Table 3). For example, Awareness is second in the sequence of dimensions in the low power intensity group. It is third in the sequence in the moderate and high power intensity groups. Even though the moderate and high intensity power groups have the same order of dimensional intensity (see Table 3), there are subtle differences. For example, there is an approximate one point difference between choices and awareness scores, while involvement in creating change and freedom to act with intention are approximately equal. In the high intensity power group, the opposite is seen, i.e., choices and awareness are approximately equal and involvement in creating change and freedom have a difference of approximately one point.
In the low power intensity group, it was of interest that women expressed a lower capacity for freedom to act with intention than the other two power intensity groups, where freedom to act with intention was the most intense dimension. These data suggest that the form of power is different for breast cancer survivors in the different power intensity groups.
While there are no studies that have examined or compared forms of power as defined in the current study, Kim, Kim et al. (2008) reported PKPCT mean dimension scores (ranging from 55.47 [13.84] for awareness to 57.55 [11.19] for choices) for a sample of Korean (n = 881) adults, all of which were lower than those reported in the current study. Similarly, the dimensional intensities produced a different sequence pattern than the current study. Cultural and situational differences may account for the variations in intensity and form between the sample of Korean adults and this sample of breast cancer survivors.
From a qualitative perspective, Smith (1993) explored participation in men and women who did (n = 15) and did not participate (n = 18) in a cardiovascular rehabilitation program. Smith reported themes that were thought to be consistent with the power theory. For example, Smith identified themes for those participating in the program that included guides to facilitate change and fears inhibiting and facilitating participation. Themes identified for those not participating in the program included participating with health care professionals in care decisions and making changes on a continuum of action (Smith). The findings suggested different forms of power as knowing participation in change for those who did and did not participate in the program. The current study findings of varying forms of power are consistent with the findings of other researchers (Kim, Kim et al., 2008; Smith) and add further support to Barrett's (2010) ideas about inseparable, yet, varying sequences or order of power dimensions in different situations.
Additionally, mean power differences in the power intensity groups were found. Post hoc analyses indicated statistically significant differences in all dimensions. These findings provide preliminary support for differing forms of power among different power intensity groups of breast cancer survivors. Again, different forms of power in low, moderate, and high power intensity groups have not been reported, so no comparisons are available.
Conclusions and Implications
Breast cancer survivors in the extended stage of survivorship experience low, moderate, or high intensity power. The findings demonstrate that in this sample of extended stage breast cancer survivors, there was a high capacity for knowing participation in change regardless of power intensity group or the dimension. The power dimensions are integral with power and oscillated at high frequency in this sample of breast cancer survivors. Furthermore, there are variations in the intensities of the power dimensions that occur across the different power intensity groups (low, moderate, high). It is important to note that power intensities, frequency, and forms are not separate and that like Barrett's power dimensions or Rogers' (1992) principles of homeodynamics, they are all interrelated and integral.
There are limitations in the current study. The findings are preliminary and cannot be generalized. The sample size (n = 104), while sufficient for the parent study, was a limiting factor and prohibited the examination of correlational and regression analyses in the power intensity groups (n = 33, 36, 35, respectively). This secondary analysis is the first to examine power in this detail and the definitions, approaches to analyses, and findings must be considered preliminary. As such, normative power scores for breast cancer survivors can only be established through additional research that can continue to build on this preliminary work. Similarly, further work is needed to determine if or to what extent this line of inquiry (power intensity, frequency, and forms of power) may have in terms of clinical significance.
The implications of this study include support for Barrett's power theory, the need for further research, and preliminary implications for practice. The current study adds to an understanding of power in breast cancer survivors. Enhancing an understanding of the theory is essential for engaging in theoryguided practice. Knowing the form or pattern of power dimensions is a way of pattern manifestation knowing and can contribute to designing voluntary mutual patterning to assist breast cancer survivors.
In future studies of power, it is important for researchers to examine and report power intensity, frequency, and form so that a better understanding of power in breast cancer survivors and others can emerge. Ultimately, it is the breast cancer survivor with a unique power profile that teaches us about power as knowing participation in change within the situation of the extended stage of survivorship. Barrett (2010) describes a power profile as the association of the inseparable power dimensions and identifies the profile as dynamic and nonlinear. Data that contribute to power profiles of breast cancer survivors were identified in the current study, however, further exploration of power profiles of breast cancer survivors is best done using a mixed methods design using the PKPCT and qualitative methods designed within a Rogerian perspective.
The current study assists nurses and other health care providers to increase their awareness of the importance of power as a continuous theme in the lives of extended stage breast cancer survivors. Nurses with increased awareness of the findings regarding power in survivors can use the PKPCT and pattern knowing and appreciation to learn about survivors' power and engage with women for voluntary mutual patterning. Barrett (2010) describes the use of PKPCT for power prescriptions. Barrett defined power prescriptions as "individually designed application of a health patterning modality (p. 49)," which can be mutually created to assist survivors towards enhanced power-as-freedom.
In summary, this secondary analysis of power in breast cancer survivors was conducted to answer three research questions related to power intensities, frequency, and form. Low, moderate, and high power intensity groups were identified. The dimensions of power oscillate at high frequency and are inseparable contributors to unitary power. Variations in the pattern or forms of power are evident and differences among the power intensity groups were found. Despite the limitations, study findings support Barrett's power theory; give direction for defining and measuring power intensity, frequency, and form; and provide preliminary data to enhance an understanding of power in breast cancer survivorship. Power is a human pattern manifestation and is important for nurses and other health care providers to consider in breast cancer survivors.
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Arlene T. Farren, RN; PhD; AOCN, CTN-A
College of Staten Island/CUNY
Arlene T. Farren, Assistant Professor, Nursing Department, College of Staten Island/CUNY Author Note
This manuscript is based on data from a parent study that was published in Nursing Science Quarterly, January 2010 and a dissertation published with UMI in 2008. The preliminary report of the secondary analysis was presented at the SRS 2009 Conference.
Box 1 Definitions Term Conceptual and Operational Definitions including Interpretive Information Intensity Variations in the ranges of power scores measured by the PKPCT with descriptive statistics such as range, means, and standard deviations. The current study will identify low, moderate, and high power intensity. Frequency Dimensions oscillating together to manifest power as measured by PKPCT dimension correlations with power and contributions to the variation in Power. Higher frequency power will be manifest in strong, statistically significant positive correlations of dimensions with power and/or all dimensions with strong, statistically significant contributions to a high percent explained variance in power. Lower frequency power will be manifest by dimensions with varying strengths of correlations of dimensions with power and/or variations in the strength and significance of the dimensions to varying percents of explained variance in power. Form Pattern of dimensional intensities measured by the PKPCT mean and standard deviation scores that reflect variations in the combinations of the inseparable power dimensions. Power Profiles "The inseparable association of the four power dimensions" (Barrett, 2010, p. 49). Power profiles may be measured by the PKPCT and the expressed experiences of individuals, using a mixed method approach.
Table 1 Power Intensity Measures for Each Group and Total Sample of Breast Cancer Survivors Group/N Range Mean SD Low Intensity 180-265.85 238.47 23.16 (n = 33) Moderate Intensity 267-291 280.39 8.41 (n = 36) High Intensity 296-336 310.41 12.46 (n = 35) Total Sample 180-336 277.19 33.18 (n = 104) Table 2: Power Intensity by Dimension and Total Power Score for Each Group and Total Sample Dimension Low Intensity Moderate High Intensity and (n = 33) Intensity (n = 35) Total PKPCT Mean & SD (n = 36) Mean & SD Mean & SD Awareness 59.87 (6.23) 69.83 (4.27) 77.10 (4.13) (A) Choices (C) 58.95 (6.29) 69.04 (3.32) 76.69 (4.37) Freedom to 59.22 (7.50) 70.89 (3.55) 78.77 (4.11) Act with Intention (I) Involvement 60.42 (8.16) 70.64 (4.26) 77.85 (6.51) in Creating Change (I) Total PKPCT 238.46 280.39 310.41 (23.16) (8.41) (12.46) Dimension Total PKPCT and (N = 104) Total PKPCT Mean & SD Awareness 69.12 (8.55) (A) Choices (C) 68.41 (8.63) Freedom to 69.84 (9.54) Act with Intention (I) Involvement 69.82 (9.56) in Creating Change (I) Total PKPCT 277.19 (33.18) Table 3: Forms of Power Intensity Mean (SD) on Power Dimensions by Group Order (low to high) of Dimensional Intensity Low C F A Intensity 58.95 59.22 59.87 60.42 (n = 33) (6.23) (7.50) (6.23) (8.16) Moderate C A I F Intensity 69.04 69.83 70.64 70.89 (n = 36) (3.32) (4.27) (4.26) (3.55) High C A I F Intensity 76.69 77.10 77.85 78.77 (n = 35) (4.37) (4.13) (6.51) (4.11) Total C A I F (n = 104) 68.41 (8.63) 69.12 (8.55) 69.82 (9.56) 69.84 (9.54) Intensity Form Group Low Intensity CF AI (n = 33) Moderate Intensity C A IF (n = 36) High Intensity CA I F (n = 35) Total (n = 104) C A IF Power Dimensions: A = Awareness; C = Choices; F = Freedom to Act with Intention; I = Involvement in Creating Change Table 4: Analysis of Variance in Power Dimensions and Total Power Source Sums of df F Sig Squares Awareness Between Groups 5069.702 2 104.107 .000 Within Groups 2459.197 101 Total 7528.899 103 Choices 117.747 .000 Between Groups 5366.238 2 Within Groups 2301.497 101 Total 7667.735 103 Freedom 117.583 .000 Between Groups 6552.586 2 Within Groups 2814.224 101 Total 9366.810 103 Involvement in CC 62.285 .000 Between Groups 5193.910 2 Within Groups 4211.184 101 Total 9405.094 103 Total PKPCT 179.359 .000 Between Groups 88476.760 2 Within Groups 24911.410 101 Total 113388.17 103
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