Measuring Financial Well-Being in Cancer Survivorship
Atlanta, GA—To effectively address socioeconomic disparities in healthcare, particularly regarding cancer survivorship, it is critical that we improve our understanding of the material, psychosocial, and behavioral dimensions of financial well-being, said Reginald D. Tucker-Seeley, MA, ScM, ScD, Edward L. Schneider Chair in Gerontology, University of Southern California, Los Angeles, at the 2017 AACR Science of Cancer Health Disparities Conference.
These 3 dimensions describe how individual socioeconomic circumstances are experienced, managed, and leveraged in health outcomes and health behaviors throughout the life course.
Socioeconomic status is known to be positively associated with health and health behavior. But the traditional measures—income, education, occupation—of socioeconomic circumstances in population health research may be limited, said Dr Tucker-Seeley.
“There may be variability between groups when using these socioeconomic measures. But by tapping into this variability, we may learn more about how one’s socioeconomic status is actually lived,” he said.
Several theories have been proposed to describe the differential impact of socioeconomic status across racial and ethnic groups. The diminishing returns hypothesis posits that racial or ethnic minorities may not experience the same returns on increasing levels of socioeconomic status as their white counterparts, whereas the minority poverty hypothesis suggests a unique disadvantage for racial or ethnic minorities who are living in poverty, largely the result of residential racial or ethnic and economic segregation.
Several concepts have also been used to describe the experience of financial hardship, distress, strain, or toxicity. These terms are all used interchangeably, and, according to Dr Tucker-Seeley’s research, have all been shown to be associated with several health outcomes, including health self-efficacy, intensive end-of-life care, oral health, self-rated health, morbidity, and mortality.
“But there’s some variability in the association between socioeconomic circumstances and health that may not be captured by traditional measures of socioeconomic status,” reported Dr Tucker-Seeley. “In these studies, we controlled for the traditional measures of socioeconomic status, and the measures of financial hardship were still strongly associated with the health outcomes listed here.”
Financial Health Across the Cancer Continuum
Financial well-being across the cancer continuum presents many conceptual and operational challenges, such as how do we define it, how do we measure it, and, when in the cancer continuum do we measure it—who measures it, and what do we do with it after we measure it?
“Are we just arguing over semantics here?” he asked. “We all know what we mean when we use these terms. However, I can tell you that providing some conceptual and measurement clarity in defining economic insecurity is absolutely necessary, particularly for the development of interventions and policy,” argued Dr Tucker-Seeley.
Various explanations for health inequalities have been proffered in the literature. The material hypothesis emphasizes access to tangible material conditions, whereas the psychosocial hypothesis emphasizes the direct or indirect effects of stress, either from being lower on the socioeconomic hierarchy or from living under relative socioeconomic disadvantage.
“Most of us agree it’s a combination of both of these that influence differences in health across groups,” Dr Tucker-Seeley said. “Within population health, there hasn’t been an effort to develop measures that capture both the material and the psychosocial aspects of socioeconomic status, but this is where I’ve focused my work.”
The Money-Health Connection Study
Dr Tucker-Seeley and colleagues designed the Money-Health Connection study to develop a transdisciplinary conceptual model of financial well-being. The study goals included conceptual clarity, “to ensure that we are accurately defining the experience we think we are defining,” and measurement clarity, “to ensure that we are consistently measuring the same experience we think we are measuring across studies,” he said.
The researchers defined financial well-being using Burkhard Strumpel’s 1976 definition. “Financial well-being refers to the material and psychosocial aspects of one’s economic situation, and describes how well an individual is ‘making ends meet’ and if he/she has the financial resources to handle unexpected life events,” said Dr Tucker-Seeley.
Overall, 3 themes became evident in the description and measurement of the articles reviewed, and the various definitions could be categorized into those that captured material aspects of socioeconomic circumstances, psychosocial aspects, or behavioral aspects.
Dr Tucker-Seeley and colleagues conducted a survey of their conceptual model, which comprised 17 material questions, 24 psychosocial questions, and 30 behavioral questions. The survey was distributed to 629 individuals through professional networks, with a follow-up of 6 months. In addition to assessing financial well-being, the primary outcomes of interest included self-rated health, self-rated mental health, smoking behavior, and physical activity behavior.
“We were also interested in how correlated our measures of financial well-being were with other measures of financial well-being,” he said.
The team is still analyzing the survey data, and have developed a measures repository available on www.tuckerseeley.org that includes all the measures reviewed for this research.
Defining multiple domains of financial well-being has promising implications for population health, and will assist efforts to identify potential interventions and policy targets on material conditions (additional financial resources for specific household expenses), psychological response (stress-reduction strategies), and behavioral coping (financial literacy or education), said Dr Tucker-Seeley.