A pilot study of a gratitude journaling intervention to enhance spiritual well-being and exercise self-efficacy in Black breast cancer survivors

Abstract

Background

Breast cancer (BC) survivorship presents significant health disparities, particularly affecting Black women, who experience a 40% higher BC death rate compared to White women. These disparities are exacerbated by comorbidities, which contribute to poorer overall health outcomes. Additionally, Black BC survivors often face psychosocial challenges, including increased stress and lower well-being, which can lead to adverse physical health effects. This pilot study aims to assess the feasibility and efficacy of a culturally sensitive gratitude journaling intervention designed to enhance spiritual well-being, exercise self-efficacy, and reduce inflammation among Black BC survivors.

Methods

This pilot study employed a two-group, parallel random-assignment experimental design to compare a gratitude journaling intervention with a general memory journaling control group. Twenty-six Black women aged 40 to 70 years with a history of BC were randomly assigned to either the gratitude journaling intervention group (n = 13) or the control group (n = 13). The gratitude intervention group engaged in gratitude journaling twice weekly for eight weeks, while the control group documented daily memories. Outcomes measured included Gratitude Questionnaire-6, FACIT-Spiritual Well-Being 12 Item Scale, Perceived Stress Scale, Giscombe Superwoman Schema Questionnaire, and the Stage of Motivational Readiness for Physical Activity questionnaire and inflammatory biomarkers. Statistical analyses included the Wilcoxon rank sum test and Fisher’s exact test.

Results

Twenty-six participants were enrolled, with 73% completing baseline and post-intervention assessments. The intervention group showed a significant improvement in spiritual well-being (p = 0.014) with a large effect size (ES = 0.57). Marginal improvements in exercise self-efficacy were also observed (ES = 0.39). Although there were no significant differences in dispositional gratitude and perceived stress between groups, the intervention group exhibited trends toward increased gratitude and reduced stress. Inflammatory biomarker analysis indicated non-significant changes, though IL-6 levels increased in the intervention group.

Conclusion

This study demonstrates the feasibility and acceptability of a gratitude journaling intervention among Black BC survivors. The intervention significantly enhanced spiritual well-being and showed promise in improving exercise self-efficacy, suggesting its potential for promoting holistic wellness in this population. These findings provide a foundation for future larger-scale randomized controlled trials to further evaluate the efficacy of gratitude-based interventions for Black BC survivors.

Trial registration

This study was registered prospectively at ClinicalTrials.gov (NCT05473026) on 07-13-2022.