Open Access

ARTICLE

Communication Barriers, Emotional Distress and Mental Health Promotion in Cancer Care: Insights from Rural China

Su Li¹, Nooreen Noordin², Dan Wang^3,*

1 School of Foreign Language, Nanyang Normal University, Nanyang, 473061, China
2 Faculty of Educational Studies, Universiti Putra Malaysia, Serdang, 43400, Malaysia
3 Faculty of Social Sciences & Liberal Arts, UCSI University, Kuala Lumpur, 56000, Malaysia

* Corresponding Author: Dan Wang. Email:

(This article belongs to the Special Issue: Evidence-based Approaches to Managing Stress, Depression, Anxiety, and Suicide)

International Journal of Mental Health Promotion 2025, 27(11), 1797-1812. https://doi.org/10.32604/ijmhp.2025.072301

Received 23 August 2025; Accepted 29 October 2025; Issue published 28 November 2025

Abstract

Background: Communication barriers are a critical yet underexplored determinant of psychological well-being in oncology care, particularly among rural Chinese patients treated in urban hospitals. This study examined how Mandarin proficiency influences emotional distress and identified implications for mental health promotion. Methods: A sequential mixed-methods design was adopted. Quantitative data were collected from 180 rural cancer patients using the Putonghua Proficiency Test (PSC), the Hospital Anxiety and Depression Scale (HADS), and the Distress Thermometer (DT). Multiple linear regressions estimated covariate-adjusted associations between Mandarin proficiency and distress outcomes, controlling for demographic and clinical factors. Semi-structured interviews with 20 patients explored communication experiences and psychosocial impacts. Quantitative and qualitative findings were integrated for triangulated interpretation. Results: Lower Mandarin proficiency was significantly associated with higher anxiety (β = −0.30, p = 0.001), depression (β = −0.25, p = 0.01), and distress (β = −0.28, p = 0.003), with an adjusted R² = 0.18 (F = 7.4, p < 0.001). Each 10-point increase in PSC corresponded to a 0.5-point reduction in DT score (B = −0.05, p = 0.003). Qualitative themes revealed confusion, stigma, isolation, and reliance on family interpreters, confirming that linguistic inequity functions as an independent psychosocial stressor in oncology care. Conclusion: Language barriers significantly heighten distress among rural Chinese cancer patients. Addressing these barriers through interpreter services, culturally responsive staff training, and inclusive educational materials should be recognized as a core strategy for mental health promotion and equitable cancer care.

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Keywords

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