TY  - EJOU
AU  - Li, Su 
AU  - Noordin, Nooreen 
AU  - Wang, Dan 

TI  - Communication Barriers, Emotional Distress and Mental Health Promotion in Cancer Care: Insights from Rural China
T2  - International Journal of Mental Health Promotion

PY  - 2025
VL  - 27
IS  - 11
SN  - 2049-8543

AB  - <b>Background</b><b>:</b> 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. <b>Methods:</b> 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. <b>Results:</b> Lower Mandarin proficiency was significantly associated with higher anxiety (<i>β</i> = −0.30, <i>p</i> = 0.001), depression (<i>β</i> = −0.25, <i>p</i> = 0.01), and distress (<i>β</i> = −0.28, <i>p</i> = 0.003), with an adjusted R<sup>2</sup> = 0.18 (<i>F</i> = 7.4, <i>p</i> < 0.001). Each 10-point increase in PSC corresponded to a 0.5-point reduction in DT score (B = −0.05, <i>p</i> = 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. <b>Conclusion:</b> 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.
KW  - Communication barriers; emotional distress; rural patients; Mandarin proficiency; psycho-oncology; mental health promotion

DO  - 10.32604/ijmhp.2025.072301