Data Collection and Measures

Data were collected at two time points, during baseline assessments and follow-up assessments (5–7months after baseline assessments). All respondents were administered a socio-demographic and clinical characteristics questionnaire, the Malay version of the “PTG Inventory-Short Form” (PTGI-SF), and the Malay version of the “Brief Coping Orientation to Problems Experienced Inventory” (Brief COPE) during their baseline assessments. The question about treatment modalities, the Malay version of the PTGI-SF and the Malay version of the Brief COPE were re-administered to respondents during their follow-up assessments.

The Malay version of the PTGI-SF was administered to all respondents in order to assess PTG levels. The “PTG Inventory” (PTGI) is a self-reported instrument comprising 21 items in five domains (appreciation of life, spiritual growth, increased personal strength, new possibilities in life, and improved relationship with others). The “PTGI-SF” is a shorter version of the PTGI, comprising 10 items in five similar domains (two items per domain). It can replace the PTGI without any loss of information. Each item is scored on a Likert scale, ranging from 0 (I did not experience this change) to 5 (I experienced this change to a great degree). Thus, the PTGI-SF’s total scores range from 0 to 50. The higher the total score, the greater the degree of PTG a respondent has experienced. The PTGI-SF exhibits good psychometric properties and offers the advantage of shorter administration time than the PTGI (Cann et al., 2010). The Malay version of the PTGI-SF was validated with Malaysian cancer patients, and it demonstrated good internal consistency with Cronbach’s α=0.89 (Leong Abdullah et al., 2017).

The Malay version of the Brief COPE was administered to respondents in order to measure the coping strategies used by HNC patients in response to cancer as a stressful event. The Brief COPE is a self-reported instrument and a shorter version of the 60-item COPE scale. It is often used in healthcare settings to assess how patients with a life-threatening medical illness cope with a stressful condition, including cancer (Hagan et al., 2017). The Brief COPE comprises 28 items in 14 subscales, such as positive reframing, active coping, self-distraction, denial, substance use, use of emotional support, behavioral disengagement, venting, planning, humor, acceptance, religious coping, self-blame, and use of instrumental support. Each item is scored on a Likert scale, ranging from 1 to 4. Thus, the total scores for each subscale range from 2 to 8. The Brief COPE subscales can be further categorized into two broad coping styles: avoidant coping (comprising self-distraction, denial, substance use, behavioral disengagement, self-blame, and venting) and approach coping (comprising positive reframing, active coping, use of emotional support, planning, acceptance, and use of instrumental support). The Brief COPE exhibits good psychometric properties (Carver, 1997). It was validated with the Malaysian cancer population, and its subscales’ internal consistency ranged from Cronbach’s α of 0.51–0.99 (Yusoff et al., 2009).

The study’s data collected during participants’ baseline and follow-up assessments on socio-demographic and clinical characteristics included gender, age, religion, time since diagnosis, stage of cancer, and cancer treatment received. The clinical data’s reliability was confirmed through access to all respondents’ case notes. The response options for gender were recorded as male or female. The choices for age were reported as 18–25, 26–45, 45–60years, or more than 60years. Responses to religion were recorded as Islam, Buddhism, Hinduism, or Christianity. The options for time since diagnosis were reported as less than 6 or 6–12months. The responses to stage of cancer were recorded as stage 1, stage 2, stage 3, or stage 4. The responses to cancer treatment received were reported as: no treatment received; surgery only; chemotherapy only; surgery and chemotherapy; surgery and radiotherapy; chemotherapy and radiotherapy; or surgery, chemotherapy, and radiotherapy.