应对方式在肠造口患者疾病感知和造口适应之间的中介效应研究

Coping modes as mediators of illness perception and stoma adaptation in enterostomal patients

目的基于自我调节常识模型理论,探究肠造口患者应对方式在疾病感知和造口适应之间的中介效应,为临床提高肠造口患者造口适应的干预策略提供参考。方法采用便利抽样法,在2022年6月至2023年10月采用一般资料调查表、中文版疾病感知问卷简化版、医学应对方式问卷中文版及中文版造口患者适应量表对212例肠造口患者进行调查。结果肠造口患者造口适应得分(43.79±9.83)分,7.08%的患者达到造口高适应水平;疾病感知与面对、造口适应呈负相关(P<0.01),与回避、屈服呈正相关(P<0.01);面对与造口适应呈正相关(P<0.01),回避、屈服与造口适应呈负相关(P<0.01);Process中介效应分析显示:面对、回避和屈服在疾病感知与造口适应之间的中介效应显著(P<0.05),总间接效应为-0.2508,占总效应的29.29%;各维度结构方程模型分析显示,面对在控制感知和接受维度之间起了部分中介作用,在控制感知和积极的生活态度维度之间起了完全中介作用,屈服在威胁感知和持续担忧维度之间起了部分中介作用,中介效应值分别为:0.603、0.934、0.184。结论肠造口患者的造口适应水平处于中低水平,有待进一步改善,疾病感知是造口适应重要的预测因素,应对方式在疾病感知和造口适应之间存在部分中介效应。医护人员应该及时评估和干预患者的疾病感知情况,了解患者的负性威胁感知,提高患者对造口的控制能力,减少消极应对行为,从而提高造口适应水平。

Objective To explore the mediating role of coping strategies in the relationship between illness perception and the adaptation to stoma among patients with enterostomies,grounded in the Self-Regulation Commonsense Model theory.The findings aim to inform clinical intervention approaches,enhancing the adaptation process for stoma patients.Methods From June 2022 to October 2023,a cross-sectional survey was conducted on 212 enterostomal patients.Data were collected using the general information questionnaire,Brief Illness Perception Questionnaire,Medical Coping Modes Questionnaire,and the Ostomy Adjustment Inventory-20.Results The stoma adaptation score for enterostomal patients was(43.79±9.83),with 7.08%achieving a high level of stoma adaptation.Illness perception was negatively correlated with both facing coping and stoma adaptation(P<0.01),and positively correlated with avoidance and yielding coping(P<0.01).Facing coping was positively associated with stoma adaptation(P<0.01),while avoidance and yielding coping were negatively associated(P<0.01).Mediation analysis revealed significant mediating effects of facing,avoidance,and yielding coping between illness perception and stoma adaptation(P<0.05),with an indirect effect of-0.2508,accounting for 29.29%of the total effect.The structural equation model indicated that facing strategies partially mediated the relationship between control perception and acceptance,as well as between control perception and a positive attitude towards life,with indirect effects of 0.603 and 0.934,respectively.Yield coping partially mediated the relationship between threat perception and worry,with an indirect effect of 0.184.Conclusion Stoma adaptation levels among enterostomal patients are suboptimal and require further enhancement.Illness perception is a significant predictor of stoma adaptation.Coping strategies exert a partial mediating effect between illness perception and stoma adaptation.Healthcare providers should assess and intervene in illness perceptions promptly,addressing health threat perceptions,enhancing self-management capabilities,and mitigating negative behaviors to improve ostomy adaptation levels.