病耻感对糖尿病足患者自我管理行为的影响:社会支持和应对方式的链式中介作用  

Influence of stigma on self-management behavior of patients with diabetic foot:the chain mediating effect of social support and coping style

作　　者：孟珂[1] 李明楠 张坤 陈莉[4] Meng Ke;Li Mingnan;Zhang Kun;Chen Li(Department of General Practice,Xinxiang Central Hospital,Xinxiang 453001,China;Fourth Department of Cardiovascular Medicine,Xinxiang Central Hospital,Xinxiang 453001,China;Xinxiang Key Laboratory on Healing Mechanism Research of Diabetic Foot Ulcer,Xinxiang 453001,China;‘Department of Wound Treatment,the Affiliated Peoples Hospital of Xinxiang Medical University,Xinxiang 453000,China)

机构地区：[1]新乡市中心医院全科医学科,新乡453001 [2]新乡市中心医院心血管内四科,新乡453001 [3]新乡市糖尿病足溃疡愈合机制研究重点实验室,新乡453001 [4]新乡市第一人民医院伤口治疗部,新乡453000

出　　处：《中华现代护理杂志》2024年第27期3657-3663,共7页Chinese Journal of Modern Nursing

摘　　要：目的探讨社会支持和应对方式在糖尿病足患者病耻感和自我管理行为之间的链式中介作用。方法采用便利抽样法,选取在新乡市中心医院门诊就诊的糖尿病足患者224例为研究对象,采用2型糖尿病病耻感评估量表、社会支持评定量表、医学应对方式问卷和糖尿病足部自我管理行为量表对其进行问卷调查,采用SPSSPROCESS程序中的Model6对链式中介效应进行检验。结果单因素分析显示,不同年龄、文化程度、工作状况、家庭人均月收入、Wagner分级及是否接受足部健康教育的患者自我管理行为评分差异有统计学意义(P<0.05)。相关性分析显示,病耻感、社会支持、应对方式、自我管理行为之间均具有相关性(P<0.05)。中介效应分析显示,病耻感除了对糖尿病足患者自我管理行为产生直接效应外,还通过社会支持和应对方式(面对和屈服)的单独中介作用及二者的链式中介作用对自我管理行为产生影响。结论病耻感不仅可以直接影响糖尿病足患者的自我管理行为,还可以通过社会支持、应对方式(面对和屈服)的中介作用对其产生间接影响。今后可通过降低糖尿病足患者病耻感,增加社会支持力度,鼓励患者勇于面对疾病来提高其自我管理水平。Objective To explore the chain mediating effect of social support and coping style between stigma and self-management behavior in diabetic foot patients.Methods A total of 224 patients with diabetic foot who visited the Outpatient Department of Xinxiang Central Hospital were selected as participants by convenience sampling.Type 2 Diabetes Stigma Assessment Scale,Social Support Rating Scale,Medical Coping Modes Questionnaire and Diabetes Foot Self-Care Behavior Scale were used for survey.Model 6 in the SPSS PROCESS program was used to test for chain mediating effects.Results Univariate analysis showed that there were statistically significant differences in self-management behavior scores among patients of different ages,educational levels,work status,average monthly family income,Wagner grading,and whether they received foot health education(P<0.05).Correlation analysis showed that there was a significant correlation between stigma,social support,coping style,and self-management behavior,with statistical differences(P<0.05).Mediating effect analysis showed that,in addition to the direct effect of stigma on the self-management behavior of diabetic foot patients,it also had an impact on self-management behavior through the separate mediating effect of social support and coping style(facing and resignation)and the chain mediating role of the two.Conclusions Stigma can not only directly affect the self-management behavior of diabetic foot patients,but also indirectly affect them through the mediating role of social support and coping style(facing and resignation).The self-management of patients with diabetic foot can be improved by reducing their stigma,increasing social support and encouraging patients to be brave in coping with the disease.

关 键 词：糖尿病足 病耻感 社会支持 应对方式 自我管理行为 中介作用 

分 类 号：R473.5[医药卫生—护理学]