How self-stigma affects patient activation in persons with type 2 diabetes: a cross-sectional study
How self-stigma affects patient activation in persons with type 2 diabetes: a cross-sectional study
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DOI：
10.1136/bmjopen-2019-034757
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发表时间：
2020-05-01
期刊：
影响因子：
2.9
通讯作者：
Hashimoto, Hideki
中科院分区：
文献类型：
--
作者：
Kato, Asuka;Fujimaki, Yuko;Hashimoto, Hideki
目的2型糖尿病（T2 DM）患者自我污名与自我护理的激活水平降低相关。然而，因果通路连接自我污名与患者激活自我护理尚未显示。为了确定自我耻辱如何影响患者的自我护理激活，我们测试了一个双路径假设模型，既直接又通过自尊和自我效能感介导。设计一项横断面研究。设置日本两所大学医院，一所综合医院和一所诊所。参与者接受治疗的T2 DM门诊患者（n=209）完成了一份自我管理问卷，包括自我耻辱量表，患者激活测量、Rosenberg自尊量表、一般自我效能量表、患者健康问卷、血红蛋白A1 c测试、年龄、性别和体重指数。结果路径分析显示自我污名与患者激活之间存在较强的相关性（χ 2 =27.55，p=0.120;拟合优度指数=0.97;调整拟合优度指数=0.94;比较拟合指数=0.98;近似均方根误差=0.04）。自我污名对患者激活有直接影响（β =-0.20; p=0.002）。间接地，自我污名影响患者激活沿着两个路径（β =0.31; p
Objectives Self-stigma is associated with lower patient activation levels for self-care in persons with type 2 diabetes mellitus (T2DM). However, the causal pathway linking self-stigma with patient activation for self-care has not been shown. In order to determine how self-stigma affects patient activation for self-care, we tested a two-path hypothetical model both directly and as mediated by self-esteem and self-efficacy.Design A cross-sectional study.Setting Two university hospitals, one general hospital and one clinic in Japan.Participants T2DM outpatients receiving treatment (n=209) completed a self-administered questionnaire comprising the Self-Stigma Scale, Patient Activation Measure, Rosenberg Self-Esteem Scale, General Self-Efficacy Scale, Patient Health Questionnaire, haemoglobin A1c test, age, sex and body mass index.Primary and secondary outcome measures Self-stigma levels were measured by using the Self-Stigma Scale. Patient activation levels were measured by the Patient Activation Measure.Results Path analysis showed a strong relationship between self-stigma and patient activation (chi(2)=27.55, p=0.120; goodness-of-fit index=0.97; adjusted goodness-of-fit index=0.94; comparative fit index=0.98; root mean square error of approximation=0.04). Self-stigma had a direct effect on patient activation (beta=-0.20; p=0.002). Indirectly, self-stigma affected patient activation along two paths (beta=0.31; p