The Influence of Adult Attachment on Patient Self-Management in Primary Care--The Need for a Personalized Approach and Patient-Centred Care.
The Influence of Adult Attachment on Patient Self-Management in Primary Care--The Need for a Personalized Approach and Patient-Centred Care.
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DOI：
10.1371/journal.pone.0136723
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Gensichen J
中科院分区：
文献类型：
--
作者：
Brenk-Franz K;Strauss B;Tiesler F;Fleischhauer C;Ciechanowski P;Schneider N;Gensichen J
自我管理策略是初级保健慢性病患者循证治疗的基本要素。我们的目标是分析患有多种慢性病的初级保健患者的不同自我管理技能和行为及其与成人依恋的关系。在 apricare 研究（初级保健中的成人依恋）中，我们采用前瞻性纵向设计来研究患有多种疾病的初级保健患者的成人依恋与自我管理之间的关联。使用 ECR-RD 测量依恋维度回避和焦虑。自我管理技能由 FERUS（改变动机、应对、自我效能、希望、社会支持）衡量，自我管理行为由 DSMQ（血糖管理、饮食控制、体力活动、医疗保健使用）衡量。临床诊断和疾病严重程度由患者的全科医生评估。多变量分析（GLM）用于评估成人依恋维度与患者自我管理之间的关系。该研究纳入了 219 名年龄在 50 岁至 85 岁之间、患有多种慢性病（II 型糖尿病、高血压和至少一种其他慢性病）的初级保健患者。依恋维度焦虑与改变动机呈正相关，与应对、自我效能和希望、饮食控制和身体活动呈负相关。回避与应对、自我效能、社会支持和医疗保健使用呈负相关。焦虑和回避这两个依恋维度与自我管理的不同组成部分相关。对慢性病患者的个性化、基于依恋的看法可能是初级保健中有效、个人自我管理方法的关键。
Self-management strategies are essential elements of evidence-based treatment in patients with chronic conditions in primary care. Our objective was to analyse different self-management skills and behaviours and their association to adult attachment in primary care patients with multiple chronic conditions. In the apricare study (Adult Attachment in Primary Care) we used a prospective longitudinal design to examine the association between adult attachment and self-management in primary care patients with multimorbidity. The attachment dimensions avoidance and anxiety were measured using the ECR-RD. Self-management skills were measured by the FERUS (motivation to change, coping, self-efficacy, hope, social support) and self-management-behaviour by the DSMQ (glucose management, dietary control, physical activity, health-care use). Clinical diagnosis and severity of disease were assessed by the patients’ GPs. Multivariate analyses (GLM) were used to assess the relationship between the dimensions of adult attachment and patient self-management. 219 patients in primary care with multiple chronic conditions (type II diabetes, hypertension and at least one other chronic condition) between the ages of 50 and 85 were included in the study. The attachment dimension anxiety was positively associated with motivation to change and negatively associated with coping, self-efficacy and hope, dietary control and physical activity. Avoidance was negatively associated with coping, self-efficacy, social support and health care use. The two attachment dimensions anxiety and avoidance are associated with different components of self-management. A personalized, attachment-based view on patients with chronic diseases could be the key to effective, individual self-management approaches in primary care.