本文選題：腦卒中 + 病恥感��； 參考：《天津醫(yī)科大學》2017年碩士論文

【摘要】：目的1.漢化慢性疾病病恥感量表(Stigma Scale for Chronic Illness,SSCI)并檢驗其在腦卒中患者中的信度和效度,最終形成中文版慢性疾病病恥感量表;2.調(diào)查我國腦卒中患者病恥感水平并探討該群體病恥感的影響因素。方法1.采用便利抽樣的方法于2016年3月至2016年6月選取天津市兩家社區(qū)服務(wù)中心的204名腦卒中患者為研究對象。按照量表翻譯程序?qū)β约膊〔u感量表進行漢化,形成中文版慢性疾病病恥感量表。通過一般資料調(diào)查表,中文版慢性疾病病恥感量表,Barthel指數(shù)量表、抑郁自評量表、SF-12量表進行問卷調(diào)查。檢驗中文版慢性疾病病恥感量表的心理學特征,包括信度檢驗、效度檢驗。信度使用內(nèi)部一致性和重測信度進行檢驗,效度使用內(nèi)容效度、結(jié)構(gòu)效度進行檢驗;2.采用便利抽樣的方法于2016年3月至2016年6月選取天津市兩家社區(qū)服務(wù)中心的189名腦卒中患者為研究對象。采用一般資料調(diào)查表、慢性疾病病恥感量表、Barthel指數(shù)量表、抑郁自評問卷、醫(yī)學應對方式量表、社會支持評定量表對腦卒中患者進行調(diào)查。采用單因素分析來比較各分類變量中不同類別指標對病恥感的差異,使用相關(guān)性分析檢驗各連續(xù)變量(日常生活活動、抑郁狀態(tài)、社會支持、應對方式)與病恥感水平的相關(guān)系數(shù);運用多元線性回歸分析,探討腦卒中患者病恥感水平的影響因素。結(jié)果1.慢性疾病病恥感量表的信效度檢驗項目分析結(jié)果顯示中文版SSCI能夠鑒別高分組和低分組(P0.01)。各條目得分與SSCI總分的相關(guān)系數(shù)為0.472~0.806;內(nèi)在病恥感的13個條目與所屬維度得分的相關(guān)系數(shù)為0.673~0.807;外在病恥感的11個條目與所屬維度得分的相關(guān)系數(shù)為0.519~0.845,內(nèi)在病恥感、外在病恥感得分與總量表得分的相關(guān)系數(shù)分別為0.955,0.900(P0.01);總量表的Cronbach'sα系數(shù)為0.951,內(nèi)在病恥感和外在病恥感維度的Cronbach'sα系數(shù)均為0.927;總量表的重測信度為0.881,內(nèi)在病恥感和外在病恥感維度的重測信度為0.927,0.797;探索性因子分析提取3個公因子,累計方差貢獻率為65.586%;內(nèi)容效度指數(shù)I-CVI在0.800-1.000之間,S-CVI為0.932;與抑郁、日常生活能力、SF-12心理維度及生理維度的Pearson相關(guān)系數(shù)為0.609、-0.486、-0.524、-0.462(P0.01)。2.腦卒中患者病恥感的影響因素分析腦卒中患者病恥感總分為(44.96±16.71)分,其中內(nèi)在病恥感得分為(27.70±10.91)分,外在病恥感得分為(17.26±7.00)分。單因素分析結(jié)果顯示,婚姻狀況、職業(yè)、腦卒中類型、發(fā)病次數(shù)類型、是否存在后遺癥、病程對病恥感總分差異具有統(tǒng)計學有意義(P0.05);連續(xù)性變量Pearson相關(guān)分析中日常生活活動能力、抑郁、主觀支持、客觀支持、對支持的利用程度、屈服、回避和病恥感總分的相關(guān)性具有統(tǒng)計學意義(P0.01);多元線性回歸結(jié)果顯示,抑郁、逃避、主觀支持、日常生活活動能力是腦卒中患者病恥感的主要影響因素,共解釋57.5%的變異量。單因素分析結(jié)果顯示,職業(yè)、腦卒中類型、發(fā)病次數(shù)類型、是否存在后遺癥、病程對內(nèi)在病恥感得分差異具有統(tǒng)計學有意義(P0.05);連續(xù)性變量Pearson相關(guān)分析中日常生活活動能力、抑郁、主觀支持、客觀支持、對支持的利用程度、屈服、回避和內(nèi)在病恥感的相關(guān)性具有統(tǒng)計學意義(P0.01);多元線性回歸結(jié)果顯示,抑郁、逃避、主觀支持、日常生活活動能力、是否存在后遺癥是腦卒中患者內(nèi)在病恥感的主要影響因素,共解釋57.8%的變異量。單因素分析結(jié)果顯示,職業(yè)、腦卒中發(fā)病次數(shù)類型、是否存在后遺癥、病程對外在病恥感得分差異具有統(tǒng)計學有意義(P0.05);連續(xù)性變量Pearson相關(guān)分析中日常生活活動能力、抑郁、主觀支持、客觀支持、屈服、回避和外在病恥感得分的相關(guān)性具有統(tǒng)計學意義(P0.01);多元線性回歸結(jié)果顯示,抑郁、逃避、主觀支持、日常生活活動能力是腦卒中患者外在病恥感的主要影響因素,共解釋41.5%的變異量。結(jié)論1.本研究將英文版SSCI漢化,在腦卒中患者中對中文版SSCI進行信效度檢驗,研究結(jié)果表明中文版SSCI具有較好的信度和效度,可在我國腦卒中患者中使用,為我國神經(jīng)系統(tǒng)疾病病恥感的相關(guān)研究提供了研究工具。2.我國腦卒中患者病恥感處于中等水平,內(nèi)在病恥感水平較高,外在病恥感水平較低。護理人員應重視腦卒中患者的病恥感問題,重點關(guān)注抑郁水平較高、日常生活活動能力較差及留有后遺癥人群,指導其采取積極的應對策略,提高其內(nèi)在支持。以病恥感的影響因素為切入點,采取針對性的干預方法來降低腦卒中患者病恥感水平,以促進身心康復,提高生活質(zhì)量。
[Abstract]:Objective 1. Stigma Scale for Chronic Illness (SSCI) and test its reliability and validity in stroke patients, and finally form a Chinese version of the Chinese version of chronic disease stigma, and 2. to investigate the level of the stigma of stroke patients in China and to explore the influence factors of the discomfort of the group. Method 1. adopt a convenient sampling Methods from March 2016 to June 2016, 204 stroke patients in two community service centers in Tianjin were selected as the subjects. The Chinese version of chronic disease stigma was formed according to the scale translation procedure, and the Chinese version of the chronic disease stigma, Barthel finger, was used. The scale, the self rating depression scale and the SF-12 scale were used to investigate the psychological characteristics of the Chinese version of the chronic disease stigma scale, including reliability test, validity test, reliability using internal consistency and retest reliability test, validity use content validity and structural efficiency test; 2. a convenient sampling method was used in 2016 3. From January to June 2016, 189 stroke patients in two community service centers in Tianjin were selected as the subjects. The general data questionnaire, the chronic disease stigma scale, the Barthel index scale, the self rating depression questionnaire, the medical coping style scale, and the social support rating scale were used to investigate the stroke patients. The single factor analysis was used to compare the results. The correlation coefficient of the continuous variables (daily life, depression, social support, coping style) and the level of stigma was tested by the correlation analysis, and the factors affecting the level of stigma in the stroke patients were analyzed by multivariate linear regression analysis. Results 1. chronic diseases were found. The results of the reliability and validity test of the stigma scale showed that the Chinese version of SSCI was able to distinguish between high and low scores (P0.01). The correlation coefficient of the score of each item and the total score of SSCI was 0.472~0.806; the correlation coefficient of the 13 entries of the internal disadvantageous stigma and the scores of the subordinate dimensions was 0.673~0.807; the 11 items of the external discomfort and the scores of the subordinate dimensions were scored. The correlation coefficient was 0.519~0.845, internal discomfort, the correlation coefficient between the external discomfort and the total table score was 0.955,0.900 (P0.01), the Cronbach's alpha coefficient of the total scale was 0.951, the Cronbach's alpha coefficient of the internal disadvantageous and extrinsic stigma were all 0.927, and the retest reliability of the total scale was 0.881, the internal discomfort and external diseases. The retest reliability of the dimension of the stigma was 0.927,0.797, the exploratory factor analysis extracted 3 public factors, the cumulative variance contribution rate was 65.586%, the content validity index I-CVI was between 0.800-1.000, and S-CVI was 0.932, and the Pearson correlation coefficient of depression, daily living ability, SF-12 psychological dimension and physiological dimension was 0.609, -0.486, -0.524, -0.462 (P0.01).2. brain. The influencing factors of the stigma of stroke patients were (44.96 + 16.71) points in stroke patients, including (27.70 + 10.91) scores and (17.26 + 7) points for external discomfort. Single factor analysis showed that marital status, occupation, stroke type, frequency type, sequelae, course to disease The difference in the total score of the stigma was statistically significant (P0.05); the ability of daily living, depression, subjective support and objective support in the continuous variable Pearson correlation analysis were statistically significant (P0.01) for the use of support, yield, avoidance and the total score of the diseased stigma; multiple linear regression results showed depression, escape, and subjective support. The ability of daily living was the main factor affecting the stigma of stroke patients. A total of 57.5% variations were explained. The results of single factor analysis showed that occupation, type of stroke, the number of times of the disease, the existence of sequelae, and the statistical significance (P0.05) in the difference of the internal discomfort score (P0.05) in the continuous variable Pearson correlation analysis. The ability of daily living, depression, subjective support, objective support, the correlation of use of support, yield, avoidance, and internal discomfort were statistically significant (P0.01); multiple linear regression results showed that depression, escape, subjective support, daily living activity, and whether there were sequelae were the main causes of the internal discomfort of stroke patients. To influence factors, a total of 57.8% variations were explained. The results of single factor analysis showed that the occupation, the type of stroke incidence, the existence of sequelae, the difference in the score of the stigma in the course of the disease (P0.05); the ability of daily living, depression, subjective support, objective support, and yield, in the Pearson correlation analysis of continuous variables. The correlation between avoidance and external disease stigma was statistically significant (P0.01); multiple linear regression results showed that depression, escape, subjective support, and daily living ability were the main factors affecting the external discomfort of stroke patients. A total of 41.5% variations were explained. In the 1. studies, the English version of SSCI was sinicized in stroke patients. The Chinese version of SSCI carries out the reliability and validity test. The results show that the Chinese version of SSCI has good reliability and validity. It can be used in the stroke patients in China. It provides a research tool for the related research on the pubic sense of the disease of the nervous system in our country,.2., the level of the pubic sense of the stroke patients in China is in the middle level, the internal disgrace is high, and the external disgrace is disgraced. The sense level is low. The nursing staff should pay attention to the problem of the stigma of stroke patients, pay more attention to the high level of depression, poor daily living ability and the population with sequelae, guide them to take active coping strategies and improve their internal support. The level of stigma in stroke patients is to promote physical and mental rehabilitation and improve the quality of life.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R473.2

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