Development Of The Psychosocial Adaptation Assessment Tool For Patients With Chronic Skin Disease From The Perspective Of Positive Psychology And Its Relationship With Quality Of Life

Objective: Based on the change of psychosocial adaptation concept of patients with skin disease,this study analyzed its influencing factors and interventions,clarified the concept and connotation of psychosocial adaptation of patients with chronic skin diseases,explored the construction of psychosocial adaptation model of patients with chronic skin diseases from the perspective of positive psychology;and developed psychosocial adaptation assessment tools for patients with chronic skin diseases.It analyzed the relationship between psychosocial adaptation and quality of life of patients with chronic skin diseases and its influencing factors,and provides scientific reference for the revision and application promotion of psychosocial adaptation care model of chronic skin diseases from the perspective of positive psychology.Methods: mixed methods.Part one: Research on the concept change,influencing factors and intervention measures of psychosocial adaptation in patients with chronic skin diseases In accordance with the principle of Arksey and O'Malley scoping research,relevant literatures of EMBASE,Pub Med,CINAHL and Psyc INFO in January 2018 were retrieved.According to the inclusion and exclusion criteria,relevant studies were screened independently by two researchers,and the information was extracted to summarize the psycho-social adaptation concepts,influencing factors and intervention strategies of patients with chronic skin diseases.Part two: Qualitative research on the construction of psychosocial adaptation model of patients with chronic skin diseases from the perspective of positive psychology Following a constructivist grounded theory methodology,the research object of met inclusion and exclusion criteria for observation and interview in August 2018,interview data after the initial after transcription,focus,axial and selective coding four key stages,by comparison,to iterative coding and analysis of data,until saturated,determine the chronic skin disease patients psychosocial adaptation concept and category of positive psychology perspective to build chronic skin disease patients psychosocial adaptation model.Part three: Quantitative study on development of psychosocial adjustment assessment tool and its relationship with quality of life in patients with skin disease from the perspective of positive psychology Based on the results of the scope and qualitative study,the initial psychosocial adaptation questionnaire of patients with chronic skin disease was formed.After two rounds of evaluation and revision by 5 experts,33 research subjects were selected for pre-investigation to evaluate the content validity,surface validity and internal reliability of the initial questionnaire.From May to October 2019,convenience sampling was used to conduct a cross-sectional survey on 362 patients in 4 hospitals.Cross-sectional surveys were conducted using questionnaires including the general information questionnaire,the psychosocial adaptation questionnaire for patients with chronic skin disease,the Athens insomnia scale,the hospital anxiety and depression scale,and the perceived social support scale.Critical ratio value(CRV),discriminative index(DI)and item-total correlation(ITC)analyses were used to delete items that were lower than a set criterion.Regarding construct validity,exploratory factor analysis and confirmatory factor analysis were performed.The hospital anxiety and depression scale and perceived social support scale were used as the correlation validity of the calibration test questionnaire.Known-groups comparison was used to test how well the PSAQ-CSD discriminated between subgroups of the study sample.Cronbach's alpha coefficient was used as an index of internal consistency.To evaluate test–retest reliability,30 patients were re-evaluated after 5~7 days.The correlation coefficient of the overall questionnaire and each dimension determines the correlation between the questionnaire dimension and the overall.To explore the relationship between psychosocial adaptation and quality of life in patients with chronic skin disease and its influencing factors,the relationship between psychosocial adaptation and quality of life and its influencing factors were analyzed by correlation,single factor,multiple regression and path analysis.Results:Part one: From 2261 initial records,69 studies were identified and analyzed.The concept of psychosocial adaptation in patients with chronic skin disease was referred to under an assortment of descriptions.The related factors for psychosocial adaptation in patients with chronic skin disease included the following: demographic factors(sex,age,education level,ethnicity,BMI,sleep quality,marital status,exercise amount,family history,the use of topical treatment only,personality and history of smoking);disease-related factors(disease severity,clinical symptoms,localization and duration);psychological factors(anxiety/depression,self-esteem,body image,stigma and suicidal ideation);and social factors(social support,social interaction,sexual life,economic burden and social acceptance).Despite being limited in quantity,several studies have clarified the benefits of adjuvant care in the form of cognitive behavioral training,educational training and self-help programs,all of which have become common methods for dealing with the psychosocial impacts.Part two: Reach saturation data in May 2019,a total of 19 cases of chronic skin disease patients,the observation and the interview text analysis found that from 174 the initial 42 theme is summed up in the coding,axial coding forming self adjusting,disease effects,background factors,physiological experience,psychological experience,social experience,the positive and negative psychosocial adaptation eight core categories.When individuals are faced with the impact of chronic skin diseases,self-cognition is the core,and positive or negative psychosocial adaptation is formed through a series of complex situational factors-interaction of experience,which constructed the psychosocial adaptation model for patients with chronic skin diseases.Positive psychology perspective requires individuals to seek external resources and/or stimulate their own potential for positive psychosocial adaptation.Part three: Based on the influencing factors and core categories of psychosocial adaptation of patients with chronic skin diseases,the initiation questionnaire of psychosocial adaptation of patients with chronic skin diseases was formed from the perspective of positive psychology.After 2 rounds of expert consultation,the content validity of the 64?item questionnaire was 0.996,including anxiety/depression,self-esteem,body image,stigma,social support and social interaction,and the range of content validity index was 0.975~1.000.A preliminary survey of 33 subjects found whether or not the items of the psychosocial adjustment questionnaire for patients with chronic skin diseases were difficult,appropriate,vague and complex.321 valid questionnaires were collected(the effective rate was 88.92%).11 items were deleted by CRV,DI and ITC before factor analysis.After several rounds of exploratory factor analysis,the factor loading value does not conform to the standard,or simultaneously in more than two factors of load value is greater than standard was deleted.Finally,the18-item questionnaire on psychosocial adaptation of patients with chronic skin diseases entered into exploratory factor analysis,and three factors were extracted through principal component analysis,with the cumulative contribution rate of 65.435%.The load value of the items on the corresponding factor was above 0.6,and the structure of the questionnaire was basically consistent with the previous conception.Based on the previous theories and contents,the three factors were named as affective dimension,self-cognition and social dimension.The correlation coefficients of psychosocial adjustment questionnaire,hospital anxiety and depression questionnaire and perceived social support questionnaire were-0.826 and 0.573,respectively(P<0.01).The subjects were divided into two groups according to the presence or absence of itching symptoms.The analysis of group K showed that the difference between the two groups was statistically significant(p<0.01).The overall Cronbach's alpha coefficient of psychosocial adaptation questionnaire for patients with chronic skin diseases was 0.934,and the variation range of Cronbach's coefficient in three dimensions was0.825~0.935.The correlation coefficient of the total score before and after the questionnaire retest was 0.815(p<0.01).The correlation coefficients of the questionnaire and the scores in each dimension ranged from 0.757 to 0.952(p<0.01).The correlation coefficient between the total score and each dimension of psychosocial adaptation and quality of life for chronic skin disease patients was statistically different(P < 0.01).According to the subgroup analysis of diagnosis,it was found that the differences between psychosocial adaptation and total quality of life scores of patients with psoriasis and vitiligo were statistically significant(P < 0.01).Chronic skin disease of main factors affecting the psychosocial adaptation in patients with single factor analysis showed that the way of seeing a doctor,marital status,education level,occupation,payments,diagnosis,course of the disease,whether or not to use folk prescription,visual parts and sensitive parts,lesion area,itching,pain, anxiety/depression,sleep and the impact of social support on quality of life has statistical significance(P < 0.01).The results of multiple regression analysis showed that seven variables,namely anxiety and depression,diagnosis,itch degree,social support,pain degree,motor condition and visual site,entered the regression equation and jointly predicted 68.10% of the variation of psychosocial adaptation.The results of path analysis confirm the results of multiple stepwise regression and are basically consistent with the proposed path.Chronic skin disease of main factors affecting the quality of life in patients with single factor analysis showed that the object of study way of medical institutions,medical,age,gender,smoking status,marital status,movement,education level,occupation,payments,diagnosis,course of diseases,whether used folk prescription,visual parts and sensitive parts,lesion area,itching,pain,psychosocial adaptation,anxiety/depression,sleep and the impact of social support on quality of life has statistical significance(P < 0.01).The results of multiple stepped-regression analysis showed that six variables,namely anxiety and depression,itch degree,skin lesion area,sleep condition,psychosocial adaptation and sensitive site,entered the regression equation and predicted 68.90% of the variation of quality of life.The results of path analysis confirm the results of multiple stepwise regression and are basically consistent with the proposed path.Conclusion1.The concept change,influencing factors and intervention measures of psychosocial adaptation in patients with chronic skin diseases were identified,providing a clear direction for the construction of psychosocial adaptation model and the development of assessment tools.2.Self-cognition was the core of the psychosocial adaptation model of patients with chronic skin diseases from the perspective of positive psychology,which is a complex,dynamic and interactive process.The psychosocial adaptation of patients with chronic skin diseases is a nonlinear reciprocation,characterized by dynamic interaction,which defines the core category of psychosocial adaptation of patients with chronic skin diseases,and constructs the psychosocial adaptation model of patients with chronic skin diseases from the perspective of positive psychology.3.Based on the influencing factors and core categories of psychosocial adaptation among patients with chronic skin disease,the psychosocial adaptation questionnaire was developed from the perspective of positive psychology,which proved to have good reliability and validity,and could objectively and accurately evaluate the psychosocial adaptation of patients with chronic skin diseases,thus providing a scientific tool for further clinical evaluation and research.4.The psychosocial adaptation of patients with chronic skin disease is significantly positively correlated with the quality of life.The better psychosocial adaptation is,the higher the quality of life is.As one of the main factors affecting the quality of life,improving psychosocial adaptation can improve the quality of life.5.The influence factors of psychosocial adaptation and quality of life of patients with chronic skin disease were comparative analyzed,which found that the main influencing factors and the path are the same,also have different.And There are also differences between different chronic skin diseases.Therefore,effective and feasible intervention strategies should be formulated according to the clinical characteristics of chronic skin diseases and the main influencing factors of psychosocial adaptation and quality of life.