| Objective:Conceptual analysis was used to clarify the conceptual attributes,preconditions,influencing factors and consequences of psychosocial adaptation of urinary incontinence,based on the results of conceptual analysis and guided by Roy adaptation model,a conceptual model of psychosocial adaptation of female urinary incontinence was preliminarily constructed;descriptive phenomenology was used to understand the real experience and process of psychosocial adaptation of female patients with urinary incontinence in China;developed a psychosocial adaptation assessment tool for female urinary incontinence suitable for China’s cultural background;analyzed the psychosocial adaptation level and influencing factors of female patients with urinary incontinence,explored the mechanism and path of psychosocial adaptation on the quality of life of female patients with urinary incontinence,Verified the psychosocial adaptation model of female patients with urinary incontinence,and provided a theoretical basis for formulating the intervention plan of psychosocial adaptation of female patients with urinary incontinence.Methods:Part I:conceptual analysis and preliminary construction of psychosocial adaptation model of female patients with urinary incontinenceUsing the Rodgers evolutionary concept analysis method,the relevant literatures collected by Pub Med,web of science,CINAHL,Psyc INFO,CBM,CNKI and Wanfang Data knowledge service platform from January 1997 to June 2021 were retrieved,according to the inclusion criteria,the literature was selected to analyze the concept of psychosocial adaptation of patients with urinary incontinence from the aspects of the evolution process,conceptual attributes,preconditions,influencing factors,consequences,related concepts and typical cases of psychosocial adaptation of patients with urinary incontinence.Based on the results of conceptual analysis and guided by Roy adaptation model,a conceptual model of psychosocial adaptation of female urinary incontinence was preliminarily constructed.Part II:qualitative study on psychosocial adaptation of female patients with urinary incontinenceUsing descriptive phenomenological method,15 female patients with urinary incontinence were interviewed in depth from March 2021 to July 2021,collected data through recording and other forms,Colaizzi seven step analysis method was used to analyze the data and refine the theme,deeply explore the real experience and process of psychosocial adaptation of female patients with urinary incontinence under the cultural background of China.Part III:the development of psychosocial adaptation assessment tool for female patients with urinary incontinenceBased on the results of conceptual analysis and qualitative research,a psychosocial adaptation initialization scale for female patients with urinary incontinence was formed.After two rounds of expert consultation,the scale was revised and improved.30 subjects were selected for pre investigation to evaluate the content validity and surface validity of the initialization scale.From August 2021 to October 2021,570 subjects were selected by convenient sampling method for cross-sectional survey,the survey tools included general information questionnaire,ICIQ-UI SF,the psychosocial adaptation scale for female patients with urinary incontinence developed in this study,and CAPS-SF-C.The critical ratio method and correlation coefficient method were used to screen the items,exploratory and confirmatory factor analysis were used to evaluate the structural validity of the scale,CAPS-SF-C was used as the calibration evaluation scale to evaluate the calibration relevance validity,internal consistency reliability and test-retest reliability were used to test the reliability of the scale,and the psychosocial adaptation scale for female patients with urinary incontinence(final version)was formed.Part IV:validation of psychosocial adaptation model of female urinary incontinenceFrom November 2021 to December 2021,a cross-sectional survey was conducted on 220 subjects by convenient sampling method,according to the initially constructed psychosocial adaptation model of female urinary incontinence,research tools were selected,including general information questionnaire,ICIQ-UI SF,psychosocial adaptation scale of female urinary incontinence,cognitive questionnaire of urinary incontinence,coping style scale of female urinary incontinence and quality of life scale of urinary incontinence.Through single factor,multiple linear regression analysis and structural equation model test of psychosocial adaptation of female patients with urinary incontinence,the influencing factors and action path of psychosocial adaptation of female patients with urinary incontinence were clarified;The conceptual model of psychosocial adaptation of female patients with urinary incontinence was verified by single factor,multiple linear regression analysis and structural equation model test of quality of life in female patients with urinary incontinence.Results:Part I:43 literatures were screened and included after systematic retrieval.The obtained literatures did not clearly define the psychosocial adaptation of patients with urinary incontinence.The concept of psychosocial adaptation of female patients with urinary incontinence is a developing process.The conceptual attributes include emotional state,self cognition,role function and social support.The prerequisite is the prevalence of urinary incontinence.The influencing factors are demographic sociological factors,disease-related factors,disease cognition and coping style,and the consequence is the quality of life.The conceptual model of psychosocial adaptation of female patients with urinary incontinence is the fact that individuals experience urinary incontinence,affect the psychosocial adaptation level of patients through disease cognition and coping style,and finally affect the quality of life of patients.Part II:the psychosocial adaptation experience of female patients with urinary incontinence includes 6 first-class themes and 28 second-class themes,which are physiological experience(physiological discomfort,limited drinking water,limited exercise,decreased sleep quality and sexual dysfunction),psychological adaptation(anxiety,depression,embarrassment,shame,low self-esteem,fear,worry,pressure,pain,body image,self blame,hope and confidence),social adaptation(social role weakening,social withdrawal,social support),disease cognition(lack of disease knowledge,health concept),coping strategies(concealing symptoms,passive avoidance,acceptance and adjustment),self management(lifestyle,treatment compliance).The psychosocial adaptation experience of female patients with urinary incontinence includes two themes:the process of continuous adjustment and the influence of many factors.The psychosocial adaptation of female patients with urinary incontinence is affected by the patient’s personality characteristics,disease cognition,social support,perceived health status and other factors.Part III:1.Construction of scale:based on conceptual analysis and qualitative research results,an initial scale of psychosocial adaptation for female patients with urinary incontinence was formed,including 4 dimensions and 41 items.According to the results of two rounds of expert correspondence,the initial scale was revised into 4dimensions and 44 items,including emotional state(11 items),self cognition(12items),role function(10 items)and social support(11 items).The content validity index of the scale was 0.995,and the content validity index of the four dimensions was 0.970～1.000.The pre survey results showed that the difficulty and accuracy of the items of psychosocial adaptation scale for female patients with urinary incontinence were appropriate.2.Item analysis:according to the critical ratio and correlation coefficient of items,a total of 16 items whose discrimination or correlation does not meet the standard are deleted.3.Reliability and validity analysis results of the scale:(1)Validity Analysis:The common factors were extracted by principal component analysis,and the common factors with eigenvalues greater than 1.0 were extracted.After orthogonal rotation by the maximum variance method,the factor load value was set to be greater than 0.5 for factor analysis,and three common factors wrer extracted,and the cumulative variance contribution rate was 66.952%;The confirmatory factor analysis was carried out by AMOS software,and the psychosocial adaptation scale of female urinary incontinence with 17 items was finally formed.Based on Roy’s adaptation model theory,combined with previous conceptual analysis and qualitative research results,the three dimensions are named self-concept,role function and social support respectively;The correlation coefficient between psychosocial adaptation scale and coping adaptation process scale for female patients with urinary incontinence was 0.600(P<0.01).(2)Reliability analysis:the Cronbach’s a coefficient of the total psychosocial adaptation scale of female urinary incontinence was 0.893,and the Cronbach’s a coefficient of three dimensions was 0.835～0.910;The correlation coefficient of the total score before and after the retest of the scale was 0.803(P<0.01).Part IV:203 valid questionnaires were collected(the effective recovery rate was92.27%).The total score of psychosocial adaptation of female patients with urinary incontinence was(39.06±15.49).The dimension with the highest score was role function,and the dimension with the lowest score was self-concept.The score of psychosocial adaptation in female patients with urinary incontinence was positively correlated with the score of disease cognition(P<0.01),and negatively correlated with the score of coping style(P<0.01);The score of quality of life was positively correlated with the score of psychosocial adaptation(P<0.01).The results of univariate analysis of psychosocial adaptation of female patients with urinary incontinence showed that the psychosocial adaptation level of patients was different with different age,educational background,family monthly income,occupation,medical payment mode,body mass index,number of births,course of disease,type and severity of urinary incontinence(P<0.05);Multivariate analysis showed that the mode of medical payment,course of disease,severity of urinary incontinence,disease cognition and coping style entered the multiple linear regression equation(P<0.05).The path analysis of the influencing factors of psychosocial adaptation using structural equation showed that the three endogenous variables of disease cognition,coping style and psychosocial adaptation could be effectively explained.The explanatory variables were 85%of psychosocial adaptation,49%of disease cognition and 64%of coping style respectively.Nine paths were confirmed to be consistent with the envisaged path,and one path was not confirmed.The fitting of the modified model was ideal,and the test result of model fitness wasχ~2/df=1.191,RMSEA=0.031,GFI=0.994,CFI=0.999,NFI=0.995。The mediating effect analysis of the influencing factors of psychosocial adaptation showed that disease cognition and coping style played multiple mediating roles between medical payment mode,course,severity and psychosocial adaptation;There are indirect effects between medical payment mode,course,severity and psychosocial adaptation;There is also a direct effect between medical payment mode,severity and psychosocial adaptation.The results of univariate analysis on the quality of life of female patients with urinary incontinence showed that there were significant differences in the level of quality of life among patients with different age,place of residence,educational background,monthly family income,occupation,working status,medical payment mode,number of births,course of disease,type and severity of urinary incontinence(P<0.05);Multivariate analysis showed that age,working status,severity of urinary incontinence,disease cognition,coping style and psychosocial adaptation entered the multiple linear regression equation(P<0.05).Using structural equation to analyze the path of influencing factors of quality of life,the results show that the four endogenous variables of disease cognition,coping style,psychosocial adaptation and quality of life can be effectively explained.The explanatory variables are 86%of quality of life,84%of psychosocial adaptation,44%of disease cognition and 64%of coping style.It was confirmed that 10 paths were consistent with the envisaged path,and 4 paths were not confirmed.The fitting of the modified model is ideal,and the test result of model fitness wasχ~2/df=2.176,RMSEA=0.076,GFI=0.986,CFI=0.996,NFI=0.992。The mediating effect analysis of the conceptual model of psychosocial adaptation showed that disease cognition,coping style and psychosocial adaptation played multiple mediating roles between age,severity and quality of life;There are indirect effects between age,severity and quality of life;There is also a direct effect between severity and quality of life.Conclusion:1.Based on the application of conceptual analysis to clarify the conceptual attributes,preconditions,influencing factors and consequences of psychosocial adaptation of female patients with urinary incontinence,this study preliminarily constructs the conceptual model of psychosocial adaptation of female patients with urinary incontinence based on Roy adaptation model,which provides a theoretical basis for the development of specific psychosocial adaptation evaluation tools for female patients with urinary incontinence.2.Through the qualitative research results,it is concluded that the psychosocial adaptation experience of female patients with urinary incontinence includes physiological experience,psychological adaptation,social adaptation,disease cognition,coping strategies and self management.The emotions of female patients with urinary incontinence are complex and changeable,dominated by negative emotions.The psychosocial adaptation process of female patients with urinary incontinence is a continuous changing process,which is affected by personality characteristics,disease cognition,social support,perceived health status and other factors.It is suggested that medical workers can continue to pay attention to the overall health status of female patients with urinary incontinence from the perspective of psychosocial adaptation.3.The psychosocial adaptation scale of female urinary incontinence developed based on conceptual analysis and qualitative research results has good reliability and validity.It can objectively and accurately evaluate the psychosocial adaptation of female urinary incontinence patients,and provides a scientific tool for further clinical evaluation and nursing research.4.Medical payment mode,course of disease,disease severity,disease cognition and coping style are the influencing factors of psychosocial adaptation of female patients with urinary incontinence.Demographic sociological factors and disease-related factors of female patients with urinary incontinence can have a direct and/or indirect impact on psychosocial adaptation through disease cognition and coping style.Age,work status,disease severity,disease cognition,coping style and psychosocial adaptation are the influencing factors of the quality of life of female patients with urinary incontinence.The validated conceptual model of psychosocial adaptation of female patients with urinary incontinence is basically consistent with the original idea.The psychosocial adaptation of female patients with urinary incontinence plays an intermediary role between disease cognition,coping style and quality of life.It is suggested that medical workers can improve the quality of life of female patients with urinary incontinence by improving their psychosocial adaptation level. |
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