The Influencing Factors And The Construction Of Prediction Model Of Stigma In Disabled Elderly People With Chronic Disease

Objective:Using the method of qualitative and quantitative research,this paper discusses the status of the stigma of the disabled elders with chronic disease,analyzes the path relationship between the influencing factors of the stigma of the elderly with chronic disability,and provides a reference for the nursing staff to develop the psychological nursing intervention program,so as to improve the mental health level of the elderly.Methods:Qualitative interview and questionnaire survey were used in this study.(1)Qualitative interview method: Based on the literature review and clinical practice,the interview outline is summarized.According to the reliability standard of qualitative research,the interview is conducted among the 10 most representative elderly with chronic disability in 4 elderly care institutions of Taiyuan city.The data are analyzed by the phenomenological analysis method to refine the theme.(2)Questionnaire survey : Using convenient sampling method,235 elderly people with chronic disability were selected as the research objects.General data questionnaire,Elderly Disability Assessment Scale(EDAS),Stigma Scale for Chronic Illness(SSCI),Coping Style Questionnaire,Social Support Rating Scale(SSRS),Herth Hope Index(HHI)and Self-Perceived Burden Scale(SPBS)were used to investigate the elderly with chronic disability,and to understand the influencing factors of stigma of the elderly with chronic disability.Using Excel 2010 form to input data,spss21.0 software to conduct statistical analysis,amos21.0 software to build a prediction model of the factors affecting the shame of the elderly with chronic disability.Results:1.Qualitative research: after in-depth interviews with 10 elderly people with chronic disability,the psychological experience of stigma in elderly people with chronic disability was analyzed and summarized as six themes:(1)regret and guilt;(2)shame and exclusion;(3)fear and despair;(4)family breakdown;(5)suicide;(6)avoidance of medical treatment.2.Questionnaire investigation: 250 questionnaires were sent out in this study,and 235 effective questionnaires were recovered,with an effective recovery rate of94%.The scores of stigma of the elderly with chronic disability were 70.58±17.87,39.84±9.20 and 30.72±8.72,respectively.In general information,education,marital status,monthly income,number of disease,disability,time of disability,number of hospitalizations,time of residence,type of residence and visiting frequency of relatives and friends had influence on the stigma of the elderly with chronic disability The difference was statistically significant(P<0.05).Multiple linear regression analysis was carried out on the influential factors with statistical significance in single factor analysis.The results showed that the education level,widowhood,monthly income,number of diseases ? 3,disability level,disability time,2-3 times hospitalization,time of residence ? 13 months,living in double room and visiting frequency of relatives and friends once a month significantly affected stigma of the elderly with chronic disability.3.Correlation analysis results:Correlation analysis between the stigma and self perceived burden,social support,coping style and hope level of the elderly with chronic disability showed that there was a significant positive correlation between self perceived burden and stigma(r=0.881,P<0.01);a significant negative correlation between social support and stigma(r=0.470,P<0.01);a significant negative correlation between positive coping style and stigma(r=0.633,P<0.01);a significant positive correlation between negative coping style and stigma(r=0.300,P<0.01);a significant negative correlation between hope level and pubic sensation(r=0.697,P<0.01).4.Structural equation model analysis: the results showed that self perceived burden has a direct and positive effect on the stigma,the direct effect is 0.669.Meanwhile,self perceived burden has an indirect effect on the stigma through two paths which is about hope level and positive coping,the indirect effect was 0.069;social support has a direct and negative effect on the stigma,the direct effect is 0.238,and it indirectly influences stigma through self-perceived burden,hope level,and positive coping,with indirect effect of 0.445;positive response has direct negative effect on the stigma,with direct effect of 0.138;hope level has no direct effect on the stigma,but it has an indirect negative effect on the stigma through active response,with an indirect effect of 0.035,so social support,positive response and hope level are of the stigma in the elderly with chronic disability.Conclusion:The results of qualitative research indicate that poor health,economic pressure,humiliating experience and low hope level aggravate the stigma and exclusion,regret and guilt of the elderly with chronic disability,which provides reference for the investigation of the influencing factors of the stigma of the disabled elderly.It is suggested that the elderly with disability should be given effective rehabilitation exercise,and the nursing staff should be trained and educated to reduce the humiliating experience of the elderly with disability and improve their hope level.There is a high level of stigma in the elderly with chronic disability,and the influencing factors are complex.Self perception burden has a direct and positive effect on the sense of stigma,that is,the more of self perception burden is,the more the degree of the sense of stigma is,and it has an indirect effect on the stigma through two paths which is about hope level and positive coping.Social support and positive coping has a direct and negative effect on the stigma,and it indirectly influences stigma through self-perceived burden,hope level,and positive coping.Hope level has an indirect negative effect on the stigma through active response.It can be concluded that social support,positive response and hope level are the protective influencingfactors of stigma in the elderly with chronic disability.It suggests that medical staff should formulate effective intervention programs for the elderly with chronic disability from the aspects of social support,positive response and hope level,so as to provide basis for improving their mental health.