Effect Of Stigma On Self-management And The Mediating Role Of Social Support And Coping Style In Patients With Chronic Hepatitis B

ObjectivesTo explore the influence of stigma of chronic hepatitis B patients on self-management behavior,and the mediating effect of social support and coping styles between stigma and self-management behavior,and provide theoretical basis for improving the quality of life of patients.MethodsThrough convenience sampling,patients with chronic hepatitis B were selected from a Tier 3 hospital in Jinan for questionnaire survey.The survey tools include general information questionnaire,the chronic hepatitis B virus infection discrimination scale,Social Support Rating Scale(SSRS),and Medical Coping Modes Questionnaire(MCMQ),self-management scale for patients with chronic hepatitis B.SPSS21.0 software was used for data analysis.Results1.A total of 240 subjects were included in this study.Stigma,self-management behavior,social support scores of patients with chronic hepatitis B were(74.43±19.157),(89.90±20.536),(35.23±10.872)points,and facing,yielding,and avoiding scores were(18.98±5.277),(10.56±2.986),(16.46±1.914)points in coping styles.2.The self-management behaviors of chronic hepatitis B patients with different occupations,disease courses,residences,and medical payment methods are significantly different;and there are significant differences in the stigma scores of chronic hepatitis B patients with different marital status,occupation,monthly income,and disease course.(P<0.05).3.Based on the median score of 75 stigma,the self-management behavior score of the high stigma group was lower than that of the low stigma group(t=-7.272,P<0.001).Correlation analysis results show that stigma is negatively correlated with self-management behavior,social support,and coping style(face),and positively correlated with submission and avoidance in coping style;self-management behavior is positively correlated with social support and coping style(face)Correlation,negative correlation with yield in coping style,P<0.05.4.The mediating effect of social support between stigma and self-management behavior showed that the regression coefficient of stigma on self-management behavior,that is,the total effect(path c)was-0.4077(P<0.01).The regression coefficient of stigma on social support(path a)is-0.2029(P<0.01);the regression coefficient of social support on self-management behavior(path b)is 0.7214(P<0.01);the indirect effect(path axpath)b)is-0.1464.After adding social support,the regression coefficient of stigma on self-management behavior,that is,the direct effect(path c’)is-0.2614(P<0.01),suggesting that social support plays a part in the influence of stigma on self-management behavior Intermediary,the effect ratio(path axpath b/path c)is 35.9088%.5.The results of mediating model of coping styles between stigma and self-management behaviors show that the regression coefficients of stigma facing confrontation and yielding are-0.0759 and 0.0762,facing and yielding in coping styles have impact on self-management behaviors(path b),the regression coefficients are 1.0442 and-1.9749(both P<0.01);the mediation effect(path a×path b is-0.0792 and-0.1504,respectively)is established.After facing and succumbing to the coping style,the regression coefficients of stigma on self-management behavior are-0.3285(95%CI:-0.4626,-0.1944;P<0.01),-0.2573(95%CI:-0.4084,-0.1062);P<0.01),the effects of facing and yielding are part of the mediation,and the proportions of effects are 18.6166%and 36.8899%respectively.However,the mediating role of coping style(avoidance)between stigma and self-management behavior does not hold.6.The results of the model of mediating social support and face between stigma and self-management behavior show that the indirect effect(path axpath bxpath c)coefficient is-0.0275,(95%CI:-0.0522,-0.0117),Social support and facing the chain-like mediating effect between stigma and self-management behavior are established.The indirect effect(path axpath e)is-0.1189(95%CI:-0.1963,-0.0621),and the mediation effect of social support is established.The indirect effect(path fxpath c)is-0.0289,(95%CI:-0.0765,-0.0088),and the intermediary effect is established.After adding the mediating variable social support and facing,the direct effect(path d’)is-0.2325(95%CI:-0.3701,-0.0949,P=0.001),indicating that the mediating effect is a partial mediation.7.The results of the mediating model of social support and submission between stigma and self-management behavior show that the indirect effect(path axpath bxpath c)coefficient is-0.0156(95%CI:-0.0431,-0.0036),and social support and the chain of mediating effect between stigma and self-management behavior is established.The indirect effect(path axpath e)is-0.1308(95%CI:-0.2117,-0.0749),and the mediating effect of social support is established.The indirect effect(path f×path c)is-0.1043(95%CI:-0.1762,-0.0429),and the mediation effect of yield is established.After adding the mediation variable social support and yield,the direct effect(path d’)is-0.1571(95%CI:-0.3076,-0.0065,P=0.0409),and the mediation effect is partial mediation.Conclusions1.Chronic hepatitis B patients generally have a high level of stigma,and their self-management ability is lower than that of healthy people.2.The self-management behavior of patients with chronic hepatitis B showed obvious differences in groups of different occupations,disease courses,residences and medical payment methods.The difference in stigma of patients with chronic hepatitis B is mainly manifested in different marital status,occupation,per capita monthly income,and disease course.3.Stigma is negatively correlated with self-management behavior,social support,and coping style(face),and positively correlated with submission and avoidance in coping style;self-management behavior is positively correlated with social support and coping style(face)Correlation is negatively correlated with yield and avoidance in coping styles.Medical staff can consider targeted interventions to improve patients’ self-management behavior and reduce stigma.4.Social support and coping styles(face,yielding)play a partial mediating role and a chain mediating role between the stigma of chronic hepatitis B patients and self-management behavior.