The Effects Of Intervention On Stigma Based On ENM Theory In Young People With Inflammatory Bowel Disease

Objectives1.To investigate the status of stigma in young IBD patients and to analyze the influencing factors.2.Constructing an intervention program of stigma in young patients with inflammatory bowel disease based on ENM theory.3.To explore the applicability and effectiveness of the intervention program for stigma in young patients with inflammatory bowel disease based on ENM theory.Methods1.Young patients with IBD treated in the gastroenterology departments of two tertiary care hospitals in Yangzhou City from July 2021 to January 2022 were selected for the survey using a convenience sampling method.Questionnaires were administered to lung cancer patients who met the inclusion and exclusion criteria.The questionnaire included general information questionnaire,Social Impact Scale(SIS)was entered into the questionnaire using Epidata 3.1 to build a database,and SPSS26.0 was used for statistical analysis.Descriptive statistics were used for general information,diseaserelated information,and scores of each scale,and the measurement data were normally distributed and expressed as mean and standard deviation,while the count data were expressed as frequency,composition ratio,and rate.Univariate analysis of disease stigma and general demographic information in young patients with inflammatory bowel disease was performed using chi-square tests:2*2 four-grid table chi-square test for dichotomous variables and R*C chi-square test for multicategorical variables.When the theoretical frequencies were between 1 to 5,the chi-square test with continuous correction was used;when the theoretical frequencies were 0,the Fisher exact test was used.Factors that were statistically significant(P<0.05)in the univariate analysis were used as independent variables,and the social influence scale was used as the dependent variable,and ordered multicategorical logistic regression was used to analyze the factors influencing the sense of stigma in young patients with inflammatory bowel disease.2.Initial construction of the intervention program based on evidence-based concept.Searches of the CKNI,Wanfang database,Vip databse,Web of Science,PubMed,PsycoINFO,and The Cochrane Library databases were conducted using subject terms combined with free words.After removing duplications the literature using Endnote,two researchers independently performed primary and secondary screening of the literature using inclusion and exclusion criteria.Citations to the included literature were supplemented with manual searches of Baidu and Google scholar to find relevant literature.The search period was from January 2018 to January 2023.The decision on questionable literature was made after discussion by the subject group.The literature was assessed using the National heart,lung,and blood institution quality assessment tool for controlled intervention studies(NHLBI)version Independent evaluation of quality was performed.After developing a draft version of the intervention protocol(draft version),the draft was revised using the expert meeting method to develop an intervention protocol(application version).3.Invervention study.Thirty-six cases of young IBD patients attending two tertiary hospitals in Yangzhou from April 2022 to August 2022 were selected by purposive sampling method,and they were randomly divided into two groups.The control group was given routine nursing instructions and IBD manuals,while the experimental group was given the intervention program of stigma in young patients with inflammatory bowel disease based on ENM theory.The Social Impact Scale(SIS),Self-compassion Scale(SCS),Perceived Social Support Scale(PSSS),and Self Esteem Scale(SES)were used to measure the stigma of young patients with inflammatory bowel disease before the intervention,(SES)were measured before(T0)and at the completion of the intervention(T1),and the differences between the two groups were compared in terms of observed indicators.Results1.The results of the cross-sectional survey showed that 114 young patients with inflammatory bowel disease had a total stigma score of 54.19±10.06,in which the mean scores of the entries for each dimension were,in descending order,intrinsic shame(2.62±0.53),economic discrimination(2.50±0.62),social isolation(2.23±0.60),and social exclusion(1.98±0.46).The results of univariate analysis showed marital status(χ2=10.786,P<0.05),monthly household income(χ2=11.403,P<0.05),work-study status(χ2=9.249,P<0.05),and disease activity level(χ2=18.726,P<0.01)were statistically significant(P<0.05).The results of ordered multicategorical logistic regression showed that low monthly household income was the main risk factor(OR=48.42);married patients had lower levels of disease stigma compared to divorced patients(OR=0.08);in addition to this,alternating states of work or study(OR=0.15)and vacation(OR=0.1),and in remission(OR=0.1)were protective factors for stigma.2.After a literature review,a total of 23 papers were included in the final results.A total of eight experts participated in the expert meeting with a mean expert authority coefficient(Cr)value of 0.812.After revised the intervention plan,the final intervention protocol was confirmed at a frequency of 1-2 times per week for a total of 8 weeks of intervention duration.3.An intervention study was conducted to evaluate the effectiveness of the patients in the experimental and control groups.The results showed that the baseline data of the two groups of patients dared to money were comparable,and the differences were not statistically significant(P>0.05).After the intervention,patients in the experimental group had better disease stigma level(t=-6.323,P<0.01),self-compassion level(t=3.569,P<0.01),perceived social support(t=2.078,P<0.05),self-esteem level(t=2.529,P<0.05)and disease activity(χ2=5.236,P<0.05)than the control group.Conclusion1.Young patients with inflammatory bowel disease have a moderate level of stigma,which is related to monthly income,marital status,work-study status,and disease activity level.As health care professionals,they should pay attention to the level of stigma in young patients with inflammatory bowel disease,identify patients with high level of stigma at an early stage,and provide personalized care according to the specific status of the patients.2.The ENM theory-based stigma program for young patients with inflammatory bowel disease is based on evidence integration and expert discussion,and can provide a practical basis for clinical care for young patients with inflammatory bowel disease.3.The ENM theory-based stigma intervention program for young patients with inflammatory bowel disease can effectively reduce the level of stigma,improve the level of social support and self-compassion of patients,and change the health status of patients with the disease.