A Typological Analysis Of Patients With Schizophrenia Based On The Self-management Behavioral Mechanism

Background:Self-management is an important initiative to promote the recovery and social reintegration of patients with schizophrenia.Subgroups based solely on self-management status lack behavioral mechanism,and the results might not be stable.If the internal mechanism and corresponding key elements of self-management behavior in patients with schizophrenia can be clarified,patients may be better typed and more tailored interventions can be designed.Aims:1.To explore the self-management behavioral mechanism and to clarify the key elements of self-management behavior in patients with schizophrenia.2.To divide patients into different subgroups based on the key elements.Methods:This study was composed of four parts.In the model construction,theory synthesis was adopted to decompose,compare,and redefine the four basic theories to construct the cognitive-psychological model of self-management behavior in patients with schizophrenia.In the psychometric evaluation,BACS,KAST,IPQS,TSRQ were culturally adapted and ASSQ were designed to test the reliability and validity.In the model verification and revision,341 outpatients,inpatients,and community-dwelling patients were enrolled in a cross-sectional survey.Structural equation modelling was used to verify and revise the preliminary cognitive-psychological model of self-management behavior.In the classification study,four key elements in the revised model were pointed out as the classification index,based on which 341 patients were classified using latent profile analysis to identify subgroups.Profiles of these subgroups were then depicted.Results:In the model construction,the cognitive-psychological model of self-management behavior in patients with schizophrenia began from health information to self-management behavior.Cognitive function was the key link from information to disease knowledge.Illness belief help transfer disease knowledge to attitude towards self-management behavior.Self-efficacy,motivation,and attitude synergistically predicted self-management behaviors.In the psychometric evaluation,the I-CVI index of KAST,IPQS,TSRQ,and ASSQ were 0.83 to 1.00,and S-CVI/Ave index were 0.97,0.96,0.94,and 0.98,respectively.The one-factor model of BACS fit well(x2/df=1.055,GFI=0.953,CFI=0.998,RMSEA=0.030),and the factor analysis of IPQS extracted 10 factors similar to the original scale.The four-factor model of TSRQ fit well(?2/df=1.771,GFI=0.902,CFI=0.947,RMSEA=0.069)and the two-factor model of ASSQ fit well(?2/df=2.251,GFI=0.843,CFI=0.920,RMSEA=0.079).The Cronbach's a values or KR-20 value of BACS,KAST,and ASSQ were 0.86,0.68,and 0.93,respectively.Cronbach's a values of most IPQS subscales were from 0.69 to 0.87,and those of TSRQ were from 0.49 to 0.90.In the model verification and revision,the revised model fit the empirical data well(x2/df?2.407,RMSEA=0.064,GFI=0.905,CFI=0.912,NFI=0.860,IFI=0.913).There were two relatively independent paths in the process of individuals from receiving health information to forming self-management behavior.Those were ?cognitive function?disease knowledge?control belief?attitude towards behavior?self-management behavior;? cognitive function?self-efficacy?autonomous motivation self-management behavior.In the classification study,patients with schizophrenia were divided into energetic type,potentially convertible type,and exhausted type,with a composition ratio of 39.3%,38.4%,and 22.3%,respectively.There were significant differences in the self-management status(H=78.571,P<0.05),gender(?2=14.734,P<0.05),education level(?2=38.303,P<0.05),and long-time medication(?2=26.059,P<0.05).Conclusion:The cognitive-psychological model of self-management behavior in schizophrenia reveals that cognitive function,control belief,self-efficacy,and autonomous motivation are key elements of self-management behavior in schizophrenia.Based on these four characteristics,there are three subgroups sharing same within-subtype features.Locating the characteristics and needs of different subgroups promises to be a key link in designing tailored self-management support and an effective way to provide individualized mental health services.