| ObjectiveThis study was to investigate the level of stigma,self-concealment,self-esteem and social avoidance and distress,as well as to test their associated factors and the pathway between stigma and social avoidance and distress in colostomy patients.This study will provide theoretical basis and guidance for the establishment of reasonable measures for clinical nursing.Methods236 patients with colostomy were included using convenient sampling from November 2016 to September 2017.To investigate demographic data and disease related data,stigma,self-concealment,self-esteem and social avoidance and distress,all participants were assessed with demographic characteristics questionnaire,Social Impact Scale(SIS),Self-Concealment Scale(SCS),Self-Esteem Scale(SES)and Social Avoidance and Distress Scale(SADS).All data were analyzed by SPSS version 19.0 and MPLUS version 7.0.The demographic data and disease related data were described using mean,standard deviation,frequency and percentage;t-test,one way analysis of variance and multiple linear regression were used to analyze the influencing factors of stigma,self-concealment,self-esteem and social avoidance and distress,respectively.Pearson correlation analysis was used to analyze the correlation among stigma,self-concealment,self-esteem and social avoidance and distress.Path analysis was employed to test the mediating roles of self-concealment and self-esteem in the relationship between stigma and social avoidance and distress.Results1.For these patients,the total scores of stigma was 55.59±10.58,at a higher level.The financial insecurity,social exclusion,internal shame and social isolation dimensions scores were 6.64±1.83,19.45±4.80,12.66±2.74,16.92±3.46.The influencing factors of stigma were age,family average monthly income,postorostomy time and self-care ability.2.The total scores of social avoidance and distress was 13.38±3.25.The social avoidance and social distress dimensions scores were 6.83±1.82 and 6.56±1.91.The influencing factors of social avoidance and distress were age,home place,postorostomy time and self-care ability.3.The scores of self-concealment was 31.43±5.16.The influencing factors of self-concealment were sex and degree of education.4.The scores of self-esteem was 24.99±4.53.The influencing factors of self-esteem were age,degree of education and self-care ability.5.The correlation among stigma,social avoidance and distress,self-concealment and self-esteem were as follows: stigma scores were postively correlated with self-concealment(r=0.458,P<0.01);stigma scores were negatively correlated with self-esteem(r=-0.558,P<0.01);stigma were postively correlated with social avoidance and distress(r=0.605,P<0.01);there were a significant negatively correlation between self-concealment scores and self-esteem scores(r=-0.503,P<0.01);self-concealment scores were positively correlated with social avoidance and distress(r=0.589,P<0.01);self-esteem scores were negatively correlated with social avoidance and distress(r=-0.614,P<0.05).6.The pathways between stigma and social avoidance and distress in colostomy patients were as follows: stigma may predict social avoidance and distress directly forward positive way,the standardized estimate is 0.294,the confidence interval of 95% is [0.193,0.397] and accounted for 48.8% of the total effect;self-concealment had partial mediating effect between stigma and social avoidance and distress,the standardized estimate is 0.165,the confidence interval of 95% is [0.105,0.246],and accounted for 27.4% of the total effect;self-esteem had partial mediating effect between stigma and social avoidance and distress,the standardized estimate is 0.107,the confidence interval of 95% is [0.056,0.174],and accounted for 17.8% of the total effect;stigma affected social avoidance and distress through chain intermediary effect of self-concealment and self-esteem,the standardized esteem is 0.036,the confidence interval of 95% is [0.018,0.066],and accounted for 6.0% of the total effect.Conclusion1.Stigma and social avoidance and distress of colostomy patients were all affected by postorostomy time.2.Patients with colostomy cared about their body image and had a serious sense of stigma,which seriously affected normal social life.3.Patients with colostomy had a high degree of self-concealment,who were unwilling to communicate with others.In addition,they had low self-esteem and lack confidence in their own ability and life.4.The stigma of patients with colostomy could directly affect social avoidance and distress.Self-concealment and self-esteem as intermediary variables could regulate the effect of stigma on social avoidance and distress... |
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