| Objective: To develop a psychosocial adaptation questionnaire with good validity and reliability for patients with inflammatory bowel disease;to evaluate the patients' psychosocial adaptation;to assess the quality of life of patients by Inflammatory Bowel Disease Questionnaire;and to discuss to explore the impact of psychosocial adaptation on quality of life from the patients sustained inflammatory bowel diseases.Methods: Based on the definition of the concept of psychosocial adaptation of patients with inflammatory bowel disease,the item pool was established on the basis of the definition of each dimension,then the items and answer options of the questionnaire for psychosocial adaptation of patients with IBD were preliminarily constructed via the methods from literature review,and the initial questionnaire was formed after two rounds of experts' consultation and patients' interviews.The research was conducted by investigating 246 patients with IBD from digestive department in the First affiliated hospital of China medical university and Shengjing affiliated hospital of China Medical university(Huaxiang campus)by the method of continuous sampling.The patients' demographic data and the diseases-related data were investigated by self-designed general questionnaire for IBD patients.The patients' life quality status was inquired by Inflammatory Bowel Disease Questionnaire.The convergent validity of the psychosocial adaptation questionnaire for patients with IBD was calibrated by General Self-Efficacy Scale(GSES)and Social Support Rating Questionnaire.Statistical analysis was performed on the recovered data,the non-standard items were deleted according to item analysis and screening using by discriminant analysis(critical ratio rate value),internal consistency coefficient method and item-total correlation analysis.Validity evaluation was based on content validity index(CVI),factor analysis and convergent validity.The evaluation of reliability was based on Cronbach's alpha coefficient,split-half reliability and test-retest reliability.Correlation analysis between psychosocial adaptation and QOL of patients with IBD was discussed through correlation analysis between psychosocial adaptation and QOL,univariate analysis and multiple stepwise regression analysis of QOL.Results: 1.Basic information of the respondents A total of 246 questionnaires were issued,and 220 of them were effectively recovered,with an effective recovery rate of 89.43%.The patients were between 18 and 87 years old,with an average age of 44.14±15.53 years.There were 133 male patients(60.45%)and 87 female patients(39.55%).There were 138 patients(62.73%)with ulcerative colitis and 82 patients(37.27%)with Cohn's disease.33 cases(15.00%)were in remission of disease activity,79 cases(35.91%)were in mild activity,78 cases(35.45%)were in moderate activity,and 30 cases(13.64%)were in severe activity.2.The Development of psychosocial adaptation questionnaire for patients with inflammatory bowel disease(1)Form of initialization questionnaire items Totally,there are 37 items in the psychosocial adaptation questionnaire for the patients with IBD,including five dimensions of anxiety/depression,self-efficacy,social supporting,sleep disorder and body image.(2)Evaluation of the content validity and face validity Content validity: The item-level CVI and scale-level CVI in the questionnaire is 0.8 to 1.0 after consulting with different professionals twice.Face validity: As a result of patient interview,the content is suitable,the expression is properly and easy to be understood.(3)Item analysis and screening The critical ratio rate,internal consistency coefficient method and item-total correlation analysis were used to analyze and screen the items in the questionnaire.A total of 8 items below the standard were deleted,and the remaining 29 items were analyzed for reliability and validity.(4)The validity test of the questionnaire Construct validity: The factor analysis method of principal component analysis was applied and rotated with the maximum variance.According to the eigenvalue greater than 1,a total of 6 factors were extracted,and the cumulative contribution rate was 59.93%.Then,each dimension is renamed according to factor analysis,including anxiety/depression(10),sleep disorder(4),self-efficacy(5),body image(3),social supporting(3),and attitude(4);Convergent validity: The relevant coefficient between psychosocial adaptation questionnaire for the patients with IBD and General Self-Efficacy Scale(GSES),Social Support Rating Questionnaire is 0.213-0.682(P<0.001)and 0.164-0.384(P < 0.001),individually.(5)The reliability test of the questionnaire Internal consistency reliability: The total Cronbach's coefficient is 0.891 from the questionnaire,which is 0.615 to 0.908 of each dimension;Split-half reliability: 0.888 Test-retest reliability: 50 patients with IBD were asked to measure the psychosocial adaptation questionnaire again 2 weeks later,and the correlation coefficient between the two measurements was 0.809(P<0.01).(6)Form a questionnaire on psychosocial adaptation of patients with inflammatory bowel disease After expert consultation,patient interviews,item analysis and reliability and validity test,a psychosocial adaptation questionnaire consisting of 6 dimensions and 29 items was finally formed.3.Status of psychosocial adaptation and quality of life of patients with IBD The psychosocial adaptation score of patients with IBD was 103.97±18.77,the decline rate of each dimension is obvious,among which 62 patients with low score(28.18%),100 patients with middle score(45.46%),and 58 patients with high score(26.36%).The QOL score of patients with IBD was 128.93±40.34,and the decline rate of each dimension is obvious too.4.The impact of psychosocial adaptation on QOL of patients with IBD The correlation coefficient between psychosocial adaptation score and QOL score of patients with IBD was 0.690(P < 0.01).The results of univariate analysis of QOL showed that age,working status,home address,education level,marital status,sleep status,medical payment mode,disease type,medication regimen,disease activity and psychosocial adaptation had significant influence on the quality of life of patients with IBD.After that,the above valuable univariate analysis results are involved in regression equation.From the results,disease activity index,psychosocial adaptation,working status and medication regimen are showed in the regression equation.Besides,four-term multiple correlation coefficient is 0.879,joint and combined variation is 0.772.Based on the interpretation of the separate variation,the prediction of disease activity is the most convincible result and the interpretation is 69.1%,followed by psychosocial adaptation whose interpretation is 4.7%.Conclusion: 1.The psychosocial adaptation questionnaire developed for patients with inflammatory bowel disease has good validity and reliability.2.In this study,the patients with inflammatory bowel disease had low psychosocial adaptation ability and significantly decreased quality of life 3.There is a positive correlation between psychosocial adaptation and the QOL of patients with IBD.The psychosocial adaptation of patients with IBD can significantly affect their quality of life,which is a significant influencing factor of quality of life. |
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