Construction Of Stigma Intervention Scheme For Female Patients With Pelvic Floor Dysfunction Based On PERMA Model

Research objectives:Based on the investigation and analysis of the current status of stigma in female patients with pelvic floor dysfunction in Mianyang city,this study explored the main influencing factors of stigma in women with pelvic floor dysfunction.On this basis,based on the theory of positive psychology,combined with Delphi expert correspondence method,a PERMA model-based stigma intervention program for female patients with pelvic floor dysfunction was constructed.It provides theoretical guidance for clinical staff to reduce the stigma of patients with pelvic floor dysfunction,and also provides reference for the development of positive psychotherapy in the field of chronic diseases in China.Methods:(1)Current status of stigma in female patients with pelvic floor dysfunction and analysis of influencing factors This study adopted convenience sampling method to select female patients with pelvic floor diseases in the pelvic floor rehabilitation center of a third-class A hospital in Mianyang City from November 2021 to March 2022 as research objects.General data questionnaire,Social Impact Inventory(SIS),Mental Resilience Inventory(CD-RISC-10)and Pelvic Floor Dysfunction Questionnaire 20(PFDI-20)were used to investigate.SPSS26.0 was used for statistical analysis,and frequency and component ratio were used to describe the general data of patients.Mean± standard deviation,median(interquartile distance)were used to describe the social impact scale,the brief table of mental resilience scale,the total score of the pelvic floor dysfunction questionnaire and the scores of each dimension.Spearman correlation analysis was used to analyze the relationship among stigma,mental resilience and quality of life.Stigma scores of patients with pelvic floor dysfunction were compared by one-way analysis of variance or independent sample T-test.Compared with the norm,single sample t test was used.Multiple linear regression method was used to analyze the influencing factors of stigma in patients with pelvic floor dysfunction.(2)Construct a stigma intervention scheme for female patients with pelvic floor dysfunction based on PERMA model In this part,on the basis of the previous investigation results and reference to the relevant literature,the intervention plan of female pelvic floor dysfunction stigma based on PERMA model is preliminatively formulated.Based on the opinions formed by expert correspondence,positive psychology was used as the theoretical basis,and PERMA model was used as the intervention framework.By finding and cultivating positive emotions(P),feeling free experience(E),building positive interpersonal relationship(R),helping patients understand the meaning of life(M),relaxation training(A)and other ways,the level of stigma of patients was reduced and the quality of life of patients was improved.Result:(1)Survey results of stigma,mental resilience and quality of life of female patients with pelvic floor dysfunctionAccording to the investigation,the patients with pelvic floor dysfunction had different degrees of stigma.The total score of stigma was(38.91±4.25),which was moderately above the level,the internal shame(7.47±1.50),social isolation(17.65±2.28),and social exclusion(13.97 ± 1.43).In addition to the dimension of social exclusion,All were lower than the normal values(P < 0.05).The score of other psychological variables in female patients with pelvic floor dysfunction: the score of mental resilience was(21.33±5.17)points,which was at the medium level,lower than the norm value(P < 0.05),PFDI-20 score was 38.5(16.4,59.4)points;The scores of each dimension were 12.5(0,29.1)points for UDI-6,9.38(0,18.7)points for CRADI-8,and 12.5(0,25.0)points for POPDI-6,respectively.Compared with the norm value,the total score and each dimension were lower than the norm value(P < 0.05).(2)Results of univariate analysisUnivariate analysis showed that age,education,monthly income,occupational status,place of residence,frequency of delivery,degree of vaginal relaxation,degree of stress urinary incontinence and degree of pelvic organ prolapse had statistically significant differences on stigma scores of patients(P < 0.01).(3)Correlation analysis resultsThe score of the stigma scale was negatively correlated with the score of the resilience scale(r=-0.642,P < 0.01),that is,the level of stigma was negatively correlated with the level of resilience,and the score of the stigma scale was positively correlated with the score of the pelvic floor dysfunction questionnaire(r=0.666,P <0.01),that is,the level of stigma was negatively correlated with the level of quality of life.(4)Results of multivariate regression analysisPsychological resilience score(β=-0.424,P < 0.01),total quality of life score(β=0.268,P < 0.01),age(β=0.151,P < 0.01),education level(β=-0.124,P < 0.01),severe stress incontinence(β=0.082,P < 0.05)were entered into the regression equation.It was statistically significant(P < 0.001),and adjusted R2=0.501 could explain 50.1%of the stigma variation in female patients with pelvic floor dysfunction(P < 0.05).(5)Construction of stigma intervention scheme for female patients with pelvic floor dysfunction based on PERMA modelA total of 21 experts were selected in this study,which involved psychological counseling and treatment,obstetrics and gynecology,pelvic floor rehabilitation and other fields.Two rounds of expert consultation were conducted.The effective questionnaire recovery rates were 100% and 86%,the expert judgment coefficient(Ca)was 0.904,0.900,and the expert familiarity coefficient(Cs)was 0.810 and 0.821,respectively.The expert authority coefficients(Cr)were 0.866 and 0.860,respectively.In the two rounds of expert consultation,the significance test of Kendall harmony coefficient for the importance and feasibility of all indicators had statistical significance(P < 0.05).The "PERMA Model-based Stigma Intervention Program for female patients with pelvic floor Dysfunction" constructed in this study finally contains 4 first-level indicators,13 second-level indicators and 41 third-level indicators,which are respectively elaborated from four aspects: the construction of intervention team,training of intervention personnel,content of intervention program,evaluation of intervention effect and quality control.Research conclusion:(1)Stigma is common in female patients with pelvic floor dysfunction,and the level of psychological resilience needs to be improved.Stress urinary incontinence and pelvic organ prolapse have a great impact on their quality of life.The influencing factors included age,education level,severe stress incontinence(with non-stress incontinence as reference),mental resilience level,and quality of life level.(2)The PERMA Model-based Stigma Intervention Plan for female patients with pelvic floor Dysfunction established in this study has standardized the specific implementation plan and defined the maintenance and quality control methods in the implementation process,which is scientific and reliable to a certain extent,and can provide reference for the promotion and application of positive psychology intervention in patients with pelvic floor dysfunction.