A Case Work Intervention Study On Stigma Of Chronic Disease Patients

With the development of social economic and the change of residents life style,chronic diseases such as diabetes,hypertension showed a trend of increasing incidence and younger incidence,and has become a main cause of death and disease burden of residents in our country.The control of these chronic diseases requires long-term and sustained management,and stigma is one of the important factors that hinder patients with chronic diseases from actively participating in chronic disease management.It not only makes patients suffer the pain of physical illness,also vulnerable to inferiority,shame,depression and other negative emotions of torture,thus seriously affect their quality of life and rehabilitation of disease.We need to pay more attention to the shame of patient disease and try our best to solve it.To solve the above problems,based on the practice of J hospital in Jiangxi province,rational emotion-behavior therapy as theoretical basis,this study explores the intervention effect of individual social work practice on reducing stigma in patients with chronic diseases.First of all,through the questionnaire with interviews and stigma scale for chronic illnesses which were compiled by scholars Rao et al in 2009,so as to understand the current situation and influencing factors of stigma of 50 patients with chronic diseases in gastroenterology department of J hospital.Through the data analysis of the scale,39 people were found to have the intermediate or above level of stigma,accounting for up to 78%.Through interviews,we analyzed three major factors influencing the disease in patients with shame,physiological changes caused by disease,economic pressure caused by treatment,and inadequate social support system.Then,we selected one patient with the highest shame score for case service intervention,because the anxiety and fear of disease,the treatment of resistance and rejection,the self-denial and discrimination and the social avoidance and closed are the specific performance of the disease of shame problem of him.Thus,he has many irrational beliefs.Therefore,based on rational emotion-behavior therapy,13 weeks of case work was delivered.The results of process evaluation and effect evaluation showed that the patients’ stigma decreased significantly,from 97 points before the intervention to 48 points after the intervention.At the same time,he corrected his unreasonable beliefs and learned to use rational thinking to motivate himself.In addition,his negative mood and interpersonal problems improved,which led to improved treatment adherence.Through reflection on the intervention of this case,the author summarizes the following points: first,to improve the ability to encounter.social workers should create a shared space to help patients build shared emotional lines.Second,to enable the integration of resources.social workers should help patients integrate and use multiple medical resources to form the resource information pool.Third,we should optimize emotional mobility and help patients improve their sense of self-worth.The disadvantage is that the service effect is limited in sustainability;lack of professional supervision in service scheme design;lack of practical experience leads to role conflict.