DEFACTUM - Public Health Research, Central Denmark Region, Olof Palmes Allé 15, Aarhus N, DK-8200, Denmark.
Department of Public Health - Department of Health Services Research, Aarhus University, Aarhus C, Denmark.
BMC Public Health. 2023 Aug 2;23(1):1472. doi: 10.1186/s12889-023-16316-0.
COVID-19 has highlighted the importance of patient activation in managing chronic conditions and promoting resilience during times of crisis. Patient activation refers to an individual's knowledge, skills, and confidence in managing their own health and healthcare. Previous research has shown that people with higher levels of patient activation are better prepared to navigate the challenges of chronic illness and are more likely to engage in healthy behaviors. However, the impact of patient activation on COVID-19-related concerns and mental well-being among people with chronic conditions during the pandemic remains unclear. This study aims to investigate the possible role of patient activation in shaping COVID-19-related concerns and to describe changes in mental well-being among Danish adults with one or more chronic conditions during the early months of the pandemic.
Danish adults with chronic conditions (e.g. diabetes, coronary heart disease, obstructive pulmonary lung disease, cancer) who had participated in a municipal health education program prior to the COVID-19 outbreak were asked to participate in this prospective questionnaire study in May 2020 and November 2020. Sociodemographic (sex, age, living status, educational attainment, employment status) and disease-related information (diagnosis, one or more chronic conditions) along with the Patient Activation Measure were collected before the outbreak and were obtained from a clinical database used for monitoring and evaluation of municipal health education programs. In contrast, the two questionnaires collected six months apart consisted of single items related to concerns about COVID-19 and the WHO-5 well-being index.
A total of 710 people with chronic conditions (mean age 60.9 years; 55.8% female) participated at both time points. In bivariate analyses, patient activation was associated with COVID-19-related concern and well-being. At follow-up, participants experienced a significant decrease in well-being. The decrease was associated with poorer well-being measured six months earlier, a greater perception that it had become more challenging to take care of one's health due to the pandemic, and finally, feeling lonely. The association between patient activation and well-being ceased to be significant in the multivariate regression model.
A considerable proportion of people with chronic conditions participating in this study have been mentally burdened during COVID-19. Although lower levels of patient activation were associated with greater COVID-19-related concerns, it did not have a significant impact on mental well-being over time.
COVID-19 凸显了患者激活在管理慢性病和在危机时期促进韧性方面的重要性。患者激活是指个人管理自己的健康和医疗保健的知识、技能和信心。先前的研究表明，患者激活水平较高的人更能应对慢性病的挑战，更有可能采取健康行为。然而，在大流行期间，患者激活对慢性病患者 COVID-19 相关问题和心理健康的影响尚不清楚。本研究旨在探讨患者激活在塑造 COVID-19 相关问题方面的可能作用，并描述丹麦患有一种或多种慢性病的成年人在大流行早期心理健康的变化。
在 COVID-19 爆发之前，参加过市立健康教育计划的丹麦慢性病患者（例如糖尿病、冠心病、阻塞性肺病、癌症）被邀请参加这项前瞻性问卷调查研究，分别在 2020 年 5 月和 2020 年 11 月。社会人口统计学（性别、年龄、居住状况、教育程度、就业状况）和疾病相关信息（诊断、一种或多种慢性病）以及患者激活量表在爆发前从用于监测和评估市立健康教育计划的临床数据库中收集。相比之下，相隔六个月收集的两份问卷包含与 COVID-19 相关的担忧和 WHO-5 幸福感指数的单个项目。
共有 710 名慢性病患者（平均年龄 60.9 岁；55.8%女性）在两个时间点都参加了研究。在单变量分析中，患者激活与 COVID-19 相关的担忧和幸福感有关。在随访时，参与者的幸福感显著下降。这种下降与六个月前的幸福感较差、由于大流行，人们普遍认为照顾自己的健康变得更具挑战性以及最后感到孤独有关。在多元回归模型中，患者激活与幸福感之间的关联不再显著。
在这项研究中，相当一部分患有慢性病的参与者在 COVID-19 期间精神负担沉重。尽管较低的患者激活水平与更大的 COVID-19 相关问题相关，但它并没有对随时间推移的心理健康产生显著影响。
