Xiang Ling, Yoon Sungwon, Low Andrea H L, Leung Ying Ying, Fong Warren, Lau Tang Ching, Koh Dow Rhoon, Thumboo Julian
Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Int J Rheum Dis. 2023 Nov;26(11):2258-2266. doi: 10.1111/1756-185X.14923. Epub 2023 Sep 23.
Social cognitive theory (SCT) has been successfully employed to improve symptom appraisal and help-seeking among patients with various conditions but is yet to be applied in the context of autoimmune rheumatic diseases (ARDs). This study aimed to explore the applicability of SCT in and possible approaches to improving symptom appraisal and help-seeking of patients with ARDs, one of the key barriers to earlier diagnosis.
Semi-structured interviews were conducted with 33 ARD patients with a prolonged pre-diagnosis interval (>3 months). We coded the transcripts deductively using SCT as the overarching framework and inductively for approaches identified from the interviews.
All six main concepts of SCT (behavioral capacity, expectations, self-efficacy, observational learning, reinforcements, and reciprocal determinism) were observed in the three stages of symptom appraisal and help-seeking (detection, interpretation, and response) of patients with ARDs. While many participants reported that they were able and confident to detect their symptoms, they lacked the behavioral capacity and self-efficacy to interpret symptoms correctly, which resulted in delayed help-seeking and diagnosis. Possible approaches to address this suggested by participants (such as education of the general population) could improve behavioral capacity and self-efficacy in symptom interpretation and enhance expectations, observational learning, reinforcements, and reciprocal determinism in symptom response.
Lack of behavioral capacity and self-efficacy was observed in symptom interpretation of patients with ARDs, which resulted in delayed help-seeking. Approaches could target the behavioral capacity and self-efficacy for symptom interpretation to facilitate early help-seeking and, in turn, earlier diagnosis among individuals with possible ARDs.
社会认知理论（SCT）已成功应用于改善各种疾病患者的症状评估和求助行为，但尚未应用于自身免疫性风湿病（ARDs）的背景下。本研究旨在探讨SCT在ARDs患者中的适用性以及改善症状评估和求助行为的可能方法，而症状评估和求助行为是早期诊断的关键障碍之一。
对33名诊断前间隔时间延长（>3个月）的ARDs患者进行了半结构化访谈。我们以SCT作为总体框架对访谈记录进行演绎编码，并对访谈中确定的方法进行归纳编码。
在ARDs患者症状评估和求助行为的三个阶段（检测、解释和反应）中均观察到了SCT的所有六个主要概念（行为能力、期望、自我效能感、观察学习、强化和相互决定论）。虽然许多参与者报告说他们有能力且有信心检测到自己的症状，但他们缺乏正确解释症状的行为能力和自我效能感，这导致了求助和诊断的延迟。参与者提出的解决这一问题的可能方法（如对普通人群进行教育）可以提高症状解释方面的行为能力和自我效能感，并增强症状反应方面的期望、观察学习、强化和相互决定论。
在ARDs患者的症状解释中观察到缺乏行为能力和自我效能感，这导致了求助延迟。可以针对症状解释的行为能力和自我效能感采取措施，以促进早期求助，进而促进可能患有ARDs的个体的早期诊断。
