Lightfoot Courtney Jane, Wilkinson Thomas James, Patel Naeema Aiyub, Jones Ceri Rhiannon, Smith Alice Caroline
Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK.
Leicester NIHR Biomedical Research Centre, Leicester, UK.
J Nephrol. 2024 Mar;37(2):353-364. doi: 10.1007/s40620-023-01851-1. Epub 2024 Jan 18.
Coping with health problems requires some degree of self-management; however, an individual's ability to self-manage can be threatened during challenging times, such as the COVID-19 pandemic. Exploring differences and changes in psychological well-being and coping strategies between those with low and high patient activation may inform appropriate interventions to support psychological coping.
People with chronic kidney disease (CKD) (non-dialysis and transplant) were recruited from 11 hospital sites across England between August and December 2020. Participants responded to an online survey study, including the Brief Coping Orientation to Problem Experienced (COPE) Inventory, Depression, Anxiety and Stress Scale (DASS-21), Short Health Anxiety Index (SHAI), and Patient Activation Measure (PAM-13). A follow-up survey was conducted 6-9 months later. Paired t tests assessed within-group changes, and chi-squared tests compared coping strategies utilised by low- and high-activated participants. General linear modelling was performed to determine the relationship between patient activation and coping strategies, and covariates.
Two hundred and fourteen participants were recruited (mean age: 60.7, 51% male, mean eGFR: 38.9 ml/min/1.73 m). Low-activated participants were significantly more anxious than high-activated participants (P = 0.045). Health anxiety significantly decreased (i.e., got better) for high-activated participants (P = 0.016). Higher patient activation scores were associated with greater use of problem-focused strategies (β = 0.288, P < 0.001). Age (β = - 0.174, P = 0.012), sex (β = 0.188, P = 0.004), and education level (β = 0.159, P = 0.019) significantly predicted use of problem-focused strategies.
Those with higher activation had lower levels of anxiety, and more frequently used adaptive coping strategies during the pandemic. Targeted support and interventions may be required for people with CKD to enhance patient activation, encourage more positive adaptive coping strategies, and mitigate maladaptive coping strategies.
应对健康问题需要一定程度的自我管理；然而，在诸如新冠疫情这样具有挑战性的时期，个体的自我管理能力可能会受到威胁。探究患者激活水平低和高的人群在心理健康和应对策略方面的差异与变化，可能有助于制定适当的干预措施来支持心理应对。
2020年8月至12月期间，从英格兰的11个医院站点招募了患有慢性肾脏病（CKD）（非透析和移植患者）的人群。参与者对一项在线调查研究做出回应，该研究包括简短应对经验取向（COPE）量表、抑郁、焦虑和压力量表（DASS-21）、简短健康焦虑指数（SHAI）以及患者激活度量表（PAM-13）。6至9个月后进行了随访调查。配对t检验评估组内变化，卡方检验比较低激活和高激活参与者所采用的应对策略。进行一般线性模型分析以确定患者激活与应对策略以及协变量之间的关系。
招募了214名参与者（平均年龄：60.7岁，51%为男性，平均估算肾小球滤过率：38.9 ml/min/1.73 m²）。低激活参与者比高激活参与者焦虑得多（P = 0.045）。高激活参与者的健康焦虑显著降低（即有所改善）（P = 0.016）。患者激活得分越高，越倾向于使用以问题为导向的策略（β = 0.288，P < 0.001）。年龄（β = -0.174，P = 0.012）、性别（β = 0.188，P = 0.004）和教育水平（β = 0.159，P = 0.019）显著预测了以问题为导向策略的使用情况。
激活水平较高的人在疫情期间焦虑程度较低，且更频繁地使用适应性应对策略。对于慢性肾脏病患者，可能需要有针对性的支持和干预措施，以提高患者激活水平，鼓励更多积极的适应性应对策略，并减少不良适应性应对策略。
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