Effects Of Self-management On Health Poverty Vulnerability In Patients With Chronic Disease

Objective:Poverty due to illness and return to poverty due to illness are one of the main factors causing poverty,and also the hard bone in the battle against poverty.The top-level design and institutional arrangement of the targeted health poverty alleviation mechanism should focus on the possibility of individuals,groups or organizations falling into a low welfare level after suffering from health risk factors,that is,health poverty vulnerability.Self-management of chronic diseases emphasizes the health responsibility of patients themselves.A large number of studies and practices have shown that it can improve the health-related quality of life of patients,improve the ability to resist health risks,reduce the use of health services and reduce the economic burden of diseases.From the perspective of self-management of chronic diseases,the study on the impact of self-management of chronic diseases on health poverty vulnerability is a supplement and improvement to the health poverty theory,which can improve the work efficiency of health poverty alleviation and enhance the effectiveness and precision of health poverty alleviation policies.Therefore,this study explored the mechanism of self-management of chronic disease patients on health poverty vulnerability to provide the scientific basis for the development of prospective health poverty alleviation policies.Methods:Based on self-efficacy theory,health ecology model and self-depletion theory,the connotation and extension of chronic disease self-management and health poverty vulnerability were clarified on the basis of literature review,and the evaluation index system of chronic disease patients’ self-management ability was preliminarily constructed.Using Delphi expert consultation method,invite hospital management,health management,health policy,health economy and other related domain experts to score the evaluation index system,using SPSS25.0 and EXCEL to the consultation analyse positive coefficient,the degree of judgment,the degree of familiarity,authority,importance,sensitivity operability,delete the comprehensive coefficient is less than 7.5 and according to the expert feedback deleted content indicators.Field survey data of yancheng,lianyungang,suqian was studied by means of descriptive statistics,use the three stage feasible generalized least squares method(FGLS)in patients with chronic health poverty vulnerability in measure,through the principal component analysis integrated chronic disease self-management ability index of different dimensions,construct Tobit regression model,study the inner difference of health poverty vulnerability and chronic disease self-management mechanism on its health poverty vulnerability.Results:(1)The chronic disease self-management ability evaluation index system of building:after two rounds of Delphi expert consultation method construct consists of four primary index(disease symptom management,emotional adjustment management,lifestyle management,social support management)and 29 secondary index of chronic disease self-management ability evaluation index system.Calculation can be concluded that the mean score of each index,standard deviation,coefficient of variation coefficient,comprehensive,the positive coefficient of the two rounds of expert consultation is 91.67%and 100%.the authority coefficient is 0.882 and 0.904,the judgment coefficient is 0.877 and 0.904.and the familiarity coefficient is 0.886 and 0.903,respectively,importance Kendall coefficient values were 0.404 and 0.485,sensitivity Kendall coefficient values were 0.401 and 0.462,operability Kendall coefficient values were 0,405 and 0.494 respectively.(2)health poverty vulnerability index of patients with chronic diseases:using the world bank’s median poverty line in developing countries of $2 per day as the measurement standard,314 people with chronic diseases were in a non-vulnerable state,and the mean health poverty vulnerability index was 0.130.There were 284 people in a vulnerable state,and the mean health poverty vulnerability index was 0.361.(3)the chronic disease self-management ability:the mean of the disease symptom management ability integration index of the non vulnerable chronic disease patients was 28.661,the mean of the emotion adjustment management ability integration index was 16.774,the mean of the lifestyle management ability integration index was 10.295 and the mean of the social support management ability integration index was 16.905.Among the respondents,the mean value of the disease symptom management ability integration index is 18.327.the mean value of the emotion adjustment management ability integration index is 10.701,the mean value of the lifestyle management ability integration index is 17.017,and the mean value of the social support management ability integration index is 10.315.(4)the impact of self-management of patients with chronic diseases on health poverty vulnerability:there is a significant negative relationship between the ability of disease symptom management,emotional adjustment management,lifestyle management,social support management and health poverty vulnerability.Conclusions:(1)Patients with chronic diseases have higher health poverty vulnerability,and there are differences in health poverty vulnerability among patients with chronic diseases with different demographic characteristics.(2)the self-management ability of chronic disease patients is not high,and the self-management ability of chronic disease patients in different regions is different.(3)the four dimensions of self-management ability of chronic patients have different impacts on health poverty vulnerability.Among them,social support management ability has the greatest impact on health poverty vulnerability,followed by emotional adjustment management ability,lifestyle management ability and disease symptom management ability.(4)accurately identify vulnerable patients with chronic diseases and improve their health literacy through targeted health education;Give full play to the advantage of family physician team in the process of self-management of patients with chronic diseases;Social work is involved in the process of self-management of patients with chronic diseases to build a social support network.