A Mixed Study Of Fear Of Disease Progression In Young And Middle-aged Stroke Patients Based On A Common Sense Model

ObjectiveTo understand the current situation of young and middle-aged stroke patients’ fear of disease progression and to explore the factors that influence it.To explore in-depth the real experiences of young and middle-aged stroke patients’ fear of disease progression after the onset of stroke,to understand the causes that lead to their fear of disease progression,and to understand the coping strategies and related needs that they generate,to provide some reference and basis for clinical health care professionals to carry out targeted psychological counseling,provide sound social support and promote patients’ psychological health.MethodsStudy 1: A quantitative study of the current status of fear of disease progression and its influencing factors in young and middle-aged stroke patientsBetween December 2020 and September 2021,a tertiary general hospital in Zhengzhou City,Henan Province,a choice sampling method was used to select young and middle-aged stroke patients who meet inclusion and exclusion criteria for this study.,and the samples were selected from both the neurology ward and the cerebrovascular ward.The survey instruments included the General Information Questionnaire,the Disease Information Questionnaire,the Chinese version of the Fear of Disease Progression Simplified Scale,the Medical Coping Style Scale,the Social Support Scale,and the Chinese version of the Disease Perception Questionnaire Simplified and the Hospital Anxiety and Depression Scale.SPSS21.0 software and AMOS21.0 software were applied for statistical analysis of the data,and mean ± standard deviation,frequency and percentage were used for general statistical description.T-test or ANOVA was applied for one-way analysis of this study,Pearson correlation analysis was applied to explore the correlation between each scale,multiple linear regression analysis was applied for multi-factor analysis of this study,and AMOS 21.0 software was used to construct the structural equation model for this study.Study 2: A qualitative study of the real experience of fear of disease progression in young and middleaged stroke patientsFace-to-face semi-structured interviews were conducted with young and middle-aged stroke patients who met the criteria through a purposive sampling method.Verbal and non-verbal data were collected using the principle of information saturation,and the interview data were collated and analyzed using the Colaizzi seven-step analysis method.ResultsStudy 1:Quantitative research parts(1)The total score of the Fear of Disease Progression Scale was(31.53±6.05)in 296 young and middle-aged stroke patients,of which 91 patients showed psychological dysfunction(i.e.,total score >34),accounting for 30.74% of the total number.The physical dimension score was(15.17±3.07)and the sociofamily dimension score was(16.38±3.36),with the physical dimension slightly lower than the socio-family dimension score.(2)Using the fear of disease progression score as the dependent variable,the results of the one-way ANOVA showed that there were significant differences(P<0.05)between the seven variables of age,gender,education level,household income level,number of disease episodes,and self-care ability on the fear of disease progression score.(3)Pearson correlation analysis showed that fear of disease progression was negatively correlated with confrontation(r =-0.168,P < 0.01)and positively correlated with avoidance and submission(r = 0.462,r =0.322,P < 0.01);fear of disease progression was negatively correlated with social support(r =-0.337,P <0.01)and positively correlated with anxiety depression and illness perception(r = 0.519,r = 0.596,P <0.01).(4)Multiple stepwise regression equations showed that young and middle-aged stroke patients who were younger,female,had poor self-care,high levels of disease perception,lower monthly household income,less social support,higher levels of anxiety and depression,and whose coping styles were predominantly resigned and avoidant had higher levels of fear of disease progression and was at greater risk of fear of disease progression psychological dysfunction(P < 0.05).(5)The structural equation modeling path shows that: social support indirectly influences fear of disease progression through anxiety-depression,and anxiety-depression partially mediates between the two,with a mediating effect of 44.95%;anxiety-depression indirectly influences correspondence on the manner and disease perception through fear of disease progression,and fear of disease progression partially mediates,with mediating effects of 52.64% and 35.17% respectively.Study 2: Qualitative research partsInterviews were conducted with young and middle-aged stroke patients around the real psychological experience of fear of disease progression after their illness.13 patients were interviewed and a total of 4themes and 13 sub-themes were extracted.These were the sources of fear(illness stimuli,heavy stress,triggering events),the effects of fear(reduced sleep quality,development of negative psychology,changes in health beliefs and behaviors),the handling of fear(inability to control,letting it go,closing oneself off,refusing to communicate,seeking ways to actively cope),and the help needed(emotional catharsis,social support,illness recovery,and health literacy needs).Conclusions(1)Young and middle-aged stroke patients have higher levels of fear of disease progression,and healthcare professionals should pay attention to the fears of young and middle-aged stroke patients.(2)Quantitative studies have shown that age,gender,monthly household income,self-care ability,illness perception,anxiety and depression,social support,and coping styles are independent predictors of fear of disease progression in young and middle-aged stroke patients.Social support may directly or indirectly influence fear of disease progression in young and middle-aged stroke patients,and anxiety and depression may indirectly influence coping styles and perceptions of disease in mid-stroke patients by influencing fear of disease progression.(3)Qualitative studies have found that the disease itself,the high level of stress faced by the patient,reduced somatic functioning,and negative attitudes and statements by others all contribute to fear in stroke patients,and that fear also has an impact on the patient’s physiology,psychology,thoughts,and behaviour,causing the patient to adopt different coping strategies and to seek fear control Young and middle-aged stroke patients need emotional catharsis,more social support and learning about disease recovery and health.