背景:支持干预通常同时解决自我护理和应对问题。使用不同的方法来促进自我护理和应对,因此明确干预效果可以指导临床医生和研究人员提供有益的干预措施。
目的:比较两种模型,以确定自我护理改善应对还是应对改善自我护理。
方法:我们使用了在纳入一项随机对照试验时获得的248名护理人员的横断面数据,测试了支持干预的有效性。衡量护理人员需求的量表的因子得分,自我照顾,应对,压力评估,和心理健康来自探索性因素分析。使用因子得分作为每个构建体的估计值来分析结构方程模型。为了控制可能的虚假影响护理人员的年龄,性别,与病人的关系,收入充足性包括在内。
结果:两种模型都与数据兼容,但是自我护理模式比应对模式强。该模型具有不显著的卡方和很好的数据拟合,χ2(4,N=248)=2.64,p=0.62。自我护理模型解释的心理健康差异百分比为54%,42%用于压力评估,10%用于回避应对,6%为积极应对。在应对模型中,压力评估的解释方差下降到33%,回避应对下降到0%,积极应对下降到3%。
结论:自我护理模式最强,说明自我护理可以减轻压力,促进应对,改善心理健康。这些结果表明,与旨在改善应对的干预措施相比,促进自我护理在改善心理健康方面可能更有效。
BACKGROUND: Support interventions often address both self-care and coping. Different approaches are used to promote self-care and coping so clarifying the intervention effect can guide clinicians and researchers to provide interventions that achieve benefit.
OBJECTIVE: To compare two models to determine whether self-care improves coping or coping improves self-care.
METHODS: We used cross-sectional data from 248 caregivers obtained at enrollment into a randomized controlled trial testing the efficacy of a support intervention. Factor scores for scales measuring caregiver demand, self-care, coping, stress appraisal, and mental health were derived from exploratory factor analysis. Structural equation models were analyzed using the factor scores as estimates of each construct. To control possible spurious effects caregiver age, gender, relationship with the patient, and income adequacy were included.
RESULTS: Both models were compatible with the data, but the self-care model was stronger than the coping model. That model had a non-significant chi square and an excellent fit to the data, χ2(4, N = 248) = 2.64, p = .62. The percentage of variance explained by the self-care model was 54 % for mental health, 42 % for stress appraisal, 10 % for avoidance coping, and 6 % for active coping. In the coping model the explained variance of stress appraisal dropped to 33 %, avoidance coping dropped to 0 %, and active coping dropped to 3 %.
CONCLUSIONS: The self-care model was strongest, illustrating that self-care decreases stress, promotes coping, and improves mental health. These results suggest that promoting self-care may be more effective in improving mental health than interventions aimed at improving coping.