Psychometric properties of Brief Coping Orientation to Problems Experienced in patients with multiple chronic conditions: A preliminary study.

BACKGROUND: Multiple chronic conditions (MCCs) are highly prevalent in primary care. Coping is an important psychological factor that influences patients' ability to adapt physically and mentally to MCCs. Testing a reliable and valid psychometric inventory is necessary to identify coping strategies before developing coping-oriented interventions. PURPOSE: The purpose of this study is to examine the psychometric properties of the Chinese version of the Brief Coping Orientation to Problems Experienced (Brief COPE-CN) inventory in patients with MCCs. METHOD: This study adopted a cross-sectional design. A convenience sample of 290 Chinese patients with MCCs was recruited from a tertiary hospital in East China. The Brief COPE-CN, sociodemographic characteristics and clinical data were collected using a self-reported questionnaire from November 2017 to May 2018. Factor analysis and reliability analysis were performed. RESULTS: The mean age of the participants was 58.5 years (range from 23 to 95 years), and approximately half of the participants were female (49.3%). Most participants had two chronic conditions (82.1%) and reported having had MCCs for more than 2 years. The explanatory factor analysis (EFA) identified five factors in the Brief COPE-CN that explained 58.4% of the total variance. The Cronbach's α coefficients ranged from .65 to .85 for the five subscales. CONCLUSIONS: The psychometric properties of the Brief COPE-CN were acceptable for use with Chinese patients with MCCs. With further evaluation, this instrument may help health-care professionals understand patients' coping and develop coping-based interventions to promote coping in this population.

Illness Perceptions, Coping Strategies, and Quality of Life in People With Multiple Chronic Conditions.

PURPOSE: To determine whether illness perceptions, coping strategies, and sociodemographic and clinical variables are related to the quality of life (QoL) in adults with multiple chronic conditions (MCCs) living in China. DESIGN: By employing a cross-sectional design based on the transactional stress and coping theory, a convenience sample of adults with MCCs were recruited from a university-affiliated hospital between November 2017 and May 2018 in Northern Anhui, China. METHODS: A self-reported questionnaire, including the Brief Illness Perceptions Questionnaire, the Brief Coping Orientation to Problems Experienced inventory, and the Short Form Survey version 2, was administered. Sociodemographic and clinical data regarding MCCs were also collected. Descriptive statistics including frequencies, means, standard deviations, and correlation coefficients were calculated to examine the relationship between illness perceptions, coping, and QoL. Hierarchical multiple regression models were used to identify variables associated with physical and mental QoL. FINDINGS: A total of 351 participants (50% male) were recruited, with a mean age of 58.9 years (SD = 14.6). Of the participants, 83% had two chronic conditions. Participants reported impaired physical and mental QoL when compared with the general population in China. Poorer QoL was correlated with stronger illness perceptions of consequences and timeline and increased use of denial and disengagement and self-blame. Increasing age and more chronic conditions were associated with worse QoL. A higher education level was significantly associated with better physical and mental QoL. CONCLUSIONS: This study found that adults with MCCs living in China experienced impaired QoL. The strong relationship found between the participants' perceptions of MCCs, coping strategies, and QoL suggested that healthcare professionals should recognize the physical and psychological impacts of MCCs and address the significance of adaptations to MCCs in future treatment programs. The findings will help healthcare professionals design more specific interventions to modify illness perceptions and enhance certain coping strategies to improve the QoL of people with MCCs. Healthcare professionals can mobilize available resources from healthcare and social systems to enhance people's coping and adaptation to MCCs. CLINICAL RELEVANCE: With an understanding of the illness perceptions of people with MCCs, healthcare professionals could offer information related to consequences, timeline, and personal control to enable better alignment between people's expectations and their actual situations. By knowing people's coping strategies, healthcare professionals can offer additional support to people who prefer strategies of denial and disengagement and self-blame.

Patients' experiences of coping with multiple chronic conditions: A qualitative descriptive study.

OBJECTIVE: To explore the experiences of how Chinese adults cope with multiple chronic conditions in everyday life. BACKGROUND: Having multiple chronic conditions is stressful, requiring people to make physical and mental adaptations. There is little evidence exploring how people cope with multiple chronic conditions, especially in an Asian context. DESIGN: A qualitative descriptive design was employed. The Consolidated criteria for reporting qualitative research (COREQ) was used to report this study. METHODS: This study was conducted in a tertiary referral and teaching hospital in Bengbu, Anhui, China, between August and October 2018. A purposive sample of 14 people with multiple chronic conditions, aged between 32 and 75 years, completed a demographic questionnaire and semi-structured face-to-face interviews. The interviews were digitally recorded and transcribed verbatim. Qualitative content analysis guided data analysis. RESULTS: Four distinctive themes comprising subthemes were developed from participants' narratives pertaining to coping with multiple chronic conditions: (a) appraising multiple chronic conditions, (b) addressing multiple chronic conditions management, (c) maintaining psychological well-being and (d) fulfilling a social role. Illustrative quotations were cited to support each theme. CONCLUSIONS: This study underscores that people cope with multiple chronic conditions in everyday life by using a compendium of coping strategies. As one of the influencing factors, culture dominates the ways of coping at different levels among people with multiple chronic conditions. These findings expand the current literature on coping based on an Asian perspective and inform further cross-culture research on this topic. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals should understand peoples' experiences of coping with multiple chronic conditions to provide more holistic and dynamic health care to address their actual needs. Healthcare professionals should be acquainted with how culture impacts individuals' coping and develops culture-tailored supportive programmes such as family-based interventions, to promote the health of people with multiple chronic conditions.

Validity and reliability of an Emotional Thermometer tool: an exploratory cross-sectional study.

INTRODUCTION: There are a few screening tools to detect psychological symptoms among people with multiple chronic conditions (MCCs) in China. AIM: The aim of this study was to examine the validity and reliability of a translated version of the Emotional Thermometer (ET) tool. MATERIALS AND METHODS: This cross-sectional study consisted of two phases: (1) translation and content validity testing; and (2) assessment of psychometric properties, including internal consistency, test-retest reliability, and construct validity. For the first phase, the authors used a forward-backward translation approach for the Chinese version of the instrument and tested its content validity with a panel of six experts. For the second phase, the data, including the ET tool and demographic characteristics were collected in a convenience sample of 197 Chinese people with MCCs recruited from a university hospital. The first 50 participants participated in the two-week retest. RESULTS: The Chinese version of the ET tool had satisfactory psychometric properties; content validity index (0.83), internal consistency (0.92), and ICC (0.93 to 0.98 [p < 0.01]). Principal component analysis showed that there was only one component with an eigenvalue greater than 1 (value = 3.80), with 76.67% of the variance responding. All items loaded significantly onto this factor and demonstrated strong loadings of > 0.70. CONCLUSION: The Chinese-version of the ET tool is psychometrically sound. It has the potential to be used as a screening tool for psychological symptoms in Chinese people with MCCs. IMPACT STATEMENT: Findings from testing the Chinese translation of the Emotional Thermometer indicate this could be a convenient and useful screening tool to detect psychological symptoms in patients with multiple chronic conditions.

Urban-rural differences in mental health among Chinese patients with multiple chronic conditions.

Mental health is impacted by social, economic, and environmental influences related to where people live. Mental health problems commonly co-occur with long-term physical conditions and impact individuals' health synergistically. Multiple chronic conditions (MCCs) including mental health problems are becoming a public health challenge globally. However, there is limited information about urban-rural differences in mental health among patients with MCCs in China. The present study aimed to identify differences in mental health between urban and rural patients with MCCs. Using a cross-sectional design, 347 patients with MCCs were recruited from a tertiary hospital in North Anhui, China. A self-reported questionnaire, including socio-demographic and clinical variables, the 12-item Short-Form survey version 2 on quality of life, and the Hospital Anxiety and Depression Scale, was administered to outpatients. Findings showed that rural participants reported more symptoms of anxiety and depression and had worse mental health compared to urban participants. Unemployment status, lower educational level, more long-term health conditions, and a higher degree of anxiety were associated with worse mental health. This study highlights disparities in mental health among patients with MCCs living in urban and rural areas of China. Appropriate mental health support programmes should be developed for patients with MCCs, especially for those living in rural areas.