Chronic Hepatitis-related Stigma and Self-care Efficacy in Patients with Chronic Hepatitis B or C Infection

Chronic hepatitis B and C are common in Taiwan and also the leading cause of liver cirrhosis, hepatocellular carcinoma and liver failure. Although effective therapies have recently emerged for the disease, not all patients receive treatment and the outcome is not always successful. As the majority of patients have to live with a long-term condition, the role of self-care which focuses on indivisual-centered is increasingly critical for them to manage disease, prevent disease progression and have better quality of life. Self-efficacy is believed to have a great impact on self-care behavior. In addition to manage physical change of chronic illness, patients living with hepatitis also cope with perception of stigma due to infectious and fatal of the disease. However, no study regarding hepatitis-related stigma or self-care efficacy has been carried out in Taiwan. The current study attempted to explore the current status of hepatitis-related stigma and self-care efficacy and their association factors in a group of chronic hepatitis B or C. The purposes of this study were to: (1)explore the status of hepatitis-related stigma among chronic hepatitis patients; (2) explore the relationships among demographic and disease-related, liver disease symptoms, personality factors and hepatitis-related stigma; (3) explore the status of self-care efficacy among chronic hepatitis patients; and(4) understand the demographic and disease-related, liver disease symptoms, personality and hepatitis-related stigma factors associated with self-care efficacy and explore significant explanatory factors. We conducted a cross-sectional, structured questionnaire survey with purposive sampling to recruit eligible participants from outpatient settings in six sites, including three gastroenterology departments of two medical centers and a free hepatitis screening activity held in July 2015 in northern Taiwan, one metropolitan hospital and two public health centers in southern Taiwan. The inclusion criteria were chronic hepatitis B or C patients and who still receiving standard antiviral therapy or suffering from liver cirrhosis or liver cancer were excluded. Research materials included demographic and disease-related information, liver disease symptoms and distress assessed with the Liver Disease Symptom Index 2.0, personality assessed by the Type D scale-14 Taiwanese version-revised, hepatitis-related stigma assessed with the Stigma Scale of Chronic Hepatitis Patients, self-care efficacy measured with the Self-care Efficacy Scale of chronic hepatitis patients. Data were analyzed by descriptive statistics and logistic regression methods. A total of 207 patients in this study and average age was 56.4. The results indicated that: (1) The overall mean scores of hepatitis-related stigma favored a lower perception, however, the degree of nondisclosure and negative self-estimation were relative high; (2) The factors of transfusion etiology, liver disease symptoms (include symptom severity and symptom distress) and type D personality (include negative affection and social inhibition) were associated with stigma degree; (3) The overall mean score of self-care efficacy was around the high-level, but the degree of health-care efficacy (include exercise, diet, regular lifestyle and self-monitor symptoms) was relative low; (4) The factors of marital status, smoking history,liver disease symptoms (include symptom severity and symptom distress), type D personality (include negative affection and social inhibition) and hepatitis-related stigma were associated with self-care efficacy degree. After adjusted association factors with multiple logistic regression, marital status, smoking history, symptom severity and hepatitis-related stigma were significant determinants of self-care efficacy. In conclusion and suggestion: (1) the perception of hepatitis-related stigma centralize on the level of nondisclosure and negative self-estimation. The care for chronic hepatitis could focus on promotion of positive experience and image of disease, listening and assist patients to cope with symptom distresses with education and psychological consultation. And screening of type D personality among patients to reinforce education and give mental support for them could help to reduce negative impact of physical and mental health by stigma; (2) The level of confidence with health-care needs to be enhanced by reinforcing its benefits; (3) In addition to improve disease symptoms by encouraging patients to accept treatment, help patients to reduce perception of hepatitis-related stigma are beneficial to enhance self-care efficacy and self-care ability. (4) Although type D personality not significantly explained the study outcome variables after adjusting other factors, nearly 30 percent of patients had this personality and associated with psychological variables such as stigma and self-care efficacy in the current study. As type D personality is suggested to impair health behavior and health outcomes with specific disease, more studies need to be carried out in this particular group. This study provides valuable information about hepatitis-related stigma and self-care efficacy and it is helpful in clinical care, education and future research in nursing. Key words：Chronic hepatitis, Stigma, Self-care, Self-efficacy, Personality, Symptom.