Data from: The influence of adult attachment on patient self-management in primary care

Objective: Self-management strategies are essential elements of evidence-based treatment in patients with chronic conditions in primary care. Our objective was to analyse different self-management skills and behaviours and their association to adult attachment in primary care patients with multiple chronic conditions. Methods: In the apricare study (Adult Attachment in Primary Care) we used a prospective longitudinal design to examine the association between adult attachment and self-management in primary care patients with multimorbidity. The attachment dimensions avoidance and anxiety were measured using the ECR-RD. Self-management skills were measured by the FERUS (motivation to change, coping, self-efficacy, hope, social support) and self-management-behaviour by the DSMQ (glucose management, dietary control, physical activity, health-care use). Clinical diagnosis and severity of disease were assessed by the patients’ GPs. Multivariate analyses (GLM) were used to assess the relationship between the dimensions of adult attachment and patient self-management. Results: 219 patients in primary care with multiple chronic conditions (type II diabetes, hypertension and at least one other chronic condition) between the ages of 50 and 85 were included in the study. The attachment dimension anxiety was positively associated with motivation to change and negatively associated with coping, self-efficacy and hope, dietary control and physical activity. Avoidance was negatively associated with coping, self-efficacy, social support and health care use. Conclusion: The two attachment dimensions anxiety and avoidance are associated with different components of self-management. A personalized, attachment-based view on patients with chronic diseases could be the key to effective, individual self-management approaches in primary care.

研究目标：自我管理策略是基层医疗慢性病患者循证治疗的核心要素。本研究旨在分析基层医疗共病成年患者的各类自我管理技能与行为，及其与成人依恋的关联。
研究方法：本研究依托apricare研究（Adult Attachment in Primary Care，基层医疗中的成人依恋），采用前瞻性纵向设计，探究基层医疗共病患者的成人依恋与自我管理之间的关联。采用ECR-RD量表评估成人依恋的回避与焦虑两个维度；自我管理技能采用FERUS量表评估，涵盖改变动机、应对方式、自我效能、希望水平与社会支持5个维度；自我管理行为则采用DSMQ量表评估，涵盖血糖管理、饮食控制、体力活动与医疗服务利用情况。患者的临床诊断与疾病严重程度由其全科医生进行评估，本研究采用广义线性模型（GLM）开展多变量分析，以探究成人依恋维度与患者自我管理间的关联。
研究结果：本研究共纳入219名年龄介于50至85岁的基层医疗共病患者，涵盖2型糖尿病、高血压及至少1种其他慢性病。结果显示，依恋焦虑维度与改变动机呈正相关，与应对方式、自我效能、希望水平、饮食控制及体力活动呈负相关；依恋回避维度则与应对方式、自我效能、社会支持及医疗服务利用呈负相关。
研究结论：成人依恋的焦虑与回避两个维度，分别与自我管理的不同组分存在关联。以依恋为基础的个性化诊疗视角，或可为基层医疗中慢性病患者的个体化高效自我管理方案提供关键思路。