Setting
In institution based cross-sectional study was employed in the University of Gondar. All physically disabled students and staffs (n=269) were screened for psychological distress symptoms using the validated using Kessler psychological distress scale(K-10) items questionnaire. Those scoring ≥20 had probable psychological distress (n=93) were included in the study. The brief coping with problems experienced (COPE-28) scale was used for buffering psychological distress symptoms.
Study design and period
An institution based cross-sectional study design was conducted among physically disabled students and staffs at the University of Gondar from May to June 2021.
Study area
The University of Gondar was established in 1954, and hence this is the oldest medical training institution in the country. The University has five campuses. As we got the information from Master card foundation and disability directorate, in all campuses around 44 masters and 178 undergraduate physically disabled students have been attending their classes. More than 71 physically disabled individuals have been employed at the University of Gondar.
Study population
All students, teachers and workers with physically disabled who were living at the University of Gondar during the study period. All students who were on the withdrawal and workers who were on annual/maternal/sick leave were excluded.
Sampling technique
The census was used to recruit the study participants at University of Gondar. A total of 269 study sample were identified, all physically disabled students, teachers and workers of Gondar University were screened for psychological distress symptoms by using Kessler psychological distress scale(K-10). Those who scored ≥20 were probable psychological distress. After screening, ninety-three physically disabled samples were eligible to assess their coping strategies.
Study variables
The dependent variables were coping strategies and resilience was measured by Brief cope-28 item. Independent variable includes socio-demographic factors, WHO-DAS, QOL, social support, clinical factors and substance use variables.
Data sources and measurements
Data were collected using an interviewer-administered structured questionnaires, which contains several other explanatory variables-including; socio-demographic characteristics, clinical factors, psychological factors (stigma and social support), and substance related factors. Data for collected for all variables collected by using structured questionnaires. The following instruments were employed.
Measurements
In this study one of the outcome variables was assessed by using the Brief-COPE (Coping Orientation to Problems Experienced Inventory) is a 28 item self-report questionnaire designed to measure effective and ineffective ways to cope with a stressful life event. Coping is defined broadly as an effort used to minimize distress associated with negative life experiences. The scale has three subscale; problem-focused, emotion-focused, and avoidant coping.
Respondents rate items on a 4-point Likert scale, ranging from 1 “I haven’t been doing this at all” to 4 “I have been doing this a lot”. The scale has 28 items that assess the degree to which a respondent utilizes a specific coping strategy. The 28 items have been categorized into fourteen coping strategies. In validation studies, the Brief COPE Scale was found to have reasonable reliability and validity. It was used to assess coping styles for mental illness in our country(26-32). In this study, the alpha value was 0.857.
Disability was measured using the World Health Organization Disability Assessment Schedule (WHODAS). Disability was measured in six domains of functional impairment, including understanding and communicating, getting around, self-care, getting along with people, life activities, and participation in society. Scores were from 1(not difficult) to 5 (extreme or cannot do)(33-35). In this study, the Cronbach’s Alpha was 0.8.
Social support was assessed using the Oslo 3-item social support scale which was used in several studies. It provides a brief measure of social support and functioning and is considered to be one of the best predictors of mental health. It covered different levels of social support by measuring the number of people the respondents feel close to, the interest and concern showed by others. The Oslo-3, total scores were calculated by adding up the raw scores for each item. The score scale ranges from 3 to 14 and three broad categories: “poor social support” 3 to 8, “moderate support” 9-11, and “strong support” 12-14(36-38).
Stigma was assessed by using a standard questionnaire of eight items of stigma scale for chronic illness (SSCI-8)(39). It comprises eight items rated on a five point likert scale from one (never) to five (always). Total score range from eight to forty, with a cut-off score greater than eight indicating the presence of stigma(40, 41)
Substance use factors were assessed using WHO’s Alcohol, smoking, and substance involvement screening test (ASSSIS), which is develop by the WHO and its Cronbach’s Alpha with 0.80, sensitivity of 80%, and specificity of 71%.
Patients’ quality of life was assessed by 26 items of WHOQOL-BREF questionnaire. The questionnaire consists of two parts. The first, part evaluates the individual’s overall perceptions of quality of life and the person’s overall perception of health. The second part evaluates the four domains: physical health, psychological health, social, and environmental health. Domain scores are scaled in a positive direction (i.e. higher scores correspond to better quality of life). The QOL raw scores are transformed into a range between 0 and 100. The overall QOL computed as the average of the score of the four domains. The higher mean score indicates better QOL and vice versa. In this study, the Chronbach Alpha’s was 0.784.
Data processing and analysis
The completed questionnaire was checked for completeness and then was coded, recoded, and interred into Epi-info version seven statistical programs and then was exported to SPSS version 21 for analyses. Both descriptive and analytical procedures were used. Descriptive statistics like frequency, percentage, mean and SD. After all variables fulfilled the chi-square (categorical variables), computed mean, independent sample t-test, one way ANOVA and then checked their collinearity diagnostic and independent from other Variable Inflation factors (VIF was less than 2 and Tolerance greater than 0.2 and less than 0.989) and bivariate and multivariate linear regression analysis stepwise method was employed to identify factors associated with coping strategies whose P-values were <0.2 level. Finally, the variables that had an independent associated with coping strategies were declared based on 95% CI and P-value < 0.05. Model fitness was checked by using Adjusted R square from 0.43 to 0.89 at f-test 0.0001 to 0.05). An adjusted unstandardized β coefficient was used to describe associated with coping.