Doctor Patient Relationship as a Mediator Between Attachment Dimensions and Self-Management In Chronic Patients, Yangon, Myanmar


  • May Zaw Naing Citta Consultancy
  • Santhosh Ayathupady Mohanan


Attachment Dimensions; Doctor Patient Relationship; Self-Management; Chronic Patients; Myanmar


This research studied the direct effect of attachment dimensions on self-management and the mediating effect of the doctor-patient relationship between attachment dimensions and self-management. A quantitative method with correlational research design via path analysis was utilized. The participants of the study consisted of 90 male and 90 female chronic patients. Burmese translated version of Revised Adult Attachment Scale (RAAS), Partners in Health (PIH) scale and Patient-Doctor Depth of Relationship (PDDR), and a researcher constructed demographic questionnaires were employed. The mediating role of doctor patient relationship is discussed in the context of self-management of chronic patients in Yangon, Myanmar. The results revealed the following major findings: (1) close attachment dimension had a significant direct positive effect on self-management, depend and anxiety attachment dimensions did not have a direct effect on self-management; (2) close attachment dimension had a significant indirect effect on self-management, being mediated by doctor-patient relationship (Standardized Indirect effect = .08, SE = .04, LLCI = .01, ULCI = .16), depend attachment dimension did not have a significant indirect effect on self-management, being mediated by doctor-patient relationship (Standardized Indirect Effect = .06, SE = .04, LLCI = -.01, ULCI = .14), anxiety attachment dimensions did not have a significant indirect effect on self-management, being mediated by doctor-patient relationship (Standardized Indirect Effect = .0361, SE = .03, LLCI = -.03, ULCI = .11); it is not uncommon for chronic patients in Myanmar to reach out to the quack doctors instead of consulting with doctors. Economic hardship requires chronic patients to make difficult decisions between healthcare and basic living expenses).


Angwenyi, V., Aantjes, C., Kajumi, M., De Man, J., Criel. B., Bunders-Aelen. J. (2018). Patients Experiences of Self-Management and Strategies for Dealing with Chronic Conditions in Rural Malawi. PLoS ONE 13(7): e0199977.

Abubakari, A-R., Cousins, R., Thomas, C., Sharma, D., & Naderali, E.K. (2016). Sociodemographic and Clinical Predictors of Self-Management Among People with Poorly Controlled Type 1 & 2 Diabetes: The Role of Illness Perceptions and Self-Efficacy. Journal of Diabetes Research. Article ID 6708164, 12 pages.

Adamczyk, K., & Bookwala, J. (2013). Adult Attachment and Single vs. Partnered Relationship Status In Polish University Students. Psihologijske Teme 22 (2013), 3, 481-500 Brenk-Franz, K., Strauss,

B., Tiesler, F., Fleischhauer, C., Schneider, N., & Gensichen, J. (2017). Patient Provider Relationship as Mediator Between Adult Attachment and Self-Management in Primary Care Patients with Multiple Chronic Conditions.

Babbalola, O. (2017). Consumers and Their Demand for Health Care. Journal of Health & Medical Economics. Vol. 3 No. 1:6. DOI: 10.21767/2471-9927.100032

Brenk-Franz, K., Strauss, B., Tiesler, F., Fleischhauer, C., Ciechanowski, P., Schneider, N., & Gensichen, J. (2015). The Influence of Adult Attachment on Patient Self-Management in Primary Care – The Need for a Personalized Approach and Patient-Centered Care. PLoS ONE (10)9: e136723. DOI: 10.1371/journal.pone.0136723

Collins, N. L., & Read, S. J. (1990). Adult Attachment, Working Models and Relationship Quality in Dating Couples. Journal of Personality and Social Psychology, Vol. 58, No. 4, 644-663. American Psychological Association, Inc. 0022-3514/90/$00.75

Collins, N. L. (1996). Working Models of Attachment: Implications for Explanation, Emotion and Behavior. Journal of Personality and Social Psychology, Vol. 71, No.4, 810-832. American Psychological Association, Inc. 0022-3514/96/$3.00

Cheah, J. (2001). Chronic Disease Management: A Singapore Perspective. BMJ Vol. 323:990-3.

Crotty, M. M., Henderson, J., Ward, P. R., Fuller, J., Rogers, A., Kralik, D., & Gregory, S. (2015). Analysis of Social Networks Supporting the Self-Management of Type 2 Diabetes for People with Mental Illness. BMC Health Services Research 15:257. DOI: 10.1186/s12913-015-0897-x

Danquah, R. N. (2013). An Evaluation of the Relationship Between Patient’s Adult Attachment Styles and Their Level of Trust in Their Physicians at a Veteran Health Care System.

Danquah, R., Martin, M., Martin, D., & Hale, J. (2016). An Evaluation of the Relationship Between Patients’ Adult Attachment Styles of Veterans and Their Level of Trust in Their Physicians at a Veteran Health Care System. European Journal of Business and Social Sciences, Vol 5, Issue 5, 65-82

Daneman, D., & Daneman, M. (2012). What Has Attachment Theory Got To Do With Diabetes Care? Diabetes Manage. 2 (2), 85-87. ISSN 1758-1907

El-Etreby, R. R., & El-Monshed, A. H. E-S. (2019). Effect of Self-Management Program on Quality of Life for Patients with Chronic Kidney Disease. American Journal of Nursing Research, vol. 7, 4: 657-663. DOI: 10.12691/ajnr-7-4-27.

Faul, F., Erdfelder, E., Lang, A-G., & Buchner, A. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41 (4), 1149-1160 doi:10.3758/BRM.41.4.1149

Frederiksen, H. B., Ragstrup, J. K., & Dehlholm-Lambertsen, B. (2010). Attachment in The Doctor–Patient Relationship In General Practice: A Qualitative Study. Scandinavian Journal of Primary Health Care, 2010; 28: 185–190. ISSN0281-3432 print/ISSN 1502-7724. DOI: 10.3109/02813432.2010.505447

Fuertes, J. N., Toporovsky, A., Reyes, M., & Osborne, J. B. (2017). The Physician-Patient Working Alliance: Theory, Research, and Future Possibilities. Patient Education and Counseling. Vol. 100, Issue 4, Pages 610-615.

Fletcher, I., McCollum, R., & Peters, S. (2016). Attachment styles and clinical communication performance in trainee doctors. Patient Education and Counseling. 99(11). DOI: 10.1016/j.pec.2016.05.019

Fernández, A. M., & Dufey, M. (2015). Adaptation of Collins’ Revised Adult Attachment Dimensional Scale to the Chilean Context. DOI: 10.1590/1678-7153.201528204. ISSN 1678-7153

Grady, P. A., & Gough, L. L. (2014). Self-Management: A Comprehensive Approach to Management of Chronic Conditions. American Journal of Public Health 104, No. 8. (August 1, 2014): pp. e25-e31. PMID: 24922170

Hyman, I., Shakya, Y., Jembere, N., Gucciardi, E., & Vissandjee, B. (2017). Provider and Patient-Related Determinants of Diabetes Self-Management. Peer-reviewed Canadian Family Physician; Vol. 63: e137-44

Irak, M., Aydınoğlu, B. A., & Soylu, C. (2014). Attachment Style on Attention: Electrophysiological Evidence. Conference Paper.

Jimenez, X. F. (2016). Attachment in Medical Care: A Review of the Interpersonal Model in Chronic Disease Management. Chronic Illness 13(1). DOI: 10.1177/1742395316653454

Jaarsma, T., Cameron, J., Riegel, B., & Stromberg, A. (2017). Factors Related to Self-Care in Heart Failure Patients According to the Middle-Range Theory of Self-Care of Chronic Illness: A Literature Update. Current Heart Fail Rep (2017) 14:71–77. DOI 10.1007/s11897-017-0324-1

Kueh, Y. C., Morris, T., Borkoles, E., & Shee, H. (2015). Modelling of Diabetes Knowledge, Attitudes, Self-Management, and Quality of Life: A Cross-Sectional Study with an Australian Sample. Journal of Health and Quality of Health Outcomes, 13:129. DOI: 10.1186/s12955-015-0303-8.

Lenferink, A., Effing, T. W., Harvey, P. W., & Battersby, M. (2016). Construct Validity of the Dutch Version of the 12-Item Partners in Health Scale: Measuring Patient Self-Management Behavior and Knowledge in Patients with Chronic Obstructive Pulmonary Disease. PLoS ONE 11(8): e016595. DOI: 10.1371/journal.pone.0161595

Leiter, M. P., Day, A., & Price, L. (2015). Attachment Styles at Work: Measurement, Collegial Relationships and Burnout. Burnout Research 2 (2015) 25-35

McDermott, R. C., Cheng, H. L., Wright, C., Browning, B. R., Upton, A. W., & Sevig, T. D. (2015). Adult Attachment Dimensions and College Student Distress: The Mediating Role of Hope. Vol. 43(6) 822 –852. DOI: 10.1177/001100001557539 McWilliams, L. A. (2018). Relationships between Adult Attachment Dimensions and Patient Physician Relationship Quality. Journal of Relationships Research 9, e15, 1-8. Cambridge University Press.

Maunder, R. G., & Hunter, J. J. (2016). Can Patients Be ‘Attached’ To Healthcare Providers? An Observational Study to Measure Attachment Phenomena in Patient– Provider Relationships. BMJ Open 2016;6: e011068. DOI:10.1136/bmjopen-2016011068.

Merriel, S. W. D., Salisbury, C., Metcalfe, C., & Ridd, M. (2015). Depth of the Patient–Doctor Relationship and Content of General Practice Consultations: Cross-Sectional Study. British Journal of General Practice. DOI: 10.3399/bjgp15X686125

Mikulincer, M., & Shaver, P. R. (2012). An Attachment Perspective On Psychopathology. World Psychiatry 2012; 11:11-15

McWilliams, L. A., Murphy, P. DJ., & Bailey, S. J. (2010). Associations between Adult Attachment Dimensions and Attitudes Toward Pain Behavior. Pain Res Manage 2010;15(6):378-384.

Notzon, S., Domschke, K., Holitschke, K., Ziegler, C., Arolt, V., Pauli, P., Reif, A., Deckert, J., & Zwanzger, P. (2015). Attachment Style and Oxytocin Receptor Gene Variation Interact in Influencing Social Anxiety. The World Journal of Biological Psychiatry, DOI: 10.3109/15622975.2015.1091502. ISSN: 1562-2975

Noppaprach, S. (2015). A Causal Model of The Direct and Indirect Impact of Insecure Attachment Styles on Romantic Relationship Satisfaction Mediated by Emotion Regulation Strategies and Psychological Distress Ogbeide, S., & Turner, B. J. (2018). Self-Management of Chronic Pain in Primary Care. Pain Self-Management Vol.18, Iss.9.

Provost, S., Pérez, J., Pineault, R., Borgès Da Silva, R., & Tousignant, P. (2015). An Algorithm Using Administrative Data to Identify Patient Attachment to a Family Physician. International Journal of Family Medicine Volume 2015, Article ID 967230, 11 pages.

Pelletier, L., Shanmugasegaram, S., Patten, Scott B., & Demers, A. (2017). Self-management of mood and/or anxiety disorders through physical activity/exercise. Health Promot Chronic Dis Prev Can. 37(5): 27–32. PMCID: PMC5650020

Phillips, L.A., Cohens, J., Burns, E., Abrams, J., & Renninger, S. (2016). Self-Management of Chronic Illness: The Role of ‘Habit’ vs. Reflective Factors in Exercise and Medication Adherence. Journal of Behavioral Medicine.

Qin, J., Theis, K. A., Barbour, K. E., Helmick, C. G., Baker, N. A., & Brady, T. J. (2013). Impact of Arthritis and Multiple Chronic Conditions on Selected Life Domains — United States. Morbidity and Mortality Weekly Report. June 5, 2015 / Vol. 64 / No. 21

Szabo, C., Altmayer, A., Lien, L., Poot, F., Gieler, U., Tomas-Aragones, L., Kupfer, J., Jemec, G. B. E., Misery, L., Linder, D., Sampogna, F., Middendorp, H. V., Halvorsen, J. A., Balieva, F., Szepietowski, J. C., Romanov, D., Marron, S. E., Ilknur, K. A., Finlay, A. Y., Salek, S. S., & Dalgard, F. (2017). Attachment Styles of Dermatological Patients in Europe: A Multicentre Study in 13 Countries. Acta Derm Venereol 2017; 97: 813–818. DOI: 10.2340/00015555-2619

Scruggs, P. C. (2016). A Feasibility Study of Just-in-Time Asthma Self-Management Intervention. Master’s Thesis, University of Tennessee, 2016.

Sattoe, J. N. T., Bal, M. I., Roelofs, P. D. D. M., Bal. R., Miedema, H. S., & Staa, A.L.V. (2015). Growing up with a Chronic Condition: Challenges for Self-Management and Self-management

Support. (pp 65-84). Patient Education and Counseling. 2015; 98(6):704-715

Sagala, D, S, P., Purba, J, M., Sitepu, N, F. (2019). Motivation and Quality of Life Among Patients with Chronic Renal Failure Undergoing Hemodialysis in Medan, Indonesia. International Journal of Nursing and Health Services (IJNHS), Vol 2, Issue 3, 100-106 DOI: http// v2i3.140

Thorberg, F. A., & Lyvers, M. (2010). Attachment in Relation to Affect Regulation and Interpersonal Functioning Among Substance Use Disorder Inpatients. Addiction Research and Theory, 18(4), pp. 464-478.

Traue, H. C., & Deighton, R. M. (2005). Emotional Inhibition and Somatization Across Cultures. RIPS/IRSP, 18 (1/2), 109-140.

Traue, H. C., & Deighton, R. M. (2016). Stress: Concepts, Cognition, Emotion, and Behavior. Elsevier Inc. DOI: 10.1016/B978-0-12-800951-2.00028-5

Van de Velde, D., Zutter, F. D., Satink, T., Costa, U., Janquart, S., Senn, D., & Vriendt, P.D. (2019). Delineating the Concept of Self-Management in Chronic Conditions: A Concept Analysis. BMJ Open 2019;9: e027775. DOI:10.1136/ bmjopen-2018-027775

Wilson, A. L., McNaughton, D., Meyer, S. B., & Ward, P. R. (2017). Understanding the Links between Resilience and Type-2 Diabetes Self-Management: A Qualitative Study in South Australia. Archives of Public Health (2017) 75:56. DOI 10.1186/s13690-017-0222-8




How to Cite

May Zaw Naing, & Santhosh Ayathupady Mohanan. (2021). Doctor Patient Relationship as a Mediator Between Attachment Dimensions and Self-Management In Chronic Patients, Yangon, Myanmar. Scholar: Human Sciences, 13(2), 125. Retrieved from