The Development Of Self-Management Scale And Health Education In Coronary Artery Disease

Objective: 1. To establish and evaluate the reliability and the validity of the Coronary artery disease Self-management Scale (CSMS). 2. To investigate the self management behaviors and analysis the relative factors in patients with Coronary Heart Disease (CHD) and provide the evidence for strategy making of health education and second prevention in CHD. 3. To establish and evaluation the self-management health education model for patients underwent coronary artery stent implantation.Methods: 1. The items pool was based on the theory of chronic disease self-management and the evidence of behavioral medical science related to CHD. Firstly, the preliminary scale was developed through specialists evaluation; then it was reviewed by 10 patients and specialists again; At last, 209 patients were surveyed and based on the pilot data, a series of statistic analysis was conducted such as factor analysis, correlation analysis, etc. to deduce the items to 27 and then a comprehensive set of psychometric tests was performed on the final version. 2. 209 patients were investigated with CSMS ( include three sub-scales: daily management, medical management,emotion management), the general information and the disease related information also be collected. 3. 98 patients underwent coronary artery stent implantation was enrolled in self-management education program which based on self-efficacy and concentrated on health behaviors. Analysis of t-test andχ2 test were used to compare 6 months change of 10 variances, including the scores of Self-efficacy Questionnaire, Health Promotion Lifestyle ProfileⅡ, the qualified rate of Body mass index (BMI), Total Cholesterol (TC) and Low Density Lipid (LDL).Results: 1. Psychometric tests with the application of stringent criteria confirmed the test-retest reliability (ICC = 0.910), internal consistency (Cronbach'sα=0.913), criterion-related validity(r=0.271～0.573), construct validity (factor analysis confirms the hypnosis of the scale), responsiveness (t=9.011,P<0.01) and acceptability(response rate 93.4%, effective rate 97.2%). 2. The score of self management in these patients was (52.69±18.47). The multi-variable stepwise regression shows there are statistically significant correlation between the daily life management and working status; between the medical management and education background,hypertension,classification of CHD and duration of CHD; between the emotional management and disease perception,economic status (P<0.05). 3. The scores of Self-efficacy Questionnaire, Health Promotion Lifestyle ProfileⅡ(HPLPⅡ) and the qualified rate of BMI,TC and LDL was significantly higher than baselines 6 months after self-management health education (P<0.05).Conclusion: 1. The CSMS is a practicable and scientific instrument that measures seven important dimensions of self-management skills in patients with coronary heart disease. It can be used in the second prevention practice of coronary heart disease. 2. The self management behavior of patients is poor. Those still working are not good at daily management; those less educated,not complicating with hypertension,diagnosis as UnsTab angina or Myocardial infraction,have short duration of CHD are not good at medical management; Those have negative disease perception and less income are not good at emotional management. 3. The coronary heart disease self-management health education program improved participants'self-efficacy, health behavior, and disease outcomes after 6 months implementation.