Establishing The Self-Management Scale Of Patients After Mechanical Heart Valve Replacement

Mechanical Heart Valve Replacement(MHVR), according to effectively solving the change of micro-circulation dynamics caused by heart disease, is becoming the effective way to treat the patients with severe heart valve disease, which significantly extends the survival days and improves the post-operative life quality. With the spread of the Fast Track Surgery(FTS), the hospitalization days are shortened and the turnover of hospital beds is accelerated. However, the patients are lack of proper guide of rehabilitation and self-management after MHVR, which is easily likely to cause severe complications, even death. Due to the late application of self-management in China, we are relatively familiar with the self-management of chronic disease, but without the complete assessment system to evaluate the self-management ability. Therefore, the important problem for rehabilitation in urgent is to develop a kind of evaluation scale for patients’ self- management after MHVR.Objective : To establish a set of self-management scale with comprehensive content and proper structure, which is applicable to the patients with MHVR, and analysis of items and analysis of reliability andvalidity was undertook, for objectively and scientific evaluating the self-management ability to promote the health of patient.Methods:Literature-review method, interview method and Delphi method were used to establish the scale, and analysis of reliability and validity was used to verify the rationality and reliability of the scale. The main content and method are as follows:1. The system of evaluation items for patients’ self-management after MHVR was establishedThe social cognitive theory of Bandura self determination theory,self-efficacy theory were used as the basic theory framework, based on five dimensions of symptom management, daily life management, information management, emotion management and self management, the literature review method was used to consult self management and self-validity scale in different fields at home and abroad, and the semi-structure interview method was used to interview the staff of cardiothoracic department and patients for understand the connotation of self-management ability, then the items pool of questionnaire of self-management for patients who were received MHVR was established. Delphi method was used to initially determine the content and structure of patients’ self-management, later, the initial scale was formed.2. The validity of self-management scale was detectedConvenient sampling was 203 patients dischargedfrom a certainfirst-class comprehensive hospital over 3 months in September 2012 to September 2015, and questionnaires were used to question the self-management ability, later the validity was detected. Analysis of items was used to analyze and screen degrees of items, and the initial theory structure of the scale was analyzed by exploratory factors. Cronbach’sáSplit-half reliability and Pearson coefficient was chose to detect the validity.Results:1. Construction of the self-management scaleThirty-six staffs of 12 hospitals of Grade A from Beijing, Chongqing,Sichuan, Zhengzhou, Harbin, Wuhan were received 2 round Delphi investigations, with effective respondent rate of 100% and 94%respectively, and comment rate of 55.56% and 11.76% respectively.Experts’ familiarity coefficient was 0.94, judgment coefficient was 0.96 and overall coefficient of experts’ authority was 0.95. Between these 2round investigations, score of all items was more than 3.5, average score indexes were 46.88% and 59.76%, respectively. After 2-round consultation,the variation coefficient was less than 0.25 and the coordination coefficients were 0.492 and 0.497, respectively(P<0.01). Finally, the scale included 42 items and 6 dimensions of symptom management, treatment compliance management, daily life management, emotion management,information management and self-management.2. Validity of the scaleQuestionnaire of the initial scale was used to investigate the self-management ability after the MHVR. Questionnaires of 203 were distributed and recovered, and all of them were valid, with effective recovery rate of 92.3%. According to the analysis of items and explorative factor, it was determined that the scale was composited by 6 dimensions and 27 items. six initial class factors were extracted by the explorative factor analysis, with the cumulative rate of its variance of 72.674%.Cronbach’s áwas 0.932, and split-half reliability was 0.863, The Spear coefficient between items and each scale was 0.600~0.908, between items and main scale was 0.583~0.936.Between each scale and total scale was0.256~0.936(P<0.01).Conclusion:The scale is composited by 6 dimensions and 27 items,with high positivity and authority of consultative experts, high concentration and coordination, reliable consultative results. The scale is with highly validity, stability and validity. All results of validity are reasonable and all items are reached the demands of measurement.