Analysis Of Influencing Factors Of Self-Management In Patients With Atrial Fibrillation Taking Warfarin Based On The Theory Of Planned Behavior

ObjectiveBased on the behavioral attitude,subjective norm,perceived behavioral control and behavioral intention in the Theory of planned behavior(TPB),to construct the self-management model of patients taking warfarin atrial fibrillation,and to discuss and analyze the present situation of self-management in patients with atrial fibrillation taking warfarin,so as to provide scientific reference for improving the self-management level of patients with atrial fibrillation taking warfarin.MethodsConvenience sampling 221 cases of patients with atrial fibrillation who took warfarin from February 2018 to December 2018 in department of cardiology outpatient department of a grade iii class a hospital in Qingdao were selected as the research object.Using the method of investigation and research,the self-designed general information questionnaire,self-designed questionnaires based on the Theory of planned behavior for anticoagulant self-management in patients with atrial fibrillation,including behavioral attitude questionnaire,subjective norm questionnaire,perceived behavior control questionnaire,and behavioral intention questionnaire,and a scale compiled by Lu Bingqing were selected as research tools.SPSS 22.0 and AMOS 22.0 were used for statistical analysis of all data.The state of personal characteristics,behavioral attitude,subjective norm,perceived behavior,behavioral control,behavioral intention,and self-management behavior were explored by descriptive statistical methods;multiple stepwise linear regression analysis was used to analyze the relationship between demographic characteristic variables and behavioral attitude,subjective norm,perceived behavioral control and behavioral intention;using structural equation model to quantitatively analyze the path relationship of the influence of behavioral attitude,subjective norm,perceived behavioral control and behavioral intention on the self-management of patients taking warfarin atrial fibrillation,so as to explore the main influencing factors of self-management behavior of patients with atrial fibrillation taking warfarin.Results1.The average score of self-management behavior of patients with atrial fibrillation taking warfarin was 31.93 ± 5.51,and the average scores of each dimension from high to low were as follows: poor addiction management(2.49±0.46),compliance with medical practices(2.02±0.40),lifestyle(1.57±0.47),Factors on the management of the international standardized ratio of prothrombin time(PT-INR)(1.38±0.55),administration of warfarin(1.27±0.55),detection of specific signs of atrial fibrillation(embolism)(0.75±0.61).2.The results of multiple linear regression analysis suggested that behavior attitude was influenced by residence style(b=1.783,P=0.006),medication duration(b=-0.875,P<0.001)and medication type(b=-0.403,P=0.018);subjective norm was influenced by residence style(b=2.298,P<0.001);perceptual behavioral control was influenced by previous bleeding history;behavioral intention was influenced by duration of medication(b=-0.409,P=0.014)and previous bleeding history(b=-0.596,P=0.024).3.The results of structural equation model shows that:(1)The model based on the theory of planned behavior could explain 29% of the variance of self-management behavior of the patients with atrial fibrillation taking warfarin.(2)The total effect value of behavioral intention to self-management in patients with atrial fibrillation taking warfarin was 0.60(direct effect value = 0.60);perceptual behavioral control not only had a direct effect on self-management in patients with atrial fibrillation taking warfarin,but also indirectly affected it through behavioral intention,with a total effect value of 0.44(direct effect value = 0.30,indirect effect value = 0.14);behavioral attitude had an indirect effect on self-management in patients with atrial fibrillation taking warfarin through behavioral intention,with a total effect value of 0.51(indirect effect value = 0.51);subjective norm had indirect effects on self-management in patients with atrial fibrillation taking warfarin through behavioral attitude,behavioral intention and perceptual behavioral control,with a total effect value of 0.49(indirect effect value = 0.49).(3)The total effect value of behavioral attitude to behavioral intention was 0.85(direct effect value = 0.85);subjective norm not only had direct effects on behavioral intention,but also had indirect effects on it through behavioral attitude or perceptual behavioral control,with a total effect value of 0.74(direct effect value = 0.15,indirect effect value = 0.59);perceived behavioral control had direct effects on behavioral intention,with a total effect value of 0.23,(direct effect value = 0.23).ConclusionThe self-management of patients with atrial fibrillation taking warfarin is at a poor level and needs to be further improved.Residence style,time and number of medications are the influencing factors of behavior attitude,residence style is the influencing factor of subjective norm,past history of bleeding is the influencing factor of perceived behavior control,and time and past history of bleeding are the influencing factors of behavior intention.The structural equation model based on the theory of planned behavior can well explain and predict the self-management behavior of patients with atrial fibrillation taking warfarin.The structural equation model based on the theory of planned behavior can better explain and predict the self-management behavior of patients taking warfarin atrial fibrillation.That is,behavioral intention is the main direct influencing factor of self-management behavior.Perceptual behavioral control is not only the direct influencing factor of self-management behavior,but also the indirect influencing factor of self-management behavior through behavioral intention.Subjective norm and perceived behavioral control have indirect effect on behavior through behavioral intention.