| Purpose:The purpose of this study was to investigate the trend of social participation in the first week,the fourth month,the fifth month and the sixth month after the discharge of young and middle-aged patients with coronary artery bypass grafting.To explore the influencing factors of social participation of young and middle-aged patients after coronary artery bypass grafting,and to formulate targeted intervention measures,so as to provide reference for improving the quality of rehabilitation and reflecting self-worth of patients.Methods:1.The construction of conceptual framework of influencing factors of social participation level in young and middle-aged patients after coronary artery bypass grafting.On the basis of literature review,the conceptual framework was initially drawn up,and 12 experts were surveyed by two rounds of questionnaires with the method of expert consultation.2.The prospective longitudinal study design was adopted.From September 2018 to October 2019,a convenient sampling method was used.To recruit young and middleaged patients with coronary heart disease who met the inclusion criteria from the cardiac surgery ward of a three grade hospital in Shanghai.Before discharge,they were interviewed,explained the purpose of the study,obtained consent and theysigned the informed consent.This study included 215 young and middle-aged patients with coronary heart disease.The methods of telephone follow-up and special outpatient followup were used to investigate the time points: 1 week after discharge(T0),4 months after discharge(T1),5 months after discharge(T2)and 6 months after discharge(T3).Survey tools: general situation questionnaire,disease-related information questionnaire,comprehensive health literacy scale,social support scale,coronary heart disease selfmanagement scale,medical coping style scale and Participation and Autonomy Questionaire.They were used to measure the sociodemographic information,disease-related information,health literacy level,social support,self-management,coping style,and level of participation.Statistical analysis method: the database was established by epidata3.1 software,and the data was analyzed by spss22.0 and stata15.1 software.Firstly,we use ANOVA for repeated measurement to analyze the overall trend of social participation level,secondly,we use multiple linear regression to analyze the influencing factors of the social participation level at each time point,and finally,we use mixed linear model to analyze the prediction factors of the social participation level.Results:1.The effective rate of the two rounds of expert consultation questionnaire is 100%,the authority coefficient of experts is 0.9,and the coordination coefficient of experts is0.213-0.468.Finally,the influencing factors of social participation level of young and middle-aged patients after coronary artery bypass grafting were determined,including 5first-class indicators and 17 second-class indicators2 Follow up: 215 effective samples were included in this study.The scores of social participation level were T0(73.82 ± 8.73),T1(47.62 ± 6.85),T2(39.37 ± 8.23)and T3(24.58 ± 6.36).The subjects’ social participation level was not good.However,the scores of social participation level at each time point showed a downward trend,the difference was statistically significant(P<0.05).Because the scale of participation and independent influence was a reverse integral scale,it showed that the level of social participation of patients was significantly increased.3.The multiple regression results of social participation level of young and middleaged patients at all time points after coronary artery bypass grafting showed that gender and incision position of patients were the influencing factors of social participation level of study object T0,and women’s social participation level was better.The subjects’ ability of daily activities is the influencing factor of social participation level of T0 and T1,and the subjects with better ability of daily activities have better social participation level.The occupational status and pain score of the subjects are the influencing factors of social participation level T0,T1 and T2.The active subjects have better social participation level,and the less pain the subjects feel,the better social participation level.Avoidance coping is the influencing factor of social participation level of the subjects T1,T2 and T3.The more avoidance coping stylewereused,the better social participation level;criticism Health literacy is also the influencing factor of T1,T2 and T3 social participation level.The higher the critical health literacy is,the better the social participation level;the self-management level is the influencing factor of T2 and T3 social participation level,the higher the self-management level is,the better the social participation level.The multiple regression results of social participation level of young and middle-aged patients at different time points after coronary artery bypass grafting showed that the educational level,access to medical resources,comprehensive health literacy and social support of the subjects were the influencing factors of T0,T1,T2 and T3.The results of this study show that the higher the degree of support utilization is,the worse the level of social participation is.The influencing factors of social participation level were: gender(β =-5.638),education level(β =-6.194),employment status(β =-3.101),pain score(β = 7.227),location of the graft incision(β=-1.229),accessibility of community medical resources(β =-7.526),overall health literacy(β =-0.483),ability of daily activities(β =-0.497),social support(β =-0.454)And support utilization(β = 1.276).The influencing factors of social participation level(T1)were: education level(β =-5.747),employment situa-tion(β =-2.328),pain score(β = 6.381),critical health literacy(β =-0.691),avoidance response(β =-0.329),accessibility of community medical resources(β =-5.614),ove-rall health literacy(β =-0.306),ability of daily activities(β =-0.222),social support(β =-0.425)And support utilization(β = 2.127).The influencing factors of social partici-pation level(T2)were:education level(β =-3.038),employment situation(β =-2.163),pain score(β =4.958),critical health literacy(β =-0.476),avoidance response(β =-0.389),accessibility of community medical resources(β =-4.981),overall health literacy(β =-0.941),objective support(β =-0.427),social support(β =-0.314)and Support utilization(β = 2.144),coronary heart disease self-management ability(β =-0.413).The influencing factors of social participation level(T3)were: education level(β =-1.931),critical health literacy(β =-0.507),avoidance response(β =-0.357),community medical resource accessibility(β =-3.514),overall health literacy(β =-0.287),social support(β =-0.745)and support utilization(β = 1.402),coronary heart disease self-management ability(β =-0.466).4.Analysis results of latent variable growth model: analysis results of latent variable growth model: the intercept(P < 0.05)and slope(P < 0.05)of the model reflect the difference of individual initial and change trend of social participation level of young and middle-aged patients after CABG.The changing trend of social participation level is related to the level of initial test and the level of social participation at the previous time.Further using the K-means clustering analysis results,the main influencing factors of the high-level group and the low-level group are different.The main influencing factors of high level group were time factor(β =-14.007),pain(β =4.857),medical resource accessibility(β =-4.243);the main influencing factors of low level group were time factor(β =-10.840),pain(β = 6.796)and education level(β =-3.170)5.The results of mixed linear model showed that: the ability of daily activities was higher(β =-0.330,P < 0.05),the level of social support was better(β =-0.943,P <0.05),the level of avoidance coping was higher(β =-0.171,P < 0.05),the level of coronary heart disease self-management and its dimensions were higher: daily life management(β =-0.277,P < 0.05),disease management(β =-0.126,P < 0.05),emotional management(β =-0.560,P < 0.05),higher scores of critical literacy(β =-0.351,P < 0.05),better access to medical resources(β =-0.311,P < 0.05),only the median incision graft(β =-0.847,P < 0.05)、the working patients(β =-1.482,P < 0.05),played a role in promoting the social participation level of the study subjects;higher scores of pain(β = 1.803,P < 0.05)played a role in promoting the social participation level of the study subjects The level of social participation plays an obstacle role.Conclusion:1.The results of expert consultation in this study are reliable,and the conceptual framework of influencing factors of social participation level of young and middle-aged patients after coronary artery bypass grafting determined by expert consultation is reasonable,which can be regarded as the basis for the study of influencing factors of social participation level.2.The social participation level of young and middle-aged patients after coronary artery bypass grafting gradually increased with the discharge time,and the influencing factors of social participation level of patients in different stages of postoperative reha--bilitation were different.Nurses should pay attention to identify the factors that affect the patients’ social activities and adopt dynamic attitude observation and intervention.3.For young and middle-aged patients after coronary artery bypass grafting,pain and the ability of daily activities are important factors that affect their social reintegration.Nurses should pay attention to patients’ complaints of pain as early as possible,and actively provide patients with effective pain relief measures.At the same time,nurses should identify the factors that hinder the recovery of patients’ ability of daily activities as early as possible,and promote the improvement of patients’ ability of daily activities,which will play a positive role in promoting patients’ return to society.4.For young and middle-aged patients after coronary artery bypass grafting,good self-management ability began to play a positive role in guiding the level of social participation 5 months after discharge.It is suggested that clinical nursing staff should consider the improvement of patients’ self-management ability of coronary heart disease 5 months after discharge,and carry out effective education and follow-up intervention for patients.5.The influence of employment on the social participation level of young and middle-aged patients after coronary artery bypass grafting continued to 5 months(T2)after discharge.It is suggested that the clinical workers should pay attention to the social participation of Non-incumbency patients within 5 months after discharge and encourage patients to participate in social activities.6.The critical health literacy and avoidance response of young and middle-aged patients after coronary artery bypass grafting were positively correlated with the social participation level at 4 months(T1),5 months(T2)and 6 months(T3)after discharge.It is suggested that the clinical workers should push the knowledge of disease and life management to the patients through various channels as much as possible in this period,and at the same time,the patients should avoid paying too much attention to the disease,so as to shift their attention to the reconstruction of normal social and family life.7.The educational level,access to community medical resources,comprehensive health literacy and social support of young and middle-aged patients after coronary artery bypass grafting were positively related to the social participation level of patients at 1 week(T0),4 months(T1),5 months(T2)and 6 months(T3)after discharge.This suggests that clinical workers should continue to pay attention to the return to society of patients with low education and low health literacy,guide the main caregivers of patients to actively participate in the rehabilitation process of patients,and carry out long-term disease management and health information release through various telemedicine means such as telephone or Internet follow-up,so as to supplement the lack of access to community medical resources of patients To ensure the continuity of medical effect,promote the social return of patients and improve the rehabilitation quality of patients. |
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