Development And Preliminary Application Of Self-Management Evaluation Scale For Patients With Aortic Dissection After Surgery

Objective1.Through qualitative interviews,understand the status of postoperative self-management of patients with aortic dissection(AD),and provide a reference for the compilation of postoperative self-management evaluation scales for AD patients.2.Compile the postoperative self-management evaluation scale for AD patients and test its reliability and validity to provide a tool for evaluating the postoperative self-management level of AD patients.3.Understand the self-management level of patients with AD and explore its influencing factors.Method1.Using the phenomenological method in the qualitative research,using sampling by purpose,a semi-structured interview was conducted with 18 AD postoperative patients in the cardiac surgery department of a tertiary A hospital in Fujian Province from March to May 2020,and Colaizzi was used at the same time.The seven-step analysis method analyzes the data,extracts themes,and provides reference for the construction of the entry pool of the self-management evaluation scale for AD patients.2.On the basis of qualitative research results,consulting related literature on self-management,referring to existing self-management scales and self-efficacy theories,combined with the characteristics of AD,preliminary drafting of alternatives for postoperative self-management evaluation scales for AD patients the item pool,after amending the items through Delphi expert correspondence,formed the initial version of the"Aortic Dissection Postoperative Self-Management Evaluation Scale".3.Using the convenience sampling method,201 AD postoperative patients discharged from a tertiary A hospital in Fujian Province from June 2017 to June 2020were selected as the survey subjects in August 2020,and the initial version of the scale was used for the return survey.Screening the scale items and exploratory factor analysis,forming the official version of the"Aortic Dissection Postoperative Self-Management Evaluation Scale".4.Using the convenience sampling method,select 214 postoperative AD patients discharged from a tertiary A hospital in Fujian Province from June 2017 to June 2020as the survey subjects in September 2020,and use the official version of the scale to conduct a return survey.To test the reliability and validity of the scale,analyze the postoperative self-management level of AD patients,and initially explore the factors that affect the postoperative self-management level of AD patients.Results1.A total of 18 postoperative AD patients were interviewed,and 4 subjects were extracted for self-management problems after AD patients:(1)Lack of disease-related knowledge;(2)Insufficient disease management behavior;(3)Lack of communication between doctors and nurses;(4)Bad mental state.2.A scale item pool with 6 dimensions and 40 items was initially constructed.After three rounds of Delphi expert correspondence,an initial scale with 6 dimensions and 39 items was formed.After item screening and exploratory factor analysis,4 items were deleted,and the official version of the"Aortic Dissection Postoperative Self-Management Evaluation Scale"was formed,which contained 35 items.3.Reliability and validity test results of the scale(1)Reliability:The Cronbach’sαcoefficient of the total scale is 0.908,and the Cronbach’sαcoefficient of each dimension is between 0.620 and 0.931;the half-reliability:the half-reliability of the total table is 0.790;the half-reliability of each dimension is 0.493～0.897;Test-retest reliability:The test-retest reliability of the total scale is 0.471,and the test-retest reliability of each dimension is 0.060-0.557.(2)Validity:content validity:the scale content validity index of the scale is 0.963,and the item contet validity Index is 0.769-0.923;structure validity:(1)Internal of the scale Consistency:The correlation coefficient between the dimensions of the scale is between 0.178 and 0.468,the correlation coefficient between each dimension and the total scale is between 0.552 and 0.756,and the correlation coefficient between each item and the dimension to which it belongs is 0.451-0.912,all are statistically significant(P<0.01);(2)Exploratory factor analysis:using exploratory factor analysis,combined with lithograph analysis,and finally extracting 6 common factors,the cumulative contribution rate of variance is 66.303%,The factor loads of each item are all>0.4;(3)The confirmatory factor analysis shows:except for IFI,TLI,CFI>0.85,which is slightly lower than 0.90,X~2/df<3,RMSEA<0.08,PGFI,PNFI>0.50 are in line with the model fitting Requirements,indicating that the model fit is acceptable.4.Results of preliminary application of the scale(1)The score value of postoperative self-management of AD patients is between64 and 171 points,with a total average score of 119.29±17.55,which is at a medium level.(2)One-way analysis of variance showed that the scores of AD patients’age,operation time,education level,preoperative drinking status,postoperative work status,and postoperative exercise status were statistically significant(P<0.05).(3)The results of multiple linear regression analysis showed that operation time,education level,postoperative working status and postoperative exercise status were four influencing factors into the regression equation.The regression equation was statistically significant(F=22.441,P<0.001),and the determination coefficient R2=0.436,indicating that these four factors could explain 43.6%of the total variation in the variables.Conclusion:1.This study has completed the compilation of the postoperative self-management evaluation scale for AD patients,which has good reliability and validity and can be used as a tool to evaluate the postoperative self-management level of AD patients.2.At present,postoperative self-management of AD patients is at a low-moderate level.Factors such as operation time,education level,postoperative work status and postoperative exercise status can affect the self-management level of patients.