Construction And Application Of The Self-management Ability Scale For Patients With Rheumatoid Arthritis

Purposes:1.To develop the scale of self-management ability of patients with rheumatoid arthritis(RA),so as to provide a more suitable,accurate and comprehensive survey tool for clinical evaluation of self-management ability of patients with RA.2.To analyze the status quo of self-management of patients with RA,and to develop targeted intervention programs for clinical medical staff,so as to provide basis for effectively improving self-management ability of patients with RA.Methods:1.Preliminary determination of scale item pool: Based on the concept and theory of self-management,this study clarified the risk factors of the disease and the content of patients’ self-management by reviewing relevant literature,and formed a formal interview outline through discussion of the research group.13 patients with RA were selected for semi-structured in-depth interviews by purposive sampling to understand the experience and needs related to patients’ self-management.Contents and themes were summarized by Colaizzi phenomenological analysis to form the dimensions and item pool of the scale.2.Expert consultation: 15 experts in the field of rheumatoid immunity in and outside the province were confirmed to carry out two rounds of expert consultation.The items of the scale were filtrated in the light of mean significance score and coefficient of variation,and were added,deleted and modified based on experts’ advice.3.Reliability and validity test: The preliminary scale was used to conduct a questionnaire survey on 180 patients with RA who met inclusion and exclusion criteria in a tertiary hospital in Nanchang.According to item analysis and reliability and validity results,the scale items were revised to form the final self-management ability scale.4.Status survey: Convenience sampling was used to select 182 RA patients who met inclusion and exclusion criteria in rheumatology department of a tertiary hospital in Nanchang.The survey tools included general data questionnaire and RA patients’ self-management ability scale.SPSS 25.0 was used for data entry and analysis to understand the status quo of RA patients’ self-management ability.Results:1.Determination of dimensions and item pool of scale: After literature review,qualitative interview and discussion of the research group,the self-management ability scale initially contains 4 dimensions with a total of 33 items,including 3items of information management,21 items of disease management,6 items of daily life management and 3 items of psychological management.2.Results of expert consultation: The questionnaire recovery rate of the two rounds of expert consultation was 100%,and the expert opinion submission rate was60% and 13.33%,respectively,indicating that experts were enthusiastic;The authority coefficient of experts was 0.89 and 0.91,respectively.Kendall coefficient was 0.130～0.371(P<0.05),indicating that experts’ coordination degree was good.After two rounds of expert consultation,the self-management ability scale consisted of 4 dimensions,8 secondary indicators and 32 items by splitting 1 secondary indicator into 2 secondary indicators,deleting 4 items,adding 3 items,modifying 6items,and combining 2 items into 1 item.3.Reliability and validity analysis results: Item analysis results showed that all items in the scale had good identification and homogeneity.The results of reliability and validity analysis showed that the total Cronbach’s α coefficient of the scale was 0.936,and the split reliability was 0.905 and the retest reliability was 0.925.Four common factors were extracted by exploratory factor analysis,with a cumulative contribution rate of 67.36% and I-CVI ranging from 0.833 to 1.000.S-CVI was 0.948,and the final self-management ability scale for patients with RA contained four dimensions with a total of 32 items,including 3 items of information management,18 items of disease management,6 items of daily life management and 5 items of psychological management.4.Status survey results: Among the 182 questionnaire,176 valid questionnaires were collected.The average score of RA patients’ self-management ability was(2.98±0.45),with the highest score being disease management(3.05±0.49)and the lowest score being psychological management(2.82±0.57).Conclusions:The self-management ability scale of patients with RA developed in this study has good reliability and validity,providing a scientific measurement tool for the assessment of self-management ability of patients with RA.At present,RA patients have insufficient awareness rate of disease knowledge,lack of access to information,and poor control of emotion and risk factors,and their self-management ability is at a medium and low level.Therefore,clinical medical personnel should strengthen health education of disease knowledge of RA patients,expand channels for patients to obtain information,and improve their self-management ability.