Relationship Between Perceived Stress,self-compassion And Self-management Behavior In Patients With Coronary Artery Disease

ObjectiveThe aims of this study were to investigate the current status of perceived stress,self-compassion and self-management behavior in patients with coronary artery disease(CAD),clarify the association of perceived stress and self-compassion with self-management behavior,and analyze the factors that influence the self-management behavior in patients with CAD,to provide reference for improving the level of self-management.MethodsThis is an observational study and data were collected using questionnaires and semi-structured interviews respectively.1.Questionnaire method:213 patients with CAD who attended the outpatient clinic of the cardiology department of a tertiary care hospital from August 2021 to April 2022were selected for the study using convenience sampling method.Patients were surveyed using General Information Questionnaire,Perceived Stress Scale,Self-Compassion Scale and Coronary Artery Disease Self-Management Scale.The statistical analyses were performed with SPSS26.0 software.2.Semi-structure interview method:From April 2022 to July 2022,using a purposive sampling method,we selected 12 CAD patients with high perceived stress and low self-compassion who participated in the questionnaire and conducted one-to-one semi-structured interviews to them.Colaizzi’s phenomenological approach was used to analyze the interview data.Results1.Questionnaire results:(1)The current status of perceived stress,self-compassion and self-management levels in patients with CAD:The average scores of perceived stress,self-compassion,and self-management behavior questionnaire were(25.97±9.52),(98.14±17.40)and(77.80±12.72).(2)The correlation between perceived stress,self-compassion and self-management in patients with CAD:Pearson correlation analysis showed that perceived stress was negatively correlated with self-compassion(r=-0.834,P<0.01)and self-management behavior(r=-0.793,P<0.01),while self-compassion was positively correlated with self-management behavior(r=0.864,P<0.01).(3)The results of the univariate analysis of self-management behavior in patients with CAD:There were significant differences in the scores of CAD self-management behavior questionaire among CAD patients with different age,smoking,alcohol consumption,body mass index and low-density lipoprotein(P<0.05).(4)Results of multiple linear regression analysis of self-management behavior in patients with CAD:Self-compassion(β=0.611,P<0.01),perceived stress(β=-0.177,P<0.01),obesity(β=-0.109,P<0.05)were the influencing factors of self-management behavior in patients with CAD(adjusted R~2=0.775,F=82.28,P<0.01).(5)The analysis of the mediating effect of self-compassion between perceived stress and self-management behavior in patients with CAD:the total effect of perceived stress on self-management behavior was-1.062(P<0.01),the direct effect was-0.318(P<0.01),and the indirect effect was-0.744(95%CI:-0.896 to-0.589),with a mediating effect of 70.04%.2.Eight themes were identified after the data was collated and analysed:(1)patients’negative,fluke mentality;(2)patients’lack of awareness of the importance of disease self-management;(3)unsustainable self-management due to external pressures;(4)emotional stress leading to avoidance of self-management;(5)lack of support;(6)hassle of accessing medical care;(7)low self-efficacy;(8)limitations in accessing disease knowledge.Conclusion1.Patients with CAD had low level of self-management behavior,which was influenced by age,smoking,alcohol consumption,body mass index and low-density lipoprotein.Self-compassion,perceived stress,obesity accounted for 77.5%of the variation in self-management behavior.Perceived stress and self-compassion were important influences on self-management behavior in patients with CAD.Perceived stress negatively predicted self-compassion and self-management behavior,while self-compassion positively predicted self-management behavior.Self-compassion partially mediated the relationship between perceived stress and self-management behavior.2.The initiation and maintenance of self-management behavior in patients with CAD are influenced by multiple factors.Healthcare professionals should enhance patients’self-management behavior by changing their negative and erroneous perceptions,cultivating self-compassion,strengthening social support,providing safeguards for patients’self-management,paying attention to patients’psychological status,providing good psychological support and stress relief,and providing multi-faceted personalized health education to improve patients’health literacy and other multi-faceted measures.