A Study On The Current Status Of Self-management Behavior And Factors Influencing It In Patients With Atrial Fibrillation Based On The IMB Model

Objective1.Translate the Confidence in Atrial Fibrillation Management Scale(CALM)into Chinese to provide an independent variable survey tool for analyzing factors influencing self-management behavior in patients with atrial fibrillation.2.The Information-Motivation-Behavior skills model(IMB)was used as a theoretical framework to investigate the current status of self-management behaviors and their influencing factors in patients with atrial fibrillation,constructed a structural equation model of the influencing factors of self-management behaviors in patients with atrial fibrillation,and explored the pathways of patients’knowledge of atrial fibrillation,social support,health beliefs and self-management efficacy on their self-management behaviors,in order to provide scientific theoretical guidance for clinical development of intervention programs.Methods1.Translation of the Confidence in Atrial Fibrillation Management Scale:First,we obtained written permission from the original authors and publishers of the scale,and then the English version of the scale was translated according to the Brislin translation model,with cross-cultural adaptation and pre-survey,and finally 310 patients with atrial fibrillation were surveyed using a convenience sampling method to test the reliability of the scale.2.Status investigation:From September 2021 to October 2022,350 patients with atrial fibrillation who attended the outpatient clinic and cardiology ward of an atrial fibrillation center in a tertiary care hospital in Qingdao were conveniently selected as the survey population.The survey instruments included:the General Questionnaire,the Atrial Fibrillation Cognitive Ability Questionnaire,the Perceived Social Support Scale,the Chronic Disease Health Beliefs Scale,the Confidence in Atrial Fibrillation Management Scale,and the Atrial Fibrillation Self-Management Ability Scale.The data were entered and analyzed using Excel 2010 and SPSS 26.0 software,respectively,and descriptive analyses were performed on the demographic and sociological information,disease-related information,knowledge level of atrial fibrillation,social support status,health belief status,self-management efficacy status and self-management level of the respondents;comparison of differences in self-management behaviors between patients with atrial fibrillation by demographic characteristics using either an independent samples T-test or a One-way ANOVA.We used Pearson or Spearman correlation method to analyze the two-by-two correlation between patients’knowledge of AF,social support,health beliefs and self-management efficacy and patients’self-management behavior;we used multilinear regression to examine variables influencing self-management behaviors in patients with atrial fibrillation.Using the IMB model as the theoretical framework,we used AMOS 26.0 software to construct a structure equation model of variables influencing self-management behavior in patients with atrial fibrillation,and validated and analyzed the paths of the variables in the model on patients’self-management behaviors.Results1.The Chinese version of the Confidence in Atrial Fibrillation Management Scale contains 4 dimensions:external support utilization(5 entries),disease change perception(4 entries),symptom self-remission(4 entries),and safety prediction(4 entries),with a total of 17 entries and a cumulative variance contribution rate of 82.205%.The scale’s Coefficient of the Cronbach’s alpha was 0.923,the retest reliability was 0.921,the fold-half reliability was 0.967,and the content validity was 0.914.2.The total score of self-management behavior of AF patients was(76.73±17.54),which was at a moderate level;the results of univariate analysis,association analysis and combined with multi-linear regression analysis,the results showed that the patients’years of age,educational level,family per capita monthly income,EHRA symptom classification,duration of AF,number of comorbidities,knowledge of AF,social support,health beliefs,and self-management efficacy were patients’self-management behavior(R~2=0.813,P<0.01).Structural equation modeling showed that the model of factors influencing self-management behavior in patients with AF based on the IMB model explained 95.1%of the total variation in patients’self-management behavior,and atrial fibrillation knowledge,social support,health beliefs,and self-management efficacy could directly influence the self-management behavior of patients with AF.Meanwhile,atrial fibrillation knowledge,social support,and health beliefs could also indirectly influence the self-management behaviors of patients with atrial fibrillation through self-management efficacy.Conclusions1.The Chinese version of the Confidence in Atrial Fibrillation Management Scale has good reliability and validity,and can be used as a country-specific tool to measure the self-management efficacy of patients with atrial fibrillation in China.2.The self-management behavior of AF patients was at a moderate level and still needs to be improved.Among them,years of age,educational level,family per capita monthly income,EHRA symptom classification,duration of AF,number of comorbidities,knowledge of AF,social support,health beliefs and self-management efficacy of AF patients were the influencing factors of patients’self-management behaviors.The structural equation model constructed based on the IMB model can better explain the self-management behaviors of AF patients and can provide a reference for clinical formulation of interventions.Atrial fibrillation knowledge,social support,health beliefs and self-management efficacy can directly influence patients’self-management behaviors,while atrial fibrillation knowledge,social support and health beliefs can also indirectly influence patients’self-management behaviors through the mediator of self-management efficacy.