The Effects Of Intervention Programs For The Compliance Of Anticoagulant Therapy In Patients With Non-valvular Atrial Fibrillation Based On The Theory Of Planned Behavior And Nudge

ObjectiveTo construct intervention programs for the compliance of anticoagulant therapy in patients with non-valvular atrial fibrillation based on the theory of planned behavior and nudge,aimed to explore the effects of intervention programs in patients with non-valvular atrial fibrillation,and to provide a reference for the clinical nurses.Methods1.Construction of intervention programs for the compliance of anticoagulant therapy in patients with non-valvular atrial fibrillation: a systematic literature retrieval was performed.High-quality literature studies were screened out and the best evidences were summarized.High-quality literature studies and the best evidences were used as the evidence-based basis for the intervention programs.After research group discussion,the first draft of the intervention programs for the compliance of anticoagulant therapy in patients with non-valvular atrial fibrillation based on the theory of planned behavior and nudge was constructed.Two rounds of delphi methodology were conducted.15 experts were selected for the Delphi method in this study,and research group revised the first draft of intervention programs based on expert opinions.Then a preliminary experiment was conducted among 10 patients in order to revise the intervention programs.Finally,the final draft of intervention programs of the compliance of anticoagulant therapy for patients with non-valvular atrial fibrillation was finalized.2.Application of intervention programs for the compliance of anticoagulant therapy in patients with non-valvular atrial fibrillation: convenience sampling method was adopted,and a total of 148 patients with non-valvular atrial fibrillation hospitalized in the Cardiology Department of a tertiary class A hospital in Qingdao from August 2021 and March 2022 were selected as the research objects,with 74 patients in each group.Patients in the intervention group were received the intervention programs based on the theory of planned behavior and nudge.Patients in the control group were received health education of routine nursing.The data were collected respectively at enrollment,1 month,3 months,6months after intervention to compare with two groups of medication adherence,the variables of medication adherence of the theory of planned behavior,the quality of life.Data analysis was carried out using SPSS software version 26.0.Combined the results of the statistical analyses,researchers evaluate the effects of intervention programs.Results1.Construction of intervention programs for the compliance of anticoagulant therapy in patients with non-valvular atrial fibrillation: the response rate for the two rounds of Delphi expert consultation are both 100%,and the expert authority coefficients of the first rounds of Delphi was 0.802 and second rounds was 0.838,and the Kendall coordination coefficient of the first rounds of Delphi was 0.581 and second rounds was 0.666,and P<0.05.According to the preliminary experiment,research group adjusted the program content and finally formed the final version of intervention program.2.Application of intervention programs for the compliance of anticoagulant therapy in patients with non-valvular atrial fibrillation: A total of 148 patients who met the inclusion criteria were collected,of which 2 were lost to follow-up in the intervention group,with a loss rate of 2.7%,and 16 were lost to follow-up in the control group,with a loss rate of 21.6%.Ultimately,130 patients(72 in the intervention group and 58 in the control group)completed the research.(1)Medication adherence:the medication adherence scores in the intervention group were higher than that in the control group at three and six months after intervention(P<0.05).(2)The variables of medication adherence of the theory of planned behavior: the intention,attitude and subjective norm scale scores in the intervention group were higher than that in the control group at one month,three months and six months after intervention(P<0.05).The perceived behavioral control scale scores in the intervention group were higher than that in the control group at three months and six months after intervention(P<0.05).(3)The quality of life: there were no statistically differences in the quality-of-life scale scores between the intervention group and control group at one month,three months and six months after the intervention(P<0.05).Conclusions1.The intervention programs for the compliance of anticoagulant therapy in patients with non-valvular atrial fibrillation based on the theory of planned behavior and nudge are scientific and feasible.2.The intervention programs based on the theory of planned behavior and nudge strategy could improve the attitude,intention and subjective norm,the perceived behavioral control and the anticoagulant therapy adherence in patients with non-valvular atrial fibrillation.