Kim So-Young, Lee Yun Mi, Son Youn-Jung
Department of Nursing, Pusan National University Yangsan Hospital, Busan, South Korea.
College of Nursing, Institute of Health Science Research, Inje University, Busan, South Korea.
J Adv Nurs. 2023 Jan;79(1):170-181. doi: 10.1111/jan.15440. Epub 2022 Sep 9.
To investigate the factors associated with self-management after hybrid revascularization in patients with lower extremity peripheral artery disease using a structural equation modelling approach.
A cross-sectional study was adopted.
A total of 221 patients who underwent hybrid revascularization for peripheral artery disease of the lower limbs were included from outpatient clinics at a 1200-bed tertiary care hospital in Korea. Data were collected using a self-reported questionnaire between December 1, 2019, and August 31, 2020. Structural equation modelling was applied to test the hypothetical model.
The item mean score of participants' self-management was 6.28 (standard deviation, 0.83) out of 8. The structural equation modelling had a good fit index. Autonomy support from healthcare providers was directly associated with self-management (β = 0.20, p = 0.041). Illness perception directly (β = -0.33, p = 0.031) and indirectly (β = -0.19, p = 0.032) influenced self-management through competence and relatedness in patients with peripheral artery disease. The construct of autonomy support from healthcare providers, illness perception, competence and relatedness accounted for 49% of the variance in self-management. The Sobel test confirmed the statistically significant mediating effects of competence (z = -4.52, p < 0.001) and relatedness (z = -2.12, p < 0.001) on the relationship between illness perception and self-management.
Our findings revealed that autonomy support from healthcare providers and patients' illness perception directly influenced patients' self-management. Additionally, patients' illness perception can indirectly influence self-management through their perceived competence and relatedness.
Healthcare providers' autonomy support to patients may promote self-care behaviours, leading to greater autonomous motivation. Assessment of patients' illness perception before patient education is vital to designing effective self-management strategies which can improve patients' perceived competency and meaningful relatedness with healthcare providers.
采用结构方程模型方法，研究下肢外周动脉疾病患者混合血运重建术后自我管理的相关因素。
采用横断面研究。
从韩国一家拥有1200张床位的三级医院门诊纳入221例行下肢外周动脉疾病混合血运重建术的患者。于2019年12月1日至2020年8月31日期间使用自填式问卷收集数据。应用结构方程模型检验假设模型。
参与者自我管理的项目平均得分为6.28（标准差为0.83）（满分8分）。结构方程模型具有良好的拟合指数。医疗服务提供者的自主支持与自我管理直接相关（β = 0.20，p = 0.041）。疾病认知通过外周动脉疾病患者的能力感和关系感直接（β = -0.33，p = 0.031）和间接（β = -0.19，p = 0.032）影响自我管理。医疗服务提供者的自主支持、疾病认知、能力感和关系感这几个结构因素解释了自我管理中49%的变异。索贝尔检验证实了能力感（z = -4.52，p < 0.001）和关系感（z = -2.12，p < 0.001）在疾病认知与自我管理关系中的统计学显著中介作用。
我们的研究结果表明，医疗服务提供者的自主支持和患者的疾病认知直接影响患者的自我管理。此外，患者的疾病认知可通过其感知的能力感和关系感间接影响自我管理。
医疗服务提供者对患者的自主支持可能促进自我护理行为，从而产生更强的自主动机。在患者教育前评估患者的疾病认知对于设计有效的自我管理策略至关重要，这些策略可提高患者的感知能力以及与医疗服务提供者的有意义的关系。
