There is limited research exploring the behavioral intentions, beliefs, and application of theoretical models in relation to self-care in patients with atrial fibrillation (AF).
Objective:
This study aimed to identify the factors that influence self-care behavior in patients with AF.
Methods:
The study used an integrated behavioral model and collected data from 216 patients diagnosed with AF. Data were analyzed using SPSS 24.0 and AMOS/WIN 24.0 to verify the fit of the hypothesis model, confirm factor analysis, and the validity of the hypothesis itself.
Results:
Self-care behavioral intention (β = 0.433, p < .001) and habit (β = 0.395, p = .005) had a significant direct effect, while instrumental attitude (β = 0.077, p = .045), injunctive norm (β = 0.084, p = .037), and self-efficacy (β = 0.249, p = .011) had a significant indirect effect on self-care behavior, explaining 64.4% of the variance.
Conclusion:
The final model validated the factors that impact self-care behavior in patients with AF, highlighting the importance of fostering positive recognition of instrumental attitude, bolstering social influence and self-efficacy through significant individuals to improve self-care behavior. It is recommended to create an intervention program that encourages intentions and motivations for self-care behavior and incorporates tactics to make self-care behavior a habit. The study’s path diagram can serve as a conceptual framework for designing strategies to enhance self-care behavior in patients with AF.
HindricksGPotparaTDagresN, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS) The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42(5):373-498. doi:10.1093/eurheartj/ehaa612
2.
BenjaminEJMuntnerPAlonsoA, et al. Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation. 2019;139(10):e56-e528. doi:10.112061/CIR.0000000000000659
3.
HendriksJMHeidbüchelH. The management of atrial fibrillation: an integrated team approach–insights of the 2016 European Society of Cardiology guidelines for the management of atrial fibrillation for nurses and allied health professionals. Eur J Cardiovasc Nurs. 2019;18(2):88-95. doi:10.1177/1474515118804480
4.
SrinonprasertVRatanasumawongKThongsriT, et al. Factors associated with low health-related quality of life among younger and older Thai patients with non-valvular atrial fibrillation. Qual Life Res. 2019;28(8):2091-2098. doi:10.1007/s11136-019-02171-3
5.
AkiyamaHHasegawaY. Awareness of atrial fibrillation in Japan: a large-scale, nationwide Internet survey of 50 000 Japanese adults. Geriatr Gerontol Int. 2018;18(7):1100-1107. doi:10.1111/ggi.13318
6.
KonieczyńskaMSobierajEBrykAH, et al. Differences in knowledge among patients with atrial fibrillation receiving non-vitamin K antagonist oral anticoagulants and vitamin K antagonists. Kardiol Pol. 2018;76(7):1089-1096. doi:10.5603/KP.a2018.0069
7.
ParkHKimJLeeH. Impact of an educational program on knowledge and self-care behavior among patients with atrial fibrillation. J Atrial Fibrillation. 2018;10(2):1711. doi:10.4022/jafib.1711
8.
JanuaryCTWannLSCalkinsH, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in collaboration with the Society of Thoracic Surgeons. Circulation. 2019;140(2):e125-e151. doi:10.1161/CIR.0000000000000665
9.
DingYLiFFanZ, et al. Factors influencing self-management behavior during the “blanking period” in patients with atrial fibrillation: a cross-sectional study based on the information-motivation-behavioral skills model. Heart Lung. 2023;58:62-68. doi:10.1016/j.hrtlng.2022.11.006
10.
KimMYLeeSHParkHJ. Self-care in patients with atrial fibrillation based on the theory of unpleasant symptoms. J Korean Clin Nurs Res. 2022;28(1):23-33. doi:10.22650/JKCNR.2022.28.1.23
11.
RiegelBMoserDKBuckHG, et al. Self-care for the prevention and management of cardiovascular disease and stroke: a scientific statement for healthcare professionals from the American Heart Association. J Am Heart Assoc. 2017;6(9):1-27. doi:10.1161/JAHA.117.006997
12.
LiPWCYuDSFYanBBY. A nurse-coordinated integrated care model to support decision-making and self-care in patients with atrial fibrillation: a study protocol. J Adv Nurs. 2019;75(12):3749-3757. doi:10.1111/jan.14164
13.
SonYJLeeKKimBH. Gender differences in the association between frailty, cognitive impairment, and self-care behaviors among older adults with atrial fibrillation. Int J Environ Res Public Health. 2019;16(13):2387. doi:10.3390/ijerph16132387
14.
AronisKNEdgarBLinWMartinsMAPPaasche-OrlowMKMagnaniJW. Health literacy and atrial fibrillation: relevance and future directions for patient-centered care. Eur Cardiol. 2017;12(1):52-57. doi:10.1093/eurjhf/hfp167
15.
MontañoDEKasprzykD. Theory of reasoned action, theory of planned behavior, and the integrated behavioral model. In: GlanzKRimerBKViswanathK, eds. Health Behavior and Health Education: Theory, Research and Practice. 4th ed.San Francisco, CA: Jossey-Bass; 2008:67-96.
16.
MontañoDEKasprzykD. Theory of reasoned action, theory of planned behavior, and the integrated behavioral model. In: GlanzKRimerBKViswanathK, eds. Health Behavior and Health Education: Theory, Research and Practice. 5th ed.San Francisco, CA: Jossey-Bass; 2015:95-123.
17.
BurtonALAbbottMJ. Processes and pathways to binge eating: development of an integrated cognitive and behavioural model of binge eating. J Eat Disord. 2019;7:18-19. doi:10.1186/s40337-019-0248-0
18.
GhaffariMRadTNMohammadiSRakhshanderouS. Effect of an intervention on the breast cancer screening behavior in women: application of integrated behavioral model. Int J Prev Med. 2018;9:99-99. doi:10.4103/ijpvm.IJPVM_147_17
19.
ParkJToleaMBesserLGalvinJ. Intention to be screened for Alzheimer’s disease in nondemented older adults: integrated behavioral model and self-efficacy as mediation effect. J Hum Behav Soc Environ. 2020;30(6):778-796. doi:10.1080/10911359.2020.1752349
20.
HoMHRita ChangHCLinYK, et al. Application of the Integrated Behavioral Model to oral self-care behavior of community-dwelling middle-aged and older people in Taiwan. Public Health Nurs. 2019;36(5):726-734. doi:10.1111/phn.12646
21.
MartynovaEWestSGLiuY. Review of principles and practice of structural equation modeling. Struct Equ Modeling. 2017;25:325-329. doi:10.1080/10705511.2017.1401932
22.
DestegheLEngelhardLRaymaekersZ, et al. Knowledge gaps in patients with atrial fibrillation revealed by a new validated knowledge questionnaire. Int J Cardiol. 2016;223:906-914. doi:10.1016/j.ijcard.2016.08.303
MinJChungCJungSSParkHKLeeSSLeeKM. Understanding illness perception in pulmonary tuberculosis patients: one step towards patient-centered care. PLoS ONE. 2019;14(6):e0218106. doi:10.1371/journal.pone.0218106
25.
PenchanskyRThomasJW. The concept of access: definition and relationship to consumer satisfaction. Med Care. 1981;19(2):127-140. doi:10.1097/00005650-198102000-00001
26.
VerplankenBOrbellS. Reflections on past behavior: a self-report index of habit strength. J Appl Soc Psychol. 2003;33(6):1313-1330. doi:10.1111/j.1559-1816.2003.tb01951.x
27.
JeonHRParkJS. Development and application of a self-management program based on prothrombin INR monitoring for patients with cardiac valve replacement. J Korean Acad Nurs. 2015;45(4):554-564. doi:10.4040/jkan.2015.45.4.554
28.
OhYHHwangSY. Individualized education focusing on self-management improved the knowledge and self-management behavior of elderly people with atrial fibrillation: a randomized controlled trial. Int J Nurs Pract. 2021;27:e12902. doi:10.1111/ijn.12902
29.
YuJP. The Concept and Understanding of Structural Equation Modeling. Seoul, South Korea: Hannare Publishing; 2012.
30.
YapaHEPurtellLChambersSBonnerA. Factors influencing health-related quality of life in people with chronic kidney disease: a structural equation modelling approach. J Clin Nurs. 2023;32(13-14):3445-3455. doi:10.1111/jocn.16422
31.
LeeBKSohnYKLeeSL, et al. An efficacy of social cognitive theory to predict health behavior a meta-analysis on the health belief model studies in Korea. J Public Relat. 2014;18(2):163-206. doi:10.15814/jpr.2014.18.2.163
32.
KarimyMKoohestaniHRArabanM. The association between attitude, self-efficacy, and social support and adherence to diabetes self-care behavior. Diabetol Metab Syndr. 2018;10:86-86. doi:10.1186/s13098-018-0386-6
33.
GuoYLaneDAWangL, et al. Mobile health technology to improve care for patients with atrial fibrillation. J Am Coll Cardiol. 2020;75(13):1523-1534. doi:10.1016/j.jacc.2020.01.052
34.
SeoJYChaeSMLeeJKimHKimSH. Self-efficacy and quality of life in patients with atrial fibrillation: a cross-sectional study. J Cardiovasc Nurs. 2020;35(6):E55-E62. doi:10.1097/JCN.0000000000000713
35.
BanduraA. Self-Efficacy: The Exercise of Control. New York: Macmillan; 1997.
36.
SonYJBaekK. The analysis of research topics and their instruments of atrial fibrillation patients in Korea: based on domestic nursing research papers (2000-2017). Asia-Pac J Multimedia Serv Convergent Art Humanit Sociol. 2017;7:669-682. doi:10.14257/AJMAHS.2017.10.20
37.
HuangY-YHuangT-TWuS-FVLiaoY-C. Factors influencing self-care behaviour intention and behaviour in patients with heart failure: a structural equation modelling analysis. J Adv Nurs. 2021;77(5):2208-2217. doi:10.1111/jan.14781
38.
RakhshanMNajafiHValizadehGA. Lifestyle of patients with atrial fibrillation following self-management interventions: a randomized clinical trial. J Caring Sci. 2019;8(2):83-88. doi:10.15171/jcs.2019.012
39.
ChiuYWYangYHHungSYHuSC. Atrial fibrillation knowledge and self-care behavior among older adults. J Geriatr Cardiol. 2019;16(1):20-26. doi:10.11909/j.issn.1671-5411.2019.01.002
40.
RakhshanMMirshekariFDehghanradF. The relationship between illness perception and self-care behaviors among hemodialysis patients. Iran J Psychiatry. 2020;15(2):150-158. doi:10.18502/ijps.v15i2.2687
41.
KugbeyNAsanteKOAdulaiK. Illness perception, diabetes knowledge and self-care practices among type-2 diabetes patients: a cross-sectional study. BMC Res Notes. 2017;10(1):1-7. doi:10.1186/s13104-017-2707-5
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
