Factors associated with self‐management after hybrid revascularization in patients with peripheral artery disease: A structural equations model

• Published in: Journal of advanced nursing Vol. 79; no. 1; pp. 170 - 181
• Main Authors: Kim, So‐Young, Lee, Yun Mi, Son, Youn‐Jung
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-01-2023
• Subjects: Autonomy; Competence; Cross-Sectional Studies; Disease management; Health behavior; Health education; Humans; hybrid revascularization; Illnesses; Limbs; lower extremity; Lower limbs; Models, Theoretical; Motivation; nursing; Outpatient clinics; Patient education; patients; Perceptions; Peripheral arterial disease; Peripheral Arterial Disease - surgery; Relatedness; Revascularization; Self care; Self-Management; structural equation model; Structural equation modeling; Surveys and Questionnaires; Vein & artery diseases; hybrid revascularization; patients; nursing; peripheral arterial disease; self-management; lower extremity; structural equation model
• ISSN: 0309-2402; 1365-2648
• DOI: 10.1111/jan.15440

Aim
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.
Design
A cross‐sectional study was adopted.
Methods
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.
Results
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.
Conclusion
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.
Impact
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.