Development Of Self-Management Scale For Patients With Atrial Fibrillation Taking Warfarin

Objective: To develop the self-management scale for patients with atrial fibrillation taking warfarin,and to evaluate its reliability and validity.Methods:(1)The theoretical framework of the scale was based on the self-care of Orem’s theory.(2)The pretesting scale was formed through the following methods: concept definition,reviewing of the relevant literatures,referring to evidence-based guideline of atrial fibrillation,semi-structural interviewing of patients,and experts consultating.Then the initial scale with three factors and 28 items was formed after the pre-survey.(3)A total of 149 patients with atrial fibrillation were investigated in 4 hospitals in Jiangsu,Zhejiang and Shanghai using the initial scale.The data was input into SPSS18.0 software after checking.We used item analysis method to screen the items and exploring factor analysis to form the factors.The reliability analysis included homogeneity reliability,split-half reliability and test-retest reliability.The validity analysis was evaluated by surface validity,content validity and construct validity.Results:(1)Through concept definition,reviewing reference literatures and evidence-based guidelines,combined with interviewing patients,the scale with three dimensions and 26 items was formed.(2)Two items were added after two rounds of expert consultation.The initial scale included 3 factors and 28 items.(3)Items and factors analysis results: 28 items were analyzed by item analysis and exploratory factor analysis.A total of 10 items were deleted.The formal scale include5 dimensions and 18 items: Monitoring of AF’s symptoms and complications(6 items),management of warfarin-specific problems(4 items),management of unhealthy hobby(3 items),Bleeding monitoring(3items),management of unhealthy lifestyle(2 items).(4)Reliability test:(1)The Cronbach’s α coefficient of total scale is 0.845,and each dimension ranges from 0.453~0.886.(2)The parity binary coefficient of the total scale is 0.917,and each dimension ranges from 0.453~0.901.(3)The test-retest reliability of the whole scale is 0.829,each dimension ranges from 0.570~0.846.(5)Validity test:(1)The surface validity: According to the theory and method of scale development,and our knowledge reserves,the scale showed the good surface validity.(2)Content validity: The content validity index(CVI)of total scale was 0.988,and each item ranged from 0.833~1.0.(3)Construct validity: There were five factors extracted by exploratory factor analysis,which explained 64.111% variances,and met the requirement of greater than 60%.The load coefficient for all items were greater than 0.45.(4)Known Group Validity: The scores of the illiteracy group,primary school group,junior or high school group and the junior college or above junior college group were46.14±9.01,53.91±9.04,54.04±9.60 and55.67±7.46,the coefficients were statistically significant(P<0.001).The final scale model was consistent with the theory of construction,and the structure validity was reliable.Conclusion: The scale of self-management for AF patients treated with warfarin demonstrated the good reliability and validity and can be used for the evaluation of the ability of self-management for AF patients,and provides reference for in-depth research.