| Objective1 .To develop self-management scale (SMS) for Chinese patients with chronic obstructive pulmonary disease (COPD) and analyze the psychometric properties of this scale.2. To discuss the influential factors of self-management for patients with COPD.Methods1. The SMS was developed based on the Social-Cognitive Theory, Self-Efficacy Theory, Self-Determination Theory and the definitions of symptom management, daily life management, emotion management, information management and self-efficacy. Related literature had been extensively reviewed, related instruments developed domestic and abroad already had been consulted, and suggestions from experts had been considered before the initial questionnaire formed. Exploratory factor analysis (EFA) was used to develop the intra-structure of the scale and confirmatory factor analysis (CFA) was used to evaluate that. The reliability analysis included the test-retest reliability, Cronbach'sαcoefficient, split-half reliability, and the generalizability analysis. The validity analysis included content validity, construct validity and criterion-related validity.2. The multistage stratified cluster sampling method was used to obtain the sample in Hunan Province, and the participants of 9 hospitals in 3 cities were recruited to participate in this investigation. Self-rating depression scale(SDS), social support rating scale(SSRS), quality of life scale(QOLS) for patients with COPD and self-management scale(SMS) for patients with COPD were used together to collect the data, and multinomial logistic regression analysis, correlation analysis, path analysis were employed.Results1. Item reduction and scale construction were carried out using principal component and the final scale comprised 5 dimensions grouping 51 items.2.The results of reliability were as follows: (1) the range of test-retest reliability coefficient were 0.72 to 0.87, the test-retest reliability coefficient of the total score was 0.87; (2)The range of split-half reliability coefficient (corrected by Spearman-Brown Formula) were 0.80 to 0.86, the split-half reliability coefficient of total score was 0.92; (3) Cronbach'sαcoefficient, which is an index of internal consistency reliability, ranged from 0.82 to 0.87, the Cronbach's a coefficient of total score was 0.92; (4) The correlation coefficient between each item and sub-scale ranged from 0.45 to 0.85, the correlation coefficient between subscales ranged from 0.36 to 0.64 and the correlation coefficient between subscale and total scale ranged from 0.81 to 0.92; (5) The generalizability analysis showed that the generalizability coefficient Ep~2, reliability indexΦ, error varianceσ~2 (Xpi) were ranged from 0.8174 to 0.9196, 0.8005 to 0.9027, 0.0086 to 0.0597 respectively for subscale, and was 0.9196, 0.9027 and 0.0047 for total scale.3. The results of validity were as follows: (1) the content validity index was 0.90; (2) First-order five factors were extracted using EFA, which accounted for 46.20% of the accumulated variance; second-order 1 factor extracted which accounted for 62.88%. CFA were conducted to assess the measurement of factor structure of the scale, the results showed that the first-order 5 factors model and second-order 1 factor model were fitted well. The two model's index ofχ~2 /df were lower than 5, the index of RMSEA were lower than 0.08, the index of GFI, AGFI, TLI, CFI were upper than 0.9, the index of IFI, IFI, NFI were upper than 0.85; (3) Criterion-related validity study indicated that the correlation between the total scores of SMS and the full scores of chronic disease self-management behavior scale were 0.61. The correlation between the total scores of SMS and the full scores of chronic disease self-efficacy scale were 0.66.The correlation between the total score of SMS and FEV1 percent of predicted normal were -0.55(P<0.01).There was statistical significance between the score of SMS for outpatients and inpatients with COPD, except the score of factor 4 (information management). There was statistical significance among the score of SMS for patients with COPD in different ranked hospitals (P<0.01). The score of SMS for patients with COPD was higher in top-ranked hospitals than in other one.4. The results of multinomial logistic regression analysis showed that the influential factors of participants with lower self-management levels were educational level of primary school and junior high school, family income lower than 500 RMB per month, uninsured group, duration lower than 5 years and their OR were 3.362, 2.546, 3.621, 5.974 and 4.437 respectively. The influential factors of participants with middle self-management levels were educational level of diploma, family income between 501-1500 RMB per month, medical insurance group, duration upper than 16 years and their OR were 1.272, 2.728, 1.569, 2.917 and 1.999 respectively. The influential factors of participants with lower and middle self-management levels were the gender of male, their OR were 1.795, 1.819 respectively.5. The results of Pearson correlation analysis showed that there were correlations among the score of self-management(SM), quality of life(QOL), social support(SS) and depression. Their coefficient correlation were 0.49, 0.67, 0.69 respectively.6. The results of path analysis showed that QOL had direct effect on SM. Depression affected SM directly and collaborated with QOL indirectly. SS had direct effect on SM and had indirect effect on SM through QOL and depression.Conclusion1. Psychometric properties analyses showed that the SMS for patients with COPD achieved good to excellent levels of internal consistency, test-retest reliability, and content validity, construct validity, criterion-related validity.2. The SM of patients with COPD are influenced by gender, education levels, family income, payment manner of medical care and duration. There are liner correlation among QOL, SS, depression and SM for patients with COPD. The QOL has direct on SM for patients with COPD. SS and depression has direct and indirect effect on SM for patients with COPD respectively.
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