| ObjectivesTo investigate the level of self-efficacy in patients with rheumatoid arthritis (RA) and its influence factors; To explore the relationship among the level of self-efficacy, the style of medical coping and quality of life in patients with RA; To explore the effects of an empowerment-oriented education model on self-efficacy in patients with RA.MethodsAn experiment design was used in this study. From August2010to October2011, the patients who suffer from RA and stayed in Tianjin Medical University General Hospital were invited to be as subjects. Finally, a total of103RA patients were included in the study and assigned into experimental group (n=50) and control group (n=53) by random numbers table. All of the participants were requested to finish the baseline questionnaire before the intervention. After that, patients in the experimental group would receive an empowerment-oriented health education, while the patients in the control group received routine education. Evaluation questionnaires were collected again just after intervention to evaluate the changes of patients’level of self-efficacy. The questionnaires include Demographic Data Recording Form, General Self-Efficacy Scale, Medical Coping Modes Questionnaire and Short Form36Health Survey. T-test, correlations analysis, multiple linear regression analysis and Non-parametric analysis were performed to analyze the data with SPSS16.0.Results1The average score of self-efficacy of RA patients was20.88±4.49, which was at a low level. Multiple stepwise regression analysis showed anxiety, depression and the utilization of social supports entered into regression equation.2The average score of confrontation, obviatation and submission of RA patients were17.68±1.94,16.15±1.81and9.03±1.76respectively. Compared with the normal people model of China, RA patients have a lower score of confrontation and a higher score of obviatation (P<0.01), but no statistically significant difference was found in submission between the patients with RA and domestic norm (P>0.05). Correlation analysis showed that the level of self-efficacy was positively correlated with confrontation (r=0.76) and obviatation (r=0.68), and negatively correlated with submission (r=-0.67).3The average score of QOL of RA patients was45.95±3.55. The average score of physical function (PF), role physical (RP), vitality (VT), bodily pain (BP), role emotional (RE), mental health (MH), general health (GH) and social function (SF) were43.80±5.37,34.93±4.77,49.21±6.42,37.13±6.29,53.40±8.77,53.47±5.13,36.78±5.95and57.94±4.78respectively. Compared with the normal people model of China, the scores of all SF-36subscales, including PF, RP, RP, VT, BP, RE, MH, GH and SF, were significantly lower in RA patients than in control subjects (P <0.01). Correlation analysis showed that the level of self-efficacy was positively correlated with the scores of PF, RP, BP, GH, RE and MH (r=0.30,0.22,0.41,0.83,0.83,0.87), but not with VT and SF (P>0.05).4The analysis within group.(1) Self-efficacy. After intervention, the score of self-efficacy significantly increased both in the experimental group and the control group (P<0.01).(2) The style of medical coping. After intervention, the score of confrontation was higher, and the scores of obviatation and submission were lower than pre-intervention in the experimental group (P<0.01). The score of confrontation post-intervention was higher than pre-intervention in the control group (P<0.01), but the scores of obviatation and submission post-intervention did not statistically differ from the baseline scores in the control group (P>0.05).(3) Quality of life. After intervention, the scores of PF, RP, RE, GH, MH, BP, VT and SF significantly increased both in the experimental group and the control group (P<0.01).5The analysis between groups(1) Self-efficacy. Postintervention, patients in the experimental group reported better scores than patients in the control group for self-efficacy (P<0.01), and the mean score of deviation between baseline and assessment of the patients in the experimental group was higher than control patients (P<0.01). (2) The style of medical coping. Postintervention, patients in the experimental group had significantly higher score for confrontation and significantly lower scores for obviatation and submission than routine education (P<0.01). The mean score of deviation of confrontation between baseline and assessment of patients in the experimental group was higher than that in control group (P<0.05), and the mean scores of deviation of obviatation and submission between baseline and assessment of patients in the experimental group were lower than these in control group (P<0.05).(3) Quality of life. Postintervention, significant improvements in RE, VT, BP, GH, MH and SF were observed for patients who received the empowerment-oriented education in comparison to the control group (P<0.05), but there was no statistically significant difference in PF and RP between the two groups (P>0.05). The mean scores of deviation of RE, VT, GH and MH between baseline and assessment of patients in the experimental group were significantly higher than these in control group (P<0.01).ConclusionsThe level of self-efficacy in patients with RA was generally low and it was affected by anxiety, depression and the utilization of social supports. RA patients’ self-efficacy was significantly associated with the style of medical coping they used and quality of life. Hence, the nursing staff should take all relevant factors into account to design and implement some intervention measures, so as to enhance RA patients’self-efficacy and thereby improve their heath status. The empowerment-oriented health education model plays a positive role in the improvement of the self-efficacy level in patients with RA, which makes them cope with disease positively and thereby benefits their self-management. The empowerment-oriented health education, as applied in this study, can be an effective intervention for patients with RA. |
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