The Mechanism Of Self-efficacy In Physical Disability In Patients With Rheumatoid Arthritis

Objectives1.To translate,back-translate,and culturally adapt the Rheumatoid Arthritis Self-efficacy Scale(RASE),and to test the reliability and validity of the scale in Chinese patients with rheumatoid arthritis(RA),in order to integrate the existing assessment tools associated with RA self-efficacy.2.To understand the status of physical disability in patients with RA and to analyze the total effects of self-efficacy and other factors on physical disability of patients with RA.Based on the theory of Health Belief Theory,the method of path analysis is used to test the mechanism of self-efficacy so as to provide theoretical basis for the development of personalized and effective interventions.Methods1.In the first study: the English version of RASE was translated,back-translated and cross-culturally adapted to form the Chinese version of RASE.The item analysis,validity test,and reliability test were carried out in Chinese patients with RA.The item analysis included critical ratio method and item-to-total score correlation coefficient;validity test included structural validity,discriminant validity and criterion validity;reliability test included internal consistency reliability,test-retest reliability,and the split-half reliability.Statistical analysis methods involved Pearson correlation analysis and exploratory factor analysis.2.In the second study: the cross-sectional survey was conducted to select 237 patients with RA from the outpatient department and hospitalized rheumatology department of a tertiary hospital in Tianjin.To explore the status and influencing factors of physical disability in patients with RA,and to analyze the mechanism of self-efficacy in physical disability of patients with RA based on the Health Belief Model.The following research tools were used: General Data Questionnaire,Disease Activity Index,Pain Visual Analogue Scale,Fatigue Visual Analogue Scale,Health Assessment Questionnaire-Disability Index,Chinese version of Medication Belief-Specific Questionnaire,RASE,Patient Health Questionnaire-9,and Medical Coping Style Scale were collected using SPSS 20.0 and AMOS software for statistical analysis.The statistical methods involved: rank sum test,Pearson correlation analysis,multiple stepwise regression analysis,and path analysis.Results1.In the first study: the item analysis showed that the Chinese version of RASE can identify high and low groups.Pearson correlation analysis showed the scores of the Chinese version of the scale were positively correlated with the total score(P<0.01).Exploratory factor analysis extracted 8 common factors,named as sleep self-efficacy,relaxation self-efficacy,leisure activity self-efficacy,interpersonal self-efficacy,pain self-efficacy,fatigue self-efficacy,medication self-efficacy and exercise self-efficacy,the factor load of each item on the common factor was >0.400,the cumulative variance contribution rate was 68.550%;the overall Cronbach’s α coefficient was 0.901,the Cronbach’s α coefficient of each dimension ranged from 0.660 to 0.867;the test-retest reliability of the Chinese version of the scale was 0.955 after one week,and the test-retest reliability of each dimension ranged from 0.819 to 0.984;the Spearman-Brown coefficient of the Chinese version of the scale was 0.848.2.In the second study: the score of physical disability in RA patients was(1.64±0.63).Multiple stepwise regression analysis showed self-efficacy,face,medication belief,pain,education level,depression,regular exercise,fatigue and disease activity had a significant effect on physical disability(P<0.05),which explained 60.8% of the total variability.Path analysis results showed that depression,disease factors and medication belief had a direct effect on physical disability of RA patients.Moreover,our results showed that self-efficacy had a direct effect on physical disability,and depression,disease factors and medication beliefs can have an indirect effect on functional disability of patients with RA through the mediator of self-efficacy.Conclusions1.The Chinese version of RASE can be used to evaluate the self-efficacy of patients with RA in China.2.Patients with RA have moderate physical disability.Self-efficacy,face,medication compliance,pain,education level,depression,regular exercise,fatigue,and disease activity are the influencing factors of physical disability in patients with RA;self-efficacy plays a mediating role in the effect of depression,disease factors and medication beliefs on physical disability of patients with RA.