| Objectives:1.To investigate the status of health literacy,self-efficacy,self-management,social support and quality of life in patients with coronary heart disease(CHD).2.To explore the correlations between sociodemographic characteristics,disease medical characteristics,health literacy,self-efficacy,self-management,social support and quality of life in CHD patients.3.To explore the interactions between the factors and the paths as well as the extent underlying how these factors are associated with the quality of life 4.To make suggestions and countermeasures for health management of CHD patients based on Structural Equation Model(SEM)analysis.Methods:1.Using literature analysis method and combining with relevant research results at home and abroad,to identify the key factors on life quality and put forward the structural equation model hypothesis of CHD patients.2.The convenient sampling method was adopted through cross-sectional study.(1)General information questionnaire,(2)coronary heart disease health literacy questionnaire,(3)coronary artery disease self-management scale(CSMS),(4)chronic disease self-efficacy scale(CDSS),(5)social support rating scale(SRSS),(6)european quality of life5-dimensions scale(EQ-5D)was applied in three tertiary A hospitals in Chongqing to investigate 280 CHD patients.3.Descriptive analysis of the general information,health literacy,self-efficacy,self-management,social support and quality of life of the subjects.4.Univariate generalized linear regression analysis and multivariate generalized linear regression analysis were used to explore the related factors affecting health literacy,self-efficacy,self-management,social support and quality of life in CHD patients.5.Pearson correlation analysis was used to analyze correlations of health literacy,self-efficacy,self-management,social support,quality of life,and correlations between research variable dimensions.6.The structural equation model was used to construct the model of influencing factors of quality of life in CHD patients.Based on the model,the suggestions and countermeasures of health management were made for CHD patients.Results:1.Status of each research variable:(1)The score of two dimensions of quality of life:comprehensive health index(0.88±0.15),EQ-VAS(73.34±16.52);(2)The total score of health literacy in CHD patients was(88.80±16.12).The score of four dimensions was as follows:health knowledge(40.79±9.57),health attitude(20.17±4.52),health behavior(12.01±3.60)and health skills(15.94±3.65).(3)The total score of self-efficacy was(7.15±1.67).The score of two dimensions of self-efficacy:symptom management self-efficacy(7.17±1.72),disease common management self-efficacy(7.10±1.98);(4)The total score of self-management was(81.49±13.83),and the three dimensions were as follows:daily life management(29.21±4.69),disease medical management(37.86±9.73),emotion management(14.42±3.16);(5)The total score of social support was(38.83±6.42),and the score of subjective support,objective support and utilization of support were(21.82±3.92),(9.68±2.54),(7.33±2.37),respectively.2.Multivariate generalized linear regression analysis results of various research variables:(1)age(?<0,P<0.05),self-management(?>0,P<0.05)and self-efficacy(?>0,P<0.05)were the influencing factors of comprehensive health index score.The more severe the type of coronary heart disease,especially EQ-VAS scores of myocardial infarction patients and CHD patients with complications were lower.Self-efficacy was positively correlated with EQ-VAS score(?>0,P<0.001).(2)CHD patients with higher the education level,more complications,higher the level of self-management and self-efficacy had higher the score of health literacy,and the lower the score of health literacy in patients with ST-segment elevation myocardial infarction and ischemic cardiomyopathy.(3)Health literacy,self-management and social support were positively correlated with self-efficacy in CHD patients(?>0,P<0.001).(4)The patients who experienced over 3 years and accepted regular health education had higher score of self-management,while the patients with ST segment elevation myocardial infarction had lower self-management level.Age,health literacy and self-efficacy were positively correlated with the score of self-management in CHD patients(?>0,P<0.001).(5)Patients with complications had lower social support scores,married CHD patients had higher social support scores.Sself-management,self-efficacy were positively associated with social support(?>0,P<0.001),and age was negatively associated with social support(?<0,P<0.05).3.The results of correlation analysis:(1)health literacy,self-efficacy,self-management and social support were positively correlated with comprehensive health index and EQ-VAS.(2)Health literacy was significantly associated with self-efficacy(r=0.269,P<0.001),self-management(r=0.511,P<0.001),and social support(r=0.278,P<0.001).(3)Self-efficacy was positively correlated with self-management(r=0.377,P<0.001)and social support(r=0.411,P<0.001).(4)Self-management was positively correlated with social support(r?0.239,P<0.001).4.The results of structural equation model analysis:(1)self-management and social support directly affected the quality of life,and the direct effect coefficients were 0.644 and 0.355,respectively.(2)Health literacy has an indirect impact on the quality of life through self-efficacy,self-management and social support.(3)The total effect coefficient was0.479,self-efficacy indirectly affected the quality of life through self-management,the total effect was 0.414.(4)Educational level,age,average personal monthly income and the number of complications had indirect effects on the quality of life.The total effects were 0.167,-0.126,0.091 and-0.058,respectively.(5)R~2=0.650,indicating that age,educational level,personal monthly income,health literacy,self-efficacy,self-management and social support explained 65%variation in quality of life.Conclusion:1.The health literacy of CHD patients is in the middle level,the self-efficacy is in the middle level,the self-management is in the middle and low level,the social support level is low,and the quality of life is in the middle level.And the variables are affected by sociodemographic and disease medical characteristics.It is of great significance to pay attention to CHD patients'individual characteristics to improve the life quality of CHD patients.2.The factors affecting the quality of life of coronary heart disease are complex,sorted by the effect coefficient as follows:self-management,health literacy,self-efficacy,social support,educational level,age,average personal monthly income,the number of complications.Among them,the total effect of self-management is the most direct and important factor affecting the quality of life;the second is health literacy which indirectly affects the quality of life through self-efficacy,self-management and social support,which is the most basic factor.Self-efficacy has a mediating effect on the formation of good self-management behavior and is a dynamic factor to improve the quality of life.Social support plays a direct role in the quality of life,which is an important link in the participation of patients,family members,friends and caregivers,and is an external guarantee factor to improve the quality of life.3.Health management aiming at improving the quality of life of CHD patients should focus on differences in patients'age,education level,average monthly income,complications etc.,based on improving health literacy and enhancing self-management behavior,through health education and other means.Let them know about health knowledge and master health skills through health education,strengthen their belief in health behavior through nurse-patient communication,make full use of social support system and take comprehensive intervention measures to improve self-management behavior and improve the health status of patients. |
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