| Objective:This study was designed to investigate the status of sleep quality,self-efficacy and social support in patients with coronary heart disease who went through percutaneous coronary intervention(PCI);and to explore the influence of different factors on selfefficacy,social support and sleep quality of patients,including basic personal characteristics,behavioral lifestyle situation and health resource utilization.The study also explored the correlation between sleep quality,self-efficacy and social support in patients,and provide scientific evidence for the enrichment of the theoretical model regarding factors that influence sleep quality of patients after PCI.The results provide empirical evidence for further interventional studies and intervention for sleep disorders among coronary heart disease patients after went through PCI.Methods:In this study,a self-administered questionnaire was administered to patients with coronary artery disease who went through percutaneous coronary intervention in the inpatient cardiovascular medicine department of a tertiary care hospital in Changchun from March 2021 to June 2021 using a continuous sample sampling method.The survey was conducted within 3 days after the surgery.The research team contacted 856 patients and collected 806 valid questionnaires,with a valid return rate of 96.2%.The content of the survey included basic personal characteristics,and questionnaires about behavioral lifestyle,health resource use,self-efficacy,social support and sleep quality.Information from questionnaires were encoded into computer with Epidata 3.1 software to create a database.SPSS 24.0,AMOS 23.0 and R Studio 4.1.2 statistical software were applied for data processing and data analysis.Results:(1)806 coronary heart disease patients that went through PCI showed an average self-efficacy score of(2.57±0.70).Among them,209 patients(25.9%)had low level self-efficacy,410(50.9%)had medium level self-efficacy and 187(23.2%)had high level self-efficacy.Male patients who lived in urban areas,had a university degree or higher,worked in non-agricultural jobs,had urban employee health insurance type,were commercially insured,and had a per capita household income greater than RMB 4001 reported higher self-efficacy scores,and the differences were statistically significant(P<0.05).(2)The average social support score of patients was(34.64 ± 6.86),with a subjective support sub-dimension score of(20.14 ± 4.51),an objective support subdimension score of(7.70 ± 2.55)and a utilization of support sub-dimension score of(6.79 ± 1.95).Higher social support scores were reported by female patients who were married/cohabiting,41-60 years old,university educated or above,working in nonagricultural jobs,type of medical insurance as urban employee medical insurance,per capita household income greater than RMB 4001,and overweighted according to BMI.All differences were statistically significant(P<0.05).(3)Patients’ average score of sleep quality was(7.41 ± 3.34).Among them,580 patients(72.0%)reported sleep disturbance,including 186(23.1%)suspected insomnia and 394(48.9%)insomnia.Patients who were female,had a per capita household income of less than RMB 1,000,obese according to BMI,self-rated poorer health condition,had three or more outpatient treatments and hospitalizations for heart disease in the past year,and had a higher financial burden from medical visits showed worse sleep quality.All differences were statistically significant(P<0.05).The result of the multifactorial analysis showed,after included five independent variables in the regression equation,self-rated physical status had the greatest effect on sleep quality scores.A random forest model was constructed to examine the importance of independent variables on sleep quality of patients after PCI.Specifically,ranking variables from highest influence to lowest,self-rated physical health is the most important factor,followed by per capita household income,BMI,number of outpatient visits,and gender.(4)Self-efficacy score had a significant positive correlation with social support scores(P<0.01)and a significant negative correlation with sleep quality scores(P<0.01).Also,a significant negative correlation between social support scores and sleep quality scores(P<0.05)in patients was found.(5)A structural equation model was constructed with self-efficacy as the independent variable,social support as the mediating variable,sleep quality as the dependent variable,age and gender as the control variables,and the fit indices of the model were acceptable.The results of the mediating effect test showed a significant mediating effect of social support on the main relationship.Conclusion:Coronary artery disease patients who went through PCI,in general,showed moderate levels of self-efficacy,lower levels of social support and higher rates of sleep disturbance.Female patients who were overweighted,had poor self-rated health,low household income and a previous history of heart disease were at higher risk of sleep disturbance.Patients with higher levels of self-efficacy and higher levels of social support had better sleep quality.Self-efficacy can influence patients’ sleep qualities both directly and indirectly through the mediating role of social support. |
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