Factors associated with self‐management after hybrid revascularization in patients with peripheral artery disease: A structural equations model

Abstract

Aim:To investigate the factors associated with self-management after hybrid revascularization in patients with lower extremity peripheral artery disease using a structural equation modelling approach. Design:A cross-sectional study was adopted.Methods: A total of 221 patients who underwent hybrid revascularization for peripheral artery disease of the lower limbs were included from outpatient clinics at a 1200-bed tertiary care hospital in Korea. Data were collected using a self-reported questionnaire between December 1, 2019, and August 31, 2020. Structural equation modelling was applied to test the hypothetical model. Results:The item mean score of participants' self-management was 6.28 (standard deviation, 0.83) out of 8. The structural equation modelling had a good fit index.Autonomy support from healthcare providers was directly associated with selfmanagement (β = 0.20, p = 0.041). Illness perception directly (β = −0.33, p = 0.031) and indirectly (β = −0.19, p = 0.032) influenced self-management through competence and relatedness in patients with peripheral artery disease. The construct of autonomy support from healthcare providers, illness perception, competence and relatedness accounted for 49% of the variance in self-management.The Sobel test confirmed the statistically significant mediating effects of competence (z = −4.52, p < 0.001) and relatedness (z = −2.12, p < 0.001) on the relationship between illness perception and self-management. Conclusion:Our findings revealed that autonomy support from healthcare providers and patients' illness perception directly influenced patients' self-management.Additionally, patients' illness perception can indirectly influence self-management through their perceived competence and relatedness.Impact: Healthcare providers' autonomy support to patients may promote self-care behaviours, leading to greater autonomous motivation. Assessment of patients' illness perception before patient education is vital to designing effective self-management strategies which can improve patients' perceived competency and meaningful relatedness with healthcare providers.

Public risk perceptions, emotions and behaviours under a major epidemic: A structural equation model analysis

“…Since some of the modification indices were larger than 10 (the modification index between Emotion 1 and Emotion 3 was 103.93, Emotion 1 and Emotion 5 was 61.50, Emotion 4 and Behaviour 4 was 39.34, Risk perception 3 and Emotion 1 was 33.2 and that between Emotion 3 and Emotion 5 was 22.42). Accordingly, the model was modified by allowing covariance, adding five paths between the errors of measurement of six latent endogenous variables (Goong et al, 2016; Kim et al, 2022). After trimming and resampling, the p values of the factor loading of each latent variable on each observed variable all reached a significant level ( p < 0.05), the final model exhibited good model fit, and the model fit indices improved ( X 2 /df = 4.784, RMSEA = 0.074, CFI = 0.907, IFI = 0.908, GFI = 0.948), as shown in Figure 3.…”

“…Since some of the modification indices were larger than 10 (the modification index between Emotion 1 and Emotion 3 was 103.93, Emotion 1 and Emotion 5 was 61.50, Emotion 4 and Behaviour 4 was 39.34, Risk perception 3 and Emotion 1 was 33.2 and that between Emotion 3 and Emotion 5 was 22.42). Accordingly, the model was modified by allowing covariance, adding five paths between the errors of measurement of six latent endogenous variables (Goong et al, 2016;Kim et al, 2022).…”

Association Between Mental Health Burden, Clinical Presentation, and Outcomes in Individuals With Symptomatic Peripheral Artery Disease: A Scientific Statement From the American Heart Association

“…More than 40% present with type 2 diabetes, almost 40% are obese, 46% are smokers, and up to 37% of young women present with a comorbid psychiatric disorder. 3 Even in the absence of a formal diagnosed mental health condition, whether preexistent or co-occurring, individuals with PAD face a high rate of psychosocial risk factors, including negative illness perceptions, 27 depressive and anxiety symptoms, preprocedural anxiety, 28 and perceived stress, that may affect their overall PAD outcomes and functioning. 22,[29][30][31] Lower-extremity PAD is a chronic, burdensome condition that can progress and recur despite intervention, causing stress to individuals along the continuum of disease.…”

“…31,39,40 Furthermore, illness perceptions and perceived competence are also predictive factors for improved self-management behaviors after revascularization in individuals with PAD. 27 For much of the self-management and health behaviors that individuals are encouraged to take up per the PAD guidelines, 41 including smoking cessation, engaging in exercise and walking regimens, and making overall lifestyle changes, there are important factors to understand about behavioral change in humans. There is substantial evidence that readiness to make health behavior changes, the stages of readiness, 42 and the level of selfefficacy 7,27,[43][44][45][46][47][48][49] are predictors of success and the ability for individuals to make meaningful health behavior changes as they relate to managing their PAD, which have been described by models such as the Leventhal et al 50,51 Common Sense Model of Self-Regulation and the Prochaska et al 52 Transtheoretical Model or Stages of Change model.…”

“…31,39,40 Furthermore, illness perceptions and perceived competence are also predictive factors for improved self-management behaviors after revascularization in individuals with PAD. 27…”