Self-management behaviors of patients with coronary atherosclerotic heart disease based on health belief model: model building and empirical study

Abstract

Objective To establish a model of self-management behaviors for patients with coronary atherosclerotic heart disease based on the theory of health belief model and conduct an empirical study to verify the validity and performance of the model. Methods We conducted a cross-sectional questionnaire survey among 280 patients with coronary heart disease from 3 general hospitals in Chongqing during the period from November, 2017 to April, 2018. The general condition questionnaire, social support rating scale, coronary heart disease health literacy questionnaire, chronic disease self-efficacy scale and coronary heart disease self-management scale were used in the survey. The factors in the theoretical model that potentially affected self-management behaviors of the patients were analyzed based on the structural equation model. Results Based on 276 valid questionnaires retrieved (98.57%), the total mean score of self-management behaviors of the patients with coronary heart disease was 81.49±13.83. Correlation analysis revealed that the scores for social support, health literacy and self-efficacy were positively correlated with the scores for self-management (r=0.229, 0.499, and 0.341, respectively; P < 0.001). The structural equation model demonstrated that the model of self-management behaviors was well fitted in patients with coronary heart disease. The factors affecting self-management behaviors included health literacy (0.533), self-efficacy (0.431), social support (0.398), number of complications (0.257), education level (0.165), age (-0.115), and average monthly personal income (0.079). The model also showed that social support had only an indirect positive effect (β=0.398), health literacy had both direct (β=0.452, P < 0.001) and indirect positive effects (β=0.081), and self-efficacy had a direct positive effect on self-management behaviors (β=0.431, P < 0.001). Conclusion The patients with coronary heart disease have moderate to low levels of self-management behaviors. The self-management behavior model constructed based on the health belief model has good interpretative and predictive effects in patients with coronary heart disease.

Keywords

• health belief model
• coronary atherosclerotic heart disease
• self-management
• root cause analysis
• structural equation model