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

Abstract

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. A cross-sectional study was adopted. 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. 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 self-management (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. 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. 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.