Development of a self-efficacy instrument for coronary artery bypass graft patients

Effects of Exercise Testing and Cardiac Rehabilitation in Patients with Coronary Heart Disease on Fear and Self-Efficacy of Exercise: A Pilot Study

BACKGROUND

Exercise fear and low exercise self-efficacy are common in patients attending cardiac rehabilitation (CR). This study tested whether exercise prescription methods influence exercise fear and exercise self-efficacy. We hypothesized that the use of graded exercise testing (GXT) with a target heart rate range exercise prescription, relative to standard exercise prescription using rating of perceived exertion (RPE), would produce greater reductions in exercise fear and increase self-efficacy during CR.

METHOD

Patients in CR (N = 32) were randomized to an exercise prescription using either RPE or a target heart rate range. Exercise fear and self-efficacy were assessed with questionnaires at three time points: baseline; after the GXT in target heart rate range group; and at session 6 for the RPE group and CR completion. Items were scored on a five-point Likert-type scale with higher mean scores reflecting higher fear of exercise and higher self-efficacy. To analyze mean differences, a mixed effects analysis was run.

RESULTS

There were no significant changes in exercise self-efficacy between baseline and discharge from CR; these were not statistically significant (mean differences baseline - 0.63; end - 0.27 (p = 0.13)). Similarly, there was no change in fear between groups (baseline 0.30; end 0.51 (p = 0.37)).

CONCLUSION

Patients in the RPE and target heart rate groups had non-significant changes in exercise self-efficacy over the course of CR. Contrary to our hypothesis, the use of GXT and target heart rate range did not reduce fear, and we noted sustained or increases in fear of exercise among patients with elevated baseline fear. A more targeted psychological intervention seems warranted to reduce exercise fear and self-efficacy in CR.

Self-efficacy measurement instruments for individuals with coronary artery disease: A systematic review

INTRODUCTION

Over the past decade, there has been a heightened interest in evaluating self-efficacy among patients with coronary artery disease (CAD). A significant number of instruments have been developed and validated, yet the need remains to assess the quality of their studies and their properties.

OBJECTIVES

To evaluate the measurement properties and link the content extracted from self-efficacy instrument items for individuals with CAD to the International Classification of Functioning, Disability, and Health (ICF).

METHODOLOGY

The study was conducted following the Cochrane systematic review guidelines and COnsensus norms for Selection of health Measuring INstruments (COSMIN), registered under CRD42021262613. The search was carried out on MEDLINE (Ovid), Web of Science, EMBASE, and PsycINFO, including studies involving the development and validation of self-efficacy instruments for individuals with CAD, without language or date restrictions. Data extraction was performed in May 2022 and updated in January 2023 and all the steps of this review were carried out by two different collaborators and reviewed by a third when there were divergences. Modified Grading of Recommendations, Assessment, Development and Evaluation (GRADE) recommended by COSMIN was used to determine the quality of evidence as high, moderate, low, or very low. Instrument categorization was carried out per COSMIN recommendations, according to the construct of interest and study population into three categories (A, B, or C).

RESULTS

A total of 21 studies from 12 instruments were identified. The best-rated instruments received a recommendation of B, which means, additional validation studies are needed. Barnason Efficacy Expectation Scale (BEES) showed high-quality evidence for structural, construct, criterion, and internal consistency validity; Cardiac Self-Efficacy Scale (CSES) demonstrated high quality for content, structural, cross-cultural validity, and internal consistency; Self-efficacy for Appropriate Medication Use (SEAMS) achieved a high level for structural, criterion, and internal consistency validity; Cardiovascular Management Self-Efficacy Scale exhibited high-level validity for structural, criterion, construct, and internal consistency. The CSES showed content linkage with all domains of the ICF, as well as the highest number of linkages with the categories.

CONCLUSIONS

Instruments with a B-level recommendation hold potential for use. More studies assessing measurement properties are needed to reinforce or improve these recommendations. The CSES stands out as the most comprehensive instrument concerning the ICF.

The effect of training on coronary artery bypass graft surgery patients

BACKGROUND

In the pre-operative process, patients who will undergo cardiovascular surgery and their families require planned education and education materials. Education given to patients plays a key role in reducing anxiety, overcoming stress, and accelerating discharge.

AIMS

This study was conducted to determine the effect of an education booklet in addition to training by nurses on efficacy expectation, pain and anxiety levels in coronary artery bypass grafting (CABG) surgery patients.

STUDY DESIGN

This quasi-experimental study was conducted in the cardiovascular surgery service of a university hospital in Izmir, Turkey, between June and October 2018 and involved 60 patients. The patients were divided into two groups: control (n = 30) and intervention (n = 30). The intervention group was patients educated before surgery by using the booklet, but the control group only received routine care by nurses. The data were collected using the Mini-Mental Test, Patient Information Form, Visual Analogue Pain Scale, Spielberger State-Trait Anxiety Scale, Barnason Efficacy Expectation Scale, and Education Evaluation Form.

RESULTS

After the intervention at discharge, there was a significant difference between the mean scores of anxiety, pain, and efficacy expectation among the intervention group which received booklet education with the control group which received routine care (p <  .05).

CONCLUSION

The booklet education given to patients before CABG surgery was found to have potential effects on patients' post-operative pain levels, the efficacy expectation, and satisfaction.

RELEVANCE TO CLINICAL PRACTICE

In the pre-operative process, the use of booklet education in addition to routine care increases the level of efficacy expectation and decreases pain and anxiety in CABG surgery patients. Therefore, nurses can use booklet education to improve self-efficacy and reduce pain and anxiety in patients who have CABG surgery.

Patient-centered care in Coronary Heart Disease: what do you want to measure? A systematic review of reviews on patient-reported outcome measures

Background

The number of published articles on Patient-Reported Outcomes Measures (PROMs) in Coronary Heart Disease (CHD), a leading cause of disability-adjusted life years lost worldwide, has been growing in the last decades. The aim of this study was to identify all the disease-specific PROMs developed for or used in CHD and summarize their characteristics (regardless of the construct), to facilitate the selection of the most adequate one for each purpose.

Methods

A systematic review of reviews was conducted in MEDLINE, Scopus, and the Cochrane Database of Systematic Reviews. PROQOLID and BiblioPRO libraries were also checked. PROMs were classified by construct and information was extracted from different sources regarding their main characteristics such as aim, number of items, specific dimensions, original language, and metric properties that have been assessed.

Results

After title and abstract screening of 1224 articles, 114 publications were included for full text review. Finally, we identified 56 PROMs: 12 symptoms scales, 3 measuring functional status, 21 measuring Health-Related Quality of Life (HRQL), and 20 focused on other constructs. Three of the symptoms scales were specifically designed for a study (no metric properties evaluated), and only five have been included in a published study in the last decade. Regarding functional status, reliability and validity have been assessed for Duke Activity Index and Seattle Angina Questionnaire, which present multiple language versions. For HRQL, most of the PROMs included physical, emotional, and social domains. Responsiveness has only been evaluated for 10 out the 21 HRQL PROMs identified. Other constructs included psychological aspects, self-efficacy, attitudes, perceptions, threats and expectations about the treatment, knowledge, adjustment, or limitation for work, social support, or self-care.

Conclusions

There is a wide variety of instruments to assess the patients’ perspective in CHD, covering several constructs. This is the first systematic review of specific PROMs for CHD including all constructs. It has practical significance, as it summarizes relevant information that may help clinicians, researchers, and other healthcare stakeholders to choose the most adequate instrument for promoting shared decision making in a trend towards value-based healthcare.

Relationship between self-efficacy and sexual function after open heart surgery

AIMS

The high level of self-efficacy that facilitates the adaptation of patients to their new lives and accelerates the healing process after open heart surgery has a positive effect on sexual function. The aims of the study are to examine the self-efficacy and sexual function of patients undergoing open heart surgery and factors affecting it.

METHODS AND RESULTS

This descriptive cross-sectional study was conducted with 76 patients (44 females, 32 males). The data were collected with an information form, Barnason Efficacy Expectation Scales (BEES): Cardiac Surgical Version, Beck Depression Inventory (BDI), International Index of Erectile Dysfunction (IIEF), and Female Sexual Function Index (FSFI). The mean age of the patients was 63.12 ± 7.91. It was found that 30.3% of the patients (73.9% female and 26.1% male) were sexually inactive, and they did not receive information about sexual function. The mean BEES: Cardiac Surgical Version score was 43.96 ± 6.07. The mean IIEF score was 19.07 ± 26.0, and the mean FSFI score was 15.67 ± 9.12. There was a positive correlation between BEES: Cardiac Surgical Version and IIEF (r = 0.34; P = 0.00), and there was a negative correlation between BEES: Cardiac Surgical Version and FSFI (r = -0.27; P = 0.01).

CONCLUSION

It was determined that patients did not have sufficient information about sexual life after open heart surgery. The patients had sexual problems after surgery. It was found that sexual function increased with increasing self-efficacy in men, while sexual function decreased with increasing self-efficacy in women.

Effects of tailored telemonitoring on functional status and health-related quality of life in patients with heart failure

Background

Functional status and health-related quality of life (HRQoL) are important in patients with heart failure (HF). Little is known about the effect of telemonitoring on functional status and HRQoL in that population.

Methods and results

A total of 382 patients with HF (New York Heart Association class 2–4) were included in a randomised controlled trial to investigate the effect of tailored telemonitoring on improving HRQoL and functional status in HF patients. Randomisation was computer-generated with stratification per centre. At baseline and after 12 months, patients’ functional status was determined by metabolic equivalent scores (METS). HRQoL was measured with the EuroQol five dimensions questionnaire (EQ-5D), visual analogue scale (VAS) and Borg rating of perceived exertion scale (Borg). Additional outcome data included number of HF-related outpatient clinic visits and mortality. Telemonitoring was statistically significantly related to an increase in METS after 1 year (regression coefficient 0.318; p = 0.01). Telemonitoring did not improve Borg, EQ-5D or VAS scores after 1 year. EQ-5D [hazard ratio (HR) 0.20, 95% confidence interval (CI) 0.07–0.54], VAS (HR 0.98, 95% CI 0.96–0.99), Borg (HR 1.21, 95% CI 1.11–1.31) and METS (HR 0.73, 95% CI 0.58–0.93) at baseline were significantly associated with survival after 12 months.

Conclusions

Tailored telemonitoring stabilised the functional status of HF patients but did not improve HRQoL. Therefore, telemonitoring may help to prevent deterioration of exercise capacity in patients with HF. However, because our study is a reanalysis of a randomised controlled trial (RCT), this is considered hypothesis-generating and should be confirmed by adequately powered RCTs.

Electronic supplementary material

The online version of this article (10.1007/s12471-019-01323-x) contains supplementary material, which is available to authorized users.

The Construction and Validation of a Self-Efficacy Instrument for New Graduate Nurses in a Transition to Practice Program

Background and Purpose

Transition to practice programs are an expectation for new graduate RNs and there is a need for quality outcome measures. The concept of self-efficacy was explored, and a tool developed, to identify the RN's belief regarding their capacity to perform select clinical competencies. The purpose of this study was to validate the psychometric properties of the Versant Self-Efficacy tool.

Methods

A cross-sectional analysis was conducted on data obtained between July 1, 2015, and December 31, 2016. The sample included 901 new graduate RNs at multisite locations. Reliability and validity of the tool was examined.

Results

The Versant Self-Efficacy tool demonstrated positive results for factor structure and internal reliability.

Conclusion

The Self-Efficacy tool has proven to be a robust, psychometrically sound tool to measure the self-efficacy of new graduate RNs.

Do patients have a say? A narrative review of the development of patient-reported outcome measures used in elective procedures for coronary revascularisation

PURPOSE

Patient-reported outcome measures (PROMs) capture health information from the patient's perspective that can be used when weighing up benefits, risks and costs of treatment. This is important for elective procedures such as those for coronary revascularisation. Patients should be involved in the development of PROMs to accurately capture outcomes that are important for the patient. The aims of this review are to identify if patients were involved in the development of cardiovascular-specific PROMs used for assessing outcomes from elective coronary revascularisation, and to explore what methods were used to capture patient perspectives.

METHODS

PROMs for evaluating outcomes from elective coronary revascularisation were identified from a previous review and an updated systematic search. The studies describing the development of the PROMs were reviewed for information on patient input in their conceptual and/or item development.

RESULTS

24 PROMs were identified from a previous review and three additional PROMs were identified from the updated search. Full texts were obtained for 26 of the 27 PROMs. The 26 studies (11 multidimensional, 15 unidimensional) were reviewed. Only nine studies reported developing PROMs using patient input. For eight PROMs, the inclusion of patient input could not be judged due to insufficient information in the full text.

CONCLUSIONS

Only nine of the 26 reviewed PROMs used in elective coronary revascularisation reported involving patients in their conceptual and/or item development, while patient input was unclear for eight PROMs. These findings suggest that the patient's perspective is often overlooked or poorly described in the development of PROMs.

Patients expectations and fulfilment of expectations before and after treatment for suspected coronary artery disease assessed with a newly developed questionnaire in combination with established health-related quality of life questionnaires

Background

Clinical decision-making is often based on evidence of outcome after a specific treatment. Healthcare providers and patients may, however, have different perceptions and expectations of what to achieve from a certain healthcare measure.

Aims

To evaluate patients’ expectations, perceptions and health related quality of life (HRQoL) before a care process including coronary angiography for suspected coronary artery disease and to evaluate the fulfilment of these expectations in relation to established patient reported outcome measures (PROMs) 6 months later. Furthermore, an aim was to try to define meaningful patient reported experience measures (PREMs) in this population.

Methods

544 patients planned for coronary angiography completed a newly developed questionnaire to assess expectations and perceptions of treatment, the expectation questionnaire (ExpQ) and two established HRQoL questionnaires together with the established generic Short-Form 36 (SF36) and the disease specific Seattle Angina Questionnaire (SAQ).

Results

Patients had before the intervention, in general, high expectations of improvement after investigation and treatment and there was a positive attitude towards life style changes, medication and participation in decision-making regarding their own treatment. Only, 56.4% of the patients, however, reported fulfilment of treatment expectations. Fulfilment of treatment expectations correlated strongly with improvement in HRQoL after the care process.

Conclusions

To measure patients ´ expectations and fulfilments of these may offer simple and meaningful outcomes to evaluate a healthcare process from a patient ´s perspective. To approach patients’ expectations may also strengthen patient involvement in the care process with the possibilities of both higher patient satisfaction and medical results of the treatment.

Effects of tailored telemonitoring on heart failure patients' knowledge, self-care, self-efficacy and adherence: a randomized controlled trial

BACKGROUND

The education of patients with heart failure (HF) is an essential part of disease management. The perspectives of an increasing number of patients and a shortage of professionals force healthcare to explore new strategies in supporting patients to be better informed and more active.

METHODS

Three hundred and eighty-two patients with HF (age 71±SD 11.2 years) were randomly assigned to either a telemonitoring or a usual care group. Patients received four postal questionnaires to assess their levels of self-reported knowledge, self-care, self-efficacy and adherence. Generalized estimating equations analysis was performed to assess the effects of telemonitoring during the 1-year follow-up. Corrections for baseline were performed if needed.

RESULTS

Baseline differences between groups were found for self-care (p=0.001) and self-efficacy (p=0.024). Knowledge of patients in the telemonitoring group significantly improved with 0.9 point on a 15-points scale (p<0.001). Their self-care abilities improved with 1.5 point on a 10-item scale whereas no changes were found in patients receiving usual care (p<0.001). Self-efficacy of patients in the intervention group improved significantly after 6 months yet was not significantly different after 3 months and 1 year. For patients in the intervention group adherence improved for daily weighing (p<0.001) during the whole follow-up and for fluid intake (p=0.019) after 3 months and after 12 months (p=0.086). Adherence for activity recommendations improved (p=0.023) after 3 months and importance of medication adherence increased after 6 (p=0.012) and 12 months (p=0.037). No effects were found regarding appointments, diet, smoking and use of alcohol.

CONCLUSIONS

Tailored telemonitoring was found to educate patients with HF and to improve their self-care abilities and sense of self-efficacy.

Development of an evaluation scale for self-management behavior related to physical activity of patients with coronary heart disease

BACKGROUND

To provide patients with effective self-management education that takes their lifestyle into account, medical personnel need to provide education and evaluation of self-management behaviors which patients can apply to their daily life.

AIM

This study aimed to assess the reliability and validity of the evaluation scale for self-management behavior related to physical activity of patients with coronary heart disease (ES-SMBPA-CHD).

METHODS AND RESULTS

Outpatients with coronary heart disease (n = 76) completed a self-administered questionnaire supported by a previous study of ours. The ES-SMBPA-CHD was divided into two domains, the first dealing with self-management behavior to enhance physical activity in daily life and the second with behavior to maintain the level of physical activity. Factor analysis showed that the first part comprised four factors and the second five. The ES-SMBPA-CHD was associated with the International Physical Activity Questionnaire (IPAQ) subscales and activity energy expenditure (measured by Lifecorder EX). Cronbach's α coefficient was between 0.71 and 0.90. The intraclass test-retest correlation coefficient of the subscale was between 0.75 and 0.93.

CONCLUSIONS

The ES-SMBPA-CHD is reasonably reliable and valid and is expected to prove useful for the assessment of patients' self-management behavior and for individualized instruction.

Telemonitoring in patients with heart failure, the TEHAF study: Study protocol of an ongoing prospective randomised trial

BACKGROUND

As the prevalence of heart failure (HF) rises sharply, the costs related to the care of these patients increases in parallel. Considering the already limited resources and manpower, in the future the demand for care may exceed the supply. Therefore, health care systems are encouraged to develop innovative strategies to deal with the burden of HF to improve the quality of care in order to medical outcomes and patients' quality of life. For that reason new management systems - such as telemonitoring - have to be explored.

OBJECTIVES

This paper outlines the study protocol of a tailor-made telemonitoring program in ambulant patients with HF.

DESIGN AND METHODS

A prospective randomised controlled trial is carried out at 3 hospitals in the South-Limburg area in the Netherlands. Primary outcome measures are hospital admissions and cost-effectiveness. Secondary outcomes are effects on therapy compliance, level of disease specific knowledge and quality of life. Also determinants are studied of most and less benefited patients in the intervention group. POWER CALCULATION: It is estimated that 390 patients have to be included in the study, with 185 in each arm.

RESULTS

Inclusion started in September 2007 with a follow-up time of 12 months. First results are expected at the end of 2010.

Symptom burden clusters and their impact on psychosocial functioning following coronary artery bypass surgery

Although there is extensive literature on symptoms experienced by patients after coronary artery bypass surgery (CABS), there is a paucity of data on symptom clusters and their impact on functional outcomes. The purpose of these descriptive, secondary analyses was to identify and describe cluster subgroups of 226 elderly CABS patients at discharge and to examine the cluster's impact on psychosocial functioning over time (baseline, 6 weeks, and 3 months) using the 36-item Medical Outcome Study Short Form subscales. Cluster analysis revealed a 3-cluster solution with low, low-moderate, and moderate symptom burden clusters. Significant differences were detected for Duke Activity Status Index (F(2,223) = 5.12, P = .007), Barnason Efficacy Expectation Scale (F(2,223) = 9.60, P < .0001), Hospital Anxiety and Depression Scale (F(2,219) = 15.14, P < .0001), and New York Heart Association classification (chi = 17.44, P = .008). Significant differences were noted on all variables between the low and moderate symptom burden clusters with differences between the low-moderate and moderate clusters for only the Barnason Efficacy Expectation Scale and the Hospital Anxiety and Depression Scale. Those in the moderate symptom burden cluster had more symptoms, anxiety, and depression along with lower self-efficacy and physiological functioning than those in the other 2 clusters. There was no interaction or simple main effects for the role-emotional or social subscales as measured by the 36-item Medical Outcome Study Short Form. There was no significant interaction for mental functioning by time and cluster (F(4,641) = .30, P = .88); however, there was a simple main effect for cluster (F(2,641) = 4.11, P = .02). Follow-up analysis indicated significant differences between the low and low-moderate clusters, indicating that those with low symptom burden had significantly better mental health functioning than those with moderate symptom burden. Findings provide a foundation of knowledge on symptom clusters in CABS populations and may be useful to clinicians to identify patients at risk for slowed or delayed recovery and for early intervention.

The contributions of psychological disposition and risk factor status to health following treatment for coronary artery disease

BACKGROUND

Successful adjustment following treatment for coronary artery disease is related to both psychological disposition and risk factor status. Consideration of the interplay between these variables is required to better acknowledge their relationship with health outcome.

AIMS

To determine the salience of self-efficacy and locus of control to both general self-rated health and current cardiac health, relative to risk factor status. To determine whether self-efficacy is a more salient predictor of health status than locus of control.

METHODS

Men (n=248) treated in the previous 3 years for either coronary artery disease alone or a myocardial infarction completed a questionnaire in which clinical, risk factor (knowledge of risk factors, current risk factors, change in risk factors), psychological (self-efficacy, locus of control) and health information were sought.

RESULTS

Self-efficacy and internal locus of control had both direct and indirect influences on health in the models in which knowledge of risk factors was treated as the potential mediator. This pattern of results was not evident when either current risk factors or change in risk factors were examined as potential mediators. In the models in which self-efficacy was considered as a potential mediator of locus of control in the prediction of health status, self-efficacy was determined to be the more relevant psychological construct.

CONCLUSION

The consistent positive associations obtained among self-efficacy, cognitive risk factor status and health suggest that health professionals involved in cardiac rehabilitation should be encouraged to tailor interventions that allow patients to both improve their understanding of CAD and also to develop greater self-confidence in their ability to implement the acquired knowledge.

Comparison of Health Buddy with traditional approaches to heart failure management

The purpose of this pilot study was to (a) determine the feasibility of providing a heart failure disease management program through an in-home telehealth communication device (Health Buddy) and (b) compare the effectiveness of the Health Buddy with traditional home management strategies (telephonic, home visit) in achieving selected patient outcomes (self-efficacy, functional status, depression, and health-related quality of life). Ninety participants completed the study through 2 months. Thirty percent of participants were either eliminated prior to or withdrawn after enrollment from the study based on Health Buddy issues. A mixed model ANOVA revealed those who received telephonic disease management experienced decreased confidence in their ability to manage their heart failure whereas all other groups experienced increased confidence. Further ANOVA analyses indicated improvement over time with no group differences for functional status, depression, or health-related quality of life. These findings suggest that delivering a disease management program through a telehealth communication device is feasible and may be as effective as traditional methods.

Impact of a home communication intervention for coronary artery bypass graft patients with ischemic heart failure on self-efficacy, coronary disease risk factor modification, and functioning

OBJECTIVE

The purpose of this study is to determine the impact of a home communication intervention (HCI) for ischemic heart failure Coronary Artery Bypass Graft (CABG) patients >/= 65 years of age on self-efficacy, coronary artery disease risk factor modification and functioning posthospitalization.

DESIGN

A randomized clinical trial with repeated measures was used.

SAMPLE

A subsample of ischemic heart failure CABG surgery patients (n = 35) was drawn from the parent study of 180 CABG patients.

RESULTS

HCI participants (n = 18) had significantly higher adjusted mean self-efficacy scores [F(1, 29) = 6.40, P <.05] and adjusted mean levels of functioning (physical, general health, mental, and vitality functioning) compared with the routine care group (n = 17), using repeated measures analysis of covariance with baseline scores as covariates. There were also significant effects of time on bodily pain and role emotional functioning. Significantly higher exercise adherence (t = 3.09, P <.01) and lower reported stress (t = 3.77, P <.01) at 3 months after surgery was reported by HCI subjects.

CONCLUSIONS

Data from this pilot study can be used to strengthen the HCI intervention with more tailored strategies for vulnerable subgroups of CABG patients.