Influencing factors of adherence for phaseⅠcardiac rehabilitation in patients with PCI

1.1 RespondentsUsing the convenient sampling method, we selected PCI patients admitted to the heart rehabilitation center of a third class A hospital in Harbin from August 2021 to December 2021 as the research objects. According to the requirement of sample size for structural equation analysis, the sample size is at least 430. Inclusion criteria: patients with cardiac rehabilitation indications [8] who participated in cardiac rehabilitation for the first time; Age ≥ 18 years; Have certain listening, speaking, reading and writing ability, and can cooperate with research and investigation; Voluntary participation and signing of informed consent. Exclusion criteria: severe impairment of other important organs (such as liver, lung and kidney) or other serious chronic diseases (such as malignant tumors); Other serious stress events occurred during treatment; Mental illness, hearing impairment or communication disorder can not cooperate with the study. The study was approved by the hospital ethics committee, and the patients had informed consent.1.2 Survey toolsThis study is a cross-sectional study. After the completion of Phase I cardiac rehabilitation, the following survey tools were used to collect data.(1) The general demographic data questionnaire was formulated after consulting the literature and integrating the expert opinions. The content includes age, gender, occupation status, living mode, marital status, education level, per capita monthly income of the family, etc.(2) The compliance questionnaire for patients after PCI was prepared by Liu Yan [9] to measure the compliance of patients with Phase I cardiac rehabilitation. The content includes three dimensions: medication compliance, review compliance and lifestyle compliance. In this study, Cronbach's coefficient of the scale is 0.791.(3) The Coronary Heart Disease Health Belief Questionnaire was prepared by Zhang Meng, et al. of Tianjin University of Traditional Chinese Medicine [10]. The scale has 27 items in 5 dimensions (perception of disease susceptibility, perception of disease severity, perception of health behavior benefits, perception of health behavior disorders and clues to action). Using Likert 5-level scoring method, 1-5 points will be scored from "very disagreed" to "very agreed", with a total score of 27-135. The higher the score, the higher the patient's health belief level. In this study, the Cronbach's coefficient of the scale was 0.790.(4) The Patient Health Questionnaire Depression Scale (PHQ-9) is a primary health care assessment scale for mental disorders developed by Kroenke [11] and others in 2001. As a screening tool for depression, it is widely used in primary health care research and practice. The higher the score of nine items, the higher the degree of depression. In this study, the Cronbach's coefficient of the scale was 0.723.(5) The 7-tiem Generalized Anxiety Disorder Scale (GAD-7) was developed by Spitzer [12] et al. in 2006 for the screening of Generalized anxiety and the assessment of symptom severity. The higher the score, the higher the anxiety level. The scale has 7 items in total. In this study, the Cronbach's coefficient of the scale was 0.860.(6) The Family Adaptability and Cohesion Evaluation Scale (FACES) was developed by Olson et al. [13] in 1982, translated and introduced into China by Fei Lipeng et al. [14]. The scale is mainly used to evaluate family functions, with a total of 30 items. The two dimensions include intimacy and adaptability. The Likert 5-level scoring method is adopted, with 1-5 points from "not" to "always", with a total score of 30-150 points. The higher the score, the higher the intimacy and adaptability of the family. In this study, the Cronbach's coefficient of the scale was 0.875.(7) The Chronic Illness Resource Survey (CIRS) was compiled by Glasgow et al. [15] in 2000 based on the theoretical model of social ecology, translated by Zhong Huiqin et al. [16] and introduced into China to evaluate the support of multiple social resources for chronic disease management. The scale includes 21 items and 7 dimensions: medical staff, relatives and friends, individuals, neighbors or communities, media and policies, organizations, and work units. Using the Likert 5-level scoring method, 1-5 points are scored from "never" to "very much", with a total score of 21-105 points. The higher the score, the higher the utilization of chronic disease resources. In this study, the Cronbach's coefficient of the scale was 0.763.(8) Coronary artery score (Gensini score) Gensini score is used to evaluate the severity of patients' disease, and score according to the different and severity of coronary stenosis. The total score of Gensini for each patient is obtained by quantifying the lesion level of each vessel and multiplying it by the weight of the diameter of this coronary artery.1.3 Data collection methodsAfter Phase I cardiac rehabilitation, explain the purpose and significance of this study, and collect data after obtaining informed consent. The general demographic data were obtained by asking patients and consulting medical records, and other questionnaires were filled out independently after the patients became stable; For patients with dyslexia, the researcher reads the scale and the patient makes judgment independently. A total of 443 questionnaires were distributed in this study, and 430 valid questionnaires were recovered, with a recovery rate of 97.07%.1.4 Statistical methodsSPSS25.0 and AMOS24.0 were used for statistical analysis. The counting data are described by frequency and percentage, and the measurement data are expressed by x ± s. The correlation among health belief, anxiety and depression, family cohesion and adaptability, utilization of chronic disease resources and compliance of cardiac rehabilitation was verified by Person correlation analysis. On the basis of correlation analysis, the model parameters are estimated by using AMOS to fit the model path and maximum likelihood estimation method, and the model is optimized according to the modified index to test the level α= 0.05。