Self-care Behavior for Stroke Prevention and Associated Factors among Thais with Atrial Fibrillation: A Cross-Sectional Study

Authors

DOI:

https://doi.org/10.60099/prijnr.2025.271245

Keywords:

Anticoagulants, Atrial fibrillation, Health literacy, Intention to self-care, Self-care behavior, Stroke prevention

Abstract

Atrial fibrillation significantly increases the risk of stroke. Proper self-care behavior and anticoagulants are vital for stroke prevention. However, there is limited research on this topic among Thai with atrial fibrillation. This descriptive cross-sectional study examined the association among personal factors, health literacy, intention to self-care, and self-care behavior for stroke prevention in Thai people with atrial fibrillation. Ninety participants receiving anticoagulant therapy were purposively recruited at a tertiary hospital in Bangkok, Thailand. Data collection was undertaken from March to June 2021. Participants were asked to complete four questionnaires: The Self-care Behavior for Stroke Prevention Questionnaire, Health Literacy for Stroke Prevention Questionnaire, Intention to Self-care for Stroke Prevention Questionnaire, and Patient Health Data, respectively. Data were analyzed using descriptive statistics, Pearson’s product-moment correlation, Spearman’s Rank test, and hierarchical regression analysis

Results indicated that 74.4% of the participants were older adults with atrial fibrillation, and 96.7% had received warfarin for an average of 5.13 years. Age, educational level, comorbidities, anticoagulant duration, health literacy, and intention to self-care were significant predictors, explaining 32.8% of the variance in self-care behavior for stroke prevention, with self-care being the strongest. Since the variance of self-care behavior in this study was only 32.8%, other factors, such as family support, quality of the patient-provider relationship, and care provision, should be considered in future studies to provide a more comprehensive understanding of self-care behavior for stroke prevention. Nurses can use this study to design nursing interventions promoting health literacy and the intention to self-care, thereby enhancing self-care behavior to prevent complications from atrial fibrillation.

References

Zhang J, Johnsen SP, Guo Y, Lip GYH. Epidemiology of atrial fibrillation: geographic/ecological risk factors, age, sex, genetics. Card Electrophysiol Clin. 2021 Mar;13(1):1-23. doi: 10.1016/j.ccep.2020.10.010.

Suwanwela NC, Chutinet A, Autjimanon H, Ounahachok T, Decha-Umphai C, Chockchai S, Indrabhakti S, Kijpaisalratana N, Akarathanawat W, Travanichakul S, Kitjavijitre T, Vongvasinkul P, Kanacharoen I, Bunlikitkul TO, Charnwut S, Lowres N, Freedman B. Atrial fibrillation prevalence and risk profile from novel community-based screening in Thailand: a prospective multi-centre study. Int J Cardiol Heart Vasc. 2021 Jan 12;32:100709. doi: 10.1016/j.ijcha.2020.100709.

Shantsila E, Choi EK, Lane DA, Joung B, Lip GYH. Atrial fibrillation: comorbidities, lifestyle, and patient factors. Lancet Reg Health Eur. 2024 Feb 1;37:100784. doi: 10.1016/j.lanepe.2023.100784.

Chao TF, Potpara TS, Lip GYH. Atrial fibrillation: stroke prevention. Lancet Reg Health Eur. 2024 Feb 1;37:100797. doi: 10.1016/j.lanepe.2023.100797.

Chao TF, Joung B, Takahashi Y, Lim TW, Choi EK, Chan YH, Guo Y, Sriratanasathavorn C, Oh S, Okumura K, Lip GYH. 2021 Focused update consensus guidelines of the Asia Pacific Heart Rhythm Society on Stroke Prevention in Atrial Fibrillation: Executive summary. Thromb Haemost. 2022 Jan;122(1):20-47. doi: 10.1055/s-0041-1739411.

Ng SS, Nathisuwan S, Phrommintikul A, Chaiyakunapruk N. Cost-effectiveness of warfarin care bundles and novel oral anticoagulants for stroke prevention in patients with atrial fibrillation in Thailand. Thromb Res. 2020 Jan;185:63-71. doi: 10.1016/j.thromres.2019.11.012.

Poungkaew A, Tankumpuan T, Riangkam C, Kongwatcharapong J, Daekunthod T, Sriyayang K, Krittayaphong R, Koirala B. Warfarin adherence and its associated factors in Thai older adults with atrial fibrillation. J Multidiscip Healthc. 2024;17:4455-64 https://doi.org/10.2147/JMDH.S472597.

Ophasirikhosit P, Sriprasong S, Wattanakitkrileart D, Methavigul K. Factors predicting self-care in patients with atrial fibrillation. Nurs Sci J Thail [Internet]. 2024 Mar. 28 [cited 2024 Aug. 30];42(2):19-31. Available from: https://he02.tci-thaijo.org/index.php/ns/article/view/265937. (in Thai).

Alvi Y, Khalique N, Ahmad A, Khan HS, Faizi N. World Health Organization dimensions of adherence to antiretroviral therapy: a study at the antiretroviral therapy centre, Aligarh. Indian J Community Med. 2019 Apr-Jun;44(2):118-124. doi: 10.4103/ijcm.IJCM_164_18.

Orem DE, Taylor SG, Renpenning KM. Nursing: concepts of practice. St. Louis: Mosby. 2001.

Wendelboe AM, Raskob GE, Angchaisuksiri P, Blanco AN, Büller H, Ddungu H, Dvorak JD, Hunt BJ, Hylek EM, Kakkar A, Konstantinides SV, McCumber M, McLintock C, Urano T, Weitz JI. Global public awareness about atrial fibrillation. Res Pract Thromb Haemost. 2017 Oct 25;2(1):49-57. doi: 10.1002/rth2.12051.

Wilson RE, Rush KL. Engaging patients in atrial fibrillation self-care: opportunities for future research. West J Nurs Res. 2021 Dec;43(12):1091-1092. doi: 10.1177/01939459211037041.

Alkhaqani AL. Overview of nurses’ role in management of patients with atrial fibrillation. IJNHR 2022 4(1), 15-19. https://doi.org/10.5281/zenodo.6903024.

Toscos TR, Coupe A, Wagner S, Drouin M, Roebuck AE, Daley CN, Carpenter MD, Mirro MJ. Can nurses help improve self-care of patients living with atrial fibrillation? A focus group study exploring patients' disease knowledge gaps. Nurs Open. 2020 May 12;7(4):998-1010. doi: 10.1002/nop2.472.

Aronis KN, Edgar B, Lin W, Martins MAP, Paasche-Orlow MK, Magnani JW. Health literacy and atrial fibrillation: relevance and future directions for patient-centered care. Eur Cardiol. 2017 Summer;12(1):52-7. doi: 10.15420/ecr.2017:2:2.

World Health Organization. Self-care for health and well-being. [Internet] 2024, April 26. [cited 2024, May 10]. Available from: https://www.who.int/news-room/fact-sheets/detail/self-care-health-interventions

World Health Organization. Health promotion glossary of terms 2021. [Internet] 2021, Dec. 6. [cited 2024, Nov. 6] Available from: https://www.who.int/publications/i/item/9789240038349.

Nutbeam D, Lloyd JE. Understanding and responding to health literacy as a social determinant of health. Annu Rev Public Health. 2021 Apr 1;42:159-173. doi: 10.1146/annurev-publhealth-090419-102529.

Rolls CA, Obamiro KO, Chalmers L, Bereznicki LRE. The relationship between knowledge, health literacy, and adherence among patients taking oral anticoagulants for stroke thromboprophylaxis in atrial fibrillation. Cardiovasc Ther. 2017 Dec;35(6). doi: 10.1111/1755-5922.12304.

Egbert N, Nanna K. Health literacy: challenges and strategies. OJIN 2009 Sep;14 (3). doi.org/10.3912/OJIN.Vol14No03Man01.

Panichpathom V, Sriyuktasuth A, Wattanakitkrileart D, & Dumavibhat C. Warfarin adherence and its associated factors among patients with atrial fibrillation. Nurs Sci J Thai [Internet]. 2018;37(1):73-85. Available from: https://he02.tci-thaijo.org/index.php/ns/article/view/183637 (in Thai).

Cabellos-García AC, Martínez-Sabater A, Castro-Sánchez E, Kangasniemi M, Juárez-Vela R, Gea-Caballero V. Relation between health literacy, self-care and adherence to treatment with oral anticoagulants in adults: a narrative systematic review. BMC Public Health. 2018 Oct 4;18(1):1157. doi: 10.1186/s12889-018-6070-9.

Renpenning KM, & Taylor SG. Self-care theory in nursing: selected papers of Dorothea Orem. New York: Springer Publishing. 2003.

Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL; ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021 Feb 1;42(5):373-498. doi: 10.1093/eurheartj/ehaa612. Erratum in: Eur Heart J. 2021 Feb 1;42(5):507. Erratum in: Eur Heart J. 2021 Feb 1;42(5):546-547. Erratum in: Eur Heart J. 2021 Oct 21;42(40):4194.

Zhu L, Hou J, Zhou B, Xiao X, Wang J. The relationship between exercise intention and behavior of Chinese college students: a moderated mediation model. Front Psychol. 2022 Nov 8;13:1006007. doi: 10.3389/fpsyg.2022.1006007.

Lasutham K, Siripitayakunkit A, Panpakdee O. Factors related to self-care behavior of Thai Buddhist monks with coronary artery disease. Nurs Res Inno J [Internet]. 2019 Jan. 7 [cited 2024 Aug. 30];24(3):313-27. Available from: https://he02.tci-thaijo.org/index.php/RNJ/article/view/117336 (in Thai).

Cuschieri S. The STROBE guidelines. Saudi J Anaesth. 2019 Apr;13(Suppl 1):S31-S34. doi: 10.4103/sja.SJA_543_18.

Brooke P, Bullock R. Validation of a 6-item cognitive impairment test with a view to primary care usage. Int J Geriatr Psychiatry. 1999 Nov;14(11):936-40.

Mahoney FI, Barthel DW. Functional evaluation: The Barthel Index. Md State Med J. 1965 Feb;14:61-5.

Green SB. How many subjects does it take to do a regression analysis? Multivariate Behav Res. 1991 Jul 1;26(3):499-510. doi: 10.1207/s15327906mbr2603_7.

Aree-Ue S, Youngcharoen P. The 6 Item Cognitive Function Test - Thai version: psychometric property testing. Nurs Res Inno J [Internet]. 2020 Aug. 30 [cited 2024 June. 30];26(2):188-202. Available from: https://he02.tci-thaijo.org/index.php/RNJ/article/view/217560. (in Thai).

Jitapunkul S, Kamolratanakul P, Ebrahim S. The meaning of activities of daily living in a Thai elderly population: development of a new index. Age Ageing. 1994 Mar;23(2):97-101. doi: 10.1093/ageing/23.2.97.

Senanarong V, Harnphadungkit K, Prayoonwiwat N, Poungvarin N, Sivasariyanonds N, Printarakul T, Udompunthurak S, Cummings JL. A new measurement of activities of daily living for Thai elderly with dementia. Int Psychogeriatr. 2003 Jun;15(2):135-48. doi: 10.1017/s1041610203008822.

McCormack L, Bann C, Squiers L, Berkman ND, Squire C, Schillinger D, Ohene-Frempong J, Hibbard J. Measuring health literacy: a pilot study of a new skills-based instrument. J Health Commun. 2010;15 Suppl 2:51-71. doi: 10.1080/10810730.2010.499987.

Riegel B, Lee CS, Dickson VV, Carlson B. An update on the Self-Care of Heart Failure Index. J Cardiovasc Nurs. 2009 Nov-Dec;24(6):485-97. doi: 10.1097/JCN.0b013e3181b4baa0.

Akoglu H. User’s guide to correlation coefficients. Turk J Emerg Med. 2018 Aug 7; 18(3):91-3. Doi: 10.1016/j.tjem.2018.08.001.

Wu CFJ. Jackknife, bootstrap and other resampling methods in regression analysis. Ann. Stat. 1986; 14(4): 1261-95. Available from: https://www.jstor.org/stable/2241454.

Lee KS, Moser DK, Dracup K. The association between comorbidities and self-care of heart failure: a cross-sectional study. BMC Cardiovasc Disord. 2023 Mar 27;23(1):157. doi: 10.1186/s12872-023-03166-2.

Magi CE, Bambi S, Rasero L, Longobucco Y, El Aoufy K, Amato C, Vellone E, Bonaccorsi G, Lorini C, Iovino P. Health literacy and self-care in patients with chronic illness: a systematic review and meta-analysis protocol. Healthcare (Basel). 2024 Mar 31;12(7):762. doi: 10.3390/healthcare12070762.

Center for Health Care Strategies. Health literacy and the role of culture. 2024 Mar [cited 2024 Oct 29]. Available from: https://www.chcs.org/media/Health_Literacy_Role_of_Culture.pdf

Downloads

Published

2024-12-13

How to Cite

1.
Buranurak A, Siripitayakunkit A, Duangbubpha S. Self-care Behavior for Stroke Prevention and Associated Factors among Thais with Atrial Fibrillation: A Cross-Sectional Study. PRIJNR [Internet]. 2024 Dec. 13 [cited 2024 Dec. 19];29(1):197-211. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/271245