Background
Methods
Study design
Participants and setting
Sampling procedure and sample size calculation
Data collection instrument
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The second section recorded clinical CHD-associated data, such as duration of the illness in years (≤3, 4–5, or ≥ 5), total number of medications (1–3, 4–6, or ≥ 7), the number of associated chronic morbid conditions (0, 1, 2, 3, or ≥ 4), and smoking (none, light, moderate, heavy, or ex-smoker).
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The third section concerned CSE, which was evaluated using three scales: 1) the 5-item perceived efficacy in patient-physician interaction scale (PEPPI-5). The PEPPI-5 includes five items; each item starts with “how confident are you in your ability to..? ” Items are rated by participants from one to five; 1 = “not at all confident”, 5 = “very confident”. The totalled results are in the range of 5 to 25; higher scores indicate that the participant has higher self-efficacy in patient-physician interactions [17]. 2) The self-efficacy for managing chronic disease 6-item scale (SEMCD-6) consists of six items, each starting with “How confident are you that you can...?” Participants rated each item on a 10-point scale; 1 = “not at all confident “, 10 = “totally confident”. Total scores of this scale are totalled to range from 6 to 60, with higher scores representing higher perceived self-efficacy for managing chronic diseases [18]. 3) Sullivan’s cardiac self-efficacy scale 13-items (SCSES); this was originally written in English and put through the standard process of translation into Arabic and back-translation into English by independent bilingual translators to assess its translational validity. Sullivan et al. developed the SCSES, which consists of 13 items, each starting with: ‘how confident are you that you know or can … ’. Items are rated by participants from 0 to 4: 0 = “not at all confident”, 4 = “completely confident”. This scale contains two dimensions: control symptoms (8 questions) and maintaining functioning (5 questions) [19].
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The last section was related to QoL: we used the 5-level version of the EuroQoL 5-dimensions questionnaire (EQ-5D-5 L), and Euroqol Visual Analogue Scale (EQ-VAS). The EQ-5D-5 L is designed to collect information related to QoL from five health domains: self-care, mobility, usual activity, anxiety/depression, and pain/discomfort. Each aspect of these domains was evaluated in terms of no/slight/moderate/severe/extreme problems. The EQ-VAS asks the participant to rate his/her overall health by marking an X on a scale from 0 to 100 [20]. The EuroQol Group offered the Arabic version of the EQ-5D by online registration (ID: 15871). The EQ-5D score was calculated using the UK value set [21] due to the lack of a Palestinian or regional value set at the time of this study; this value set was the most commonly used in Palestine [22‐25]. We performed a pilot study on 15 patients to test the feasibility and clarity of the questions. The patients participating in the pilot study were not included in the final analysis. Trained medical students, under the continuous supervision of research team members, completed the data collection forms in face-to-face interviews with CHD patients. The face and content validity of the instrument was established by three experts in biostatistics as well as in research related to QoL.
Ethics approval
Statistical analysis
Results
Participant’s characteristics
Variable | Frequency (%) N = 275 |
---|---|
Age (year) | |
< 48 | 28(10.2) |
48–57 | 77(28.0) |
58–67 | 114(41.5) |
68–77 | 43(15.6) |
≥ 78 | 13(4.7) |
Gender | |
Female | 121(44.0) |
Male | 154(56.0) |
Residency | |
City | 108 (39.3) |
Village | 135(49.1) |
Palestinian refugee camps | 32(11.6) |
Social status | |
Married | 198(72.0) |
Single, widowed, divorced | 77(28.0) |
Educational level | |
No Formal | 66(24.0) |
Primary | 106(38.5) |
Secondary | 60(21.8) |
University | 43(15.6) |
Occupation | |
Employed | 129(46.9) |
Unemployed | 146(53.1) |
Income (NIS) | |
Moderate to High | 116(42.2) |
Low | 159(57.8) |
BMI | |
Normal | 49(17.8) |
Overweight | 129(46.9) |
Obese | 97(35.3) |
Cigarette | |
Not smoker | 144(52.4) |
Light | 7(2.5) |
Moderate | 36 (13.1) |
Heavy | 13 (4.7) |
Ex-smoker | 75 (27.3) |
Duration of the disease (year) | |
≤ 3 | 139 (50.5) |
4–5 | 71 (25.8) |
> 5 | 65 (23.6) |
Total number of medications | |
1–3 | 81(29.5) |
4–6 | 161(58.5) |
≥ 7 | 33(12.0) |
Total number of chronic diseases | |
0 | 13 (4.7) |
1 | 38 (13.8) |
2 | 84 (30.5) |
3 | 73 (26.5) |
≥ 4 | 67 (24.4) |
EQ-5D health status
EQ-5D index values and EQ-VAS score
Variable | Total Frequency (%) or median [Q1-Q3] N = 275 | Patients with better HRQoL Frequency (%) or median [Q1-Q3] n = 140 | Patients with worse HRQoL Frequency (%) or median [Q1-Q3] n = 135 | p-value a |
---|---|---|---|---|
Age (year) | ||||
< 48 | 28(10.2) | 21(15.0) | 7(5.2) | 0.025b |
48–57 | 77(28.0) | 43(30.7) | 34(25.2) | |
58–67 | 114(41.5) | 54(38.6) | 60(44.4) | |
68–77 | 43(15.6) | 16(11.4) | 27(20.0) | |
≥ 78 | 13(4.7) | 6(4.3) | 7(5.2) | |
Gender | ||||
Female | 121(44.0) | 56(40.0) | 65(48.1) | 0.174 b |
Male | 154(56.0) | 84(60.0) | 70(51.9) | |
Residency | ||||
City | 108 (39.3) | 54(38.6) | 54(40.0) | 0.820 b |
Village | 135(49.1) | 71(50.7) | 64(47.4) | |
Palestinian refugee camps | 32(11.6) | 15(10.7) | 17(12.6) | |
Social status | ||||
Married | 198(72.0) | 103(73.6) | 95(70.4) | 0.554 b |
Single, widowed, divorced | 77(28.0) | 37(26.4) | 40(29.6) | |
Educational level | ||||
No formal | 66(24.0) | 28(20.0) | 38(28.1) | 0.181 b |
Primary | 106(38.5) | 52(37.1) | 54(40.0) | |
Secondary | 60(21.8) | 33(23.6) | 27(20.0) | |
University | 43(15.6) | 27(19.3) | 16(11.9) | |
Occupation | ||||
Employed | 129(46.9) | 77(55.0) | 52(38.5) | 0.006b |
Unemployed | 146(53.1) | 63(45.0) | 83(61.5) | |
Income (NIS) | ||||
Moderate to high | 116(42.2) | 67(47.9) | 49(36.3) | 0.052 b |
Low | 159(57.8) | 73(52.1) | 86(63.7) | |
BMI | ||||
Normal | 49(17.8) | 27(19.3) | 22(16.3) | 0.390 b |
Overweight | 129(46.9) | 69(49.3) | 60(44.4) | |
Obese | 97(35.3) | 44(31.4) | 53(39.3) | |
Cigarette | ||||
Not smoker | 144(52.4) | 79(56.4) | 65(48.1) | 0.541 b |
Light | 7(2.5) | 4(2.9) | 3(2.2) | |
Moderate | 36(13.1) | 18(12.9) | 18(13.3) | |
Heavy | 13(4.7) | 7(5.0) | 6(4.4) | |
Ex-smoker | 75(27.3) | 32(22.9) | 43(31.9) | |
Duration of the disease (year) | ||||
≤ 3 | 139 (50.5) | 82(58.6) | 57(42.2) | 0.025b |
4–5 | 71 (25.8) | 31(22.1) | 40(29.6) | |
> 5 | 65 (23.6) | 27(19.3) | 38(28.1) | |
Total number of medications | ||||
1–3 | 81(29.5) | 25(18.5) | 56(40.0) | < 0.001b |
4–6 | 161(58.5) | 87(64.4) | 74(52.9) | |
≥ 7 | 33(12.0) | 23(17.0) | 10(7.1) | |
Total number of chronic diseases | ||||
0 | 13(4.7) | 3(2.2) | 10(7.1) | < 0.001b |
1 | 38(13.8) | 9(6.7) | 29(20.7) | |
2 | 84(30.5) | 44(32.6) | 40(28.6) | |
3 | 73(26.5) | 34(25.2) | 39(27.9) | |
≥ 4 | 67(24.4) | 45(33.3) | 22(15.7) | |
PEPPI-5 | 17[15–20] | 18[16–20] | 16[13–8] | < 0.001c |
SEMCD-6 | 5.8[5–6.8] | 6.3[5.4–7.3] | 5.5[4.7–6.5] | < 0.001c |
SCSES | 34[29–38] | 37[31–40] | 31[26–36] | < 0.001c |
Variable | Total Frequency (%) or median [Q1-Q3] N = 275 | Patients with better HRQoL Frequency (%) or median [Q1-Q3] n = 148 | Patients with worse HRQoL Frequency (%) or median [Q1-Q3] n = 127 | p-value a |
---|---|---|---|---|
Age (year) | ||||
< 48 | 28(10.2) | 23 (15.5) | 5 (3.9) | 0.008b |
48–57 | 77(28.0) | 42 (28.4) | 35 (27.6) | |
58–67 | 114(41.5) | 60 (40.5) | 54 (42.5) | |
68–77 | 43(15.6) | 16 (10.8) | 27 (21.3) | |
≥ 78 | 13(4.7) | 7 (4.7) | 6 (4.7) | |
Gender | ||||
Female | 121(44.0) | 62 (41.9) | 59 (46.5) | 0.447 b |
Male | 154(56.0) | 86 (58.1) | 68 (53.5) | |
Residency | ||||
City | 108 (39.3) | 57 (38.5) | 51 (40.2) | 0.819 b |
Village | 135(49.1) | 75 (50.7) | 60 (47.2) | |
Palestinian refugee camps | 32(11.6) | 16 (10.8) | 16 (12.6) | |
Social status | ||||
Married | 198(72.0) | 113 (76.4) | 85 (66.9) | |
Single, widowed, divorced | 77(28.0) | 35 (23.6) | 42 (33.1) | 0.083 b |
Educational level | ||||
No formal | 66(24.0) | 27 (18.2) | 39 (30.7) | |
Primary | 106(38.5) | 51 (34.5) | 55 (43.3) | < 0.001b |
Secondary | 60(21.8) | 34 (30.0) | 26 (20.5) | |
University | 43(15.6) | 36 (24.3) | 7 (5.5) | |
Occupation | ||||
Employed | 129(46.9) | 88 (59.5) | 41 (32.3) | < 0.001b |
Unemployed | 146(53.1) | 60 (40.5) | 86 (67.7) | |
Income (NIS) | ||||
Moderate to high | 116(42.2) | 79 (53.4) | 37 (29.1) | < 0.001b |
Low | 159(57.8) | 69 (46.6) | 90 (70.9) | |
BMI | ||||
Normal | 49(17.8) | 24 (16.2) | 25 (19.7) | 0.570 b |
Overweight | 129(46.9) | 68 (45.9) | 61 (48.0) | |
Obese | 97(35.3) | 56 (37.8) | 41 (32.3) | |
Cigarette | ||||
Not smoker | 144(52.4) | 85 (57.4) | 59 (60.5) | 0.257 b |
Light | 7(2.5) | 4 (2.7) | 3 (2.4) | |
Moderate | 36(13.1) | 17 (11.5) | 19 (15.0) | |
Heavy | 13(4.7) | 4 (2.7) | 9 (7.1) | |
Ex-smoker | 75(27.3) | 38 (25.7) | 37 (29.1) | |
Duration of the disease (year) | ||||
≤ 3 | 139 (50.5) | 86(58.1) | 53(41.7) | |
4–5 | 71 (25.8) | 38(25.7) | 33(26/0) | < 0.001b |
> 5 | 65 (23.6) | 24(16.2) | 41(32.3) | |
Total number of medications | ||||
1–3 | 81(29.5) | 47 (31.8) | 34 (26.8) | 0.055 b |
4–6 | 161(58.5) | 78 (52.7) | 83 (65.4) | |
≥ 7 | 33(12.0) | 23 (15.5) | 10 (7.9) | |
Total number of chronic diseases | ||||
0 | 13(4.7) | 11 (7.4) | 2 (1.6) | |
1 | 38(13.8) | 22 (14.9) | 16 (12.6) | 0.070 b |
2 | 84(30.5) | 37 (25.0) | 47 (37.0) | |
3 | 73(26.5) | 41 (27.7) | 32 (25.2) | |
≥ 4 | 67(24.4) | 37 (25.0) | 30 (23.6) | |
PEPPI-5 | 17[15–20] | 18[16–20] | 16[14–19] | 0.002c |
SEMCD-6 | 5.8[5–6.8] | 6.1[5.3–6.8] | 5.5[4.8–6.8] | 0.005c |
SCSES | 34[29–38] | 37[30–40] | 31[27–36] | < 0.001c |
Self-efficacy scales
Univariate analysis
Scales | EQ-5D | EQ-VAS | ||
---|---|---|---|---|
P-value | Correlation | P-value | Correlation | |
PEPPI-5 | < 0.001 | 0.419 | < 0.001 | 0.419 |
Sullivan’s scale | < 0.001 | 0.524 | < 0.001 | 0.524 |
SEMCD-6 | < 0.001 | 0.273 | < 0.001 | 0.273 |
EQ-5D | < 0.001 | 0.378 | ||
EQ-VAS | < 0.001 | 0.378 |
Multiple logistic regression analysis
Variable | B | S.E. | Wald | Sig. | Odds ratio with 95% CI | |
---|---|---|---|---|---|---|
Age | < 48 | Ref. | ||||
48–57 | −0.07 | 0.59 | 0.01 | 0.912 | 0.94(0.29–2.98) | |
58–67 | −0.10 | 0.60 | 0.03 | 0.875 | 0.91(0.28–2.95) | |
68–77 | −0.08 | 0.71 | 0.01 | 0.910 | 0.92(0.23–3.70) | |
≥78 | 1.64 | 0.99 | 2.75 | 0.097 | 5.16(0.74–35.93) | |
Occupation | Unemployed | Ref. | ||||
Employed | 0.27 | 0.32 | 0.74 | 0.391 | 1.31(0.71–2.43) | |
Duration of disease (year) | ≤3 | Ref. | ||||
4–5 | −0.78 | 0.37 | 4.33 | 0.057 | 0.46(0.22–1.09) | |
> 5 | −0.69 | 0.42 | 2.71 | 0.100 | 0.50(0.22–1.14) | |
Total number of medications | 1–3 | Ref. | ||||
4–6 | −0.63 | 0.40 | 2.48 | 0.115 | 0.54(0.25–1.17) | |
≥ 7 | −1.47 | 0.62 | 5.57 | 0.018 | 0.23(0.07–0.78) | |
Total number of chronic diseases | 0 | Ref. | ||||
1 | 0.18 | 0.96 | 0.04 | 0.853 | 1.19(0.18–7.77) | |
2 | −0.91 | 0.91 | 1.00 | 0.317 | 0.40(0.07–2.39) | |
3 | −0.37 | 0.94 | 0.16 | 0.691 | 0.69(0.11–4.33) | |
≥4 | −1.10 | 0.97 | 1.30 | 0.254 | 0.33(0.05–2.21) | |
Patient-Physician Interactions score | 0.10 | 0.05 | 4.41 | 0.036 | 1.11(1.01–1.22) | |
Self-Efficacy for Managing Chronic Disease score | 0.26 | 0.14 | 3.34 | 0.068 | 1.29(0.98–1.70) | |
Cardiac Self-Efficacy score | 0.09 | 0.03 | 8.51 | 0.004 | 1.10(1.03–1.17) |