Methods
This study was part of a larger project assessing the utility of a
web-based self-care intervention for AF patients, within the context of
the COVD-19 pandemic. Patients were recruited from the patient panel of
electrophysiologists at the University of North Carolina through
electronic outreach. Patients who consented and were enrolled in the
intervention study completed several electronic surveys prior to and
following the intervention, including surveys of demographic
information, health information, and knowledge/attitudes/beliefs about
COVID-19, as well as other validated surveys.
For the purposes of this study, patient responses on the CALM,
PROMIS-29, and AFEQT were analyzed. The PROMIS-29 is a widely validated
and used assessment of general quality of life including eight domains:
pain intensity and interference, fatigue, sleep disturbance, physical
functioning, depression, anxiety, and ability to participate in social
roles and activities.15 The AFEQT is a
well-established and widely used, four-factored descriptive measure of
disease-specific patient quality of life, with demonstrated validity and
reliability (internal consistency >.88 on all
factors).12 This measure is used to describe the
patient experience of AF, specifically symptoms, daily activities, and
perceptions of treatment (i.e. concerns and satisfaction). Medical
record review was conducted to obtain information about health and
relevant comorbidities. This study was approved by the Institutional
Review Board at the University of North Carolina at Chapel Hill (IRB
#20-1121).
Items for the CALM measure were patterned after items from the Self-care
of Heart Failure Index (SCHFI) (REF: Riegel) and modified by a cardiac
electrophysiologist (AG) and clinical health psychologist (SFS) to
tailor them to AF. Next, multiple AF providers including medicine,
psychology, and nursing provided feedback on relevance and
comprehensiveness of the items to reflect the patient experience with
confidence and AF. The preliminary items were then employed in the
current study.
Statistical Analyses . The current study utilized survey
responses, prior to intervention, in order to establish the validity of
a stand-alone measure of confidence in self-management of AF, the CALM,
and to describe and compare scores on this measure with other survey
data (e.g. AFEQT).
Principle Components Analysis (PCA) was used to analyze the 16-item CALM
measure, in order to group variables into key components. A varimax
rotation was employed to simplify each component, minimizing the amount
of variance within each component and maximizing the variance between
components. Cronbach’s alpha was then used to assess reliability of the
total measure, as well as the reliability of the individual components.
Correlational analyses and independent samples t-tests were then used to
assess the relationships and differences in scores on several
demographic, health, and QOL variables.