Research Article| Volume 58, P62-68, March 2023

Factors influencing self-management behavior during the “Blanking Period” in patients with atrial fibrillation: A cross-sectional study based on the information-motivation-behavioral skills model

Published:November 17, 2022DOI:


      • The poor self-management behavior of AF patients during the "Blanking Period" after RFCA requires high attention and improvement.
      • This study is the first to apply the IMB model to explain the factors influencing self-management behavior in AF patients during the "Blanking Period" and to explore the interrelationship between each element and self-management behavior using path analysis.
      • Healthcare professionals should implement targeted interventions to improve patients' AF knowledge, self-management confidence, social support, and health literacy in order to improve their self-management behavior.



      Atrial fibrillation (AF) is becoming increasingly common. Effective self-management during the “Blanking Period” is critical. The Information-Motivation-Behavioral skills (IMB) model can be used to study health behaviors in chronic disease patients, but it has not been studied in AF patients.


      The goal of this study was to explore the influencing factors and interaction pathways of self-management behavior in AF patients during the "Blanking Period" using the IMB model.


      From June to December 2021, a cross-sectional design was conducted. Patients with AF during the "Blanking Period" (N=220) were recruited. They filled out several quantitative questionnaires, including the Jessa Atrial Fibrillation Knowledge Questionnaire, the Confidence in Atrial Fibrillation Management Scale, the Perceived Social Support Scale, the All Aspects of Health Literacy Scale, and the Self-care Scale for Chronic Atrial Fibrillation Patients. Data were analyzed using correlation analysis, multiple regression analysis, and path analysis.


      Total score of self-management behavior was (33.83 ± 10.66). AF knowledge (β = 0.252, P < 0.001), self-management confidence (β = 0.219, P < 0.001), social support (β = 0.291, P < 0.001), and health literacy (β = 0.262, P < 0.001) were all positively correlated with patients' self-management behavior, accounting for 66.50 percent of the total variance.


      During the "Blanking Period", the IMB model can be used to predict the factors that influence self-management behavior in AF patients. By using IMB model, interventions targeting patient-specific influencing factors could improve self-management behavior and quality of life in AF patients.


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        • Essien U.R.
        • Kornej J.
        • Johnson A.E.
        • Schulson L.B.
        • Benjamin E.J.
        • Magnani J.W.
        Social determinants of atrial fibrillation.
        Nat Rev Cardiol. 2021; 18: 763-773
        • Zulkifly H.
        • Lip G.Y.
        • Lane D.A.
        Epidemiology of atrial fibrillation.
        Int J Clin Pract. 2018; 72: e13070
        • Bergau L.
        • Bengel P.
        • Sciacca V.
        • Fink T.
        • Sohns C.
        • Sommer P.
        Atrial fibrillation and heart failure.
        J Clin Med. 2022; 11: 2510
        • Hindricks G.
        • Potpara T.
        • Dagres N.
        • et al.
        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; 42: 373-498
        • Pearsons A.
        • Hanson C.L.
        • Gallagher R.
        • et al.
        Atrial fibrillation self-management: a mobile telephone app scoping review and content analysis.
        Eur J Cardiovasc Nur. 2021; 20: 305-314
        • January C.T.
        • Wann L.S.
        • Alpert J.S.
        • et al.
        2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American college of cardiology/American heart association task force on practice guidelines and the heart rhythm society.
        J Am Coll Cardiol. 2014; 64: e1-e76
        • Larsson S.C.
        • Drca N.
        • Wolk A.
        Alcohol consumption and risk of atrial fibrillation: a prospective study and dose-response meta-analysis.
        J Am Coll Cardiol. 2014; 64: 281-289
        • Bingqing L.U.
        • Xiaohua W.
        • Xiaofang Y.
        • Yuan X.
        • HuiJie S.T.
        The status of self-management in patients with atrial fibrillation who taking warfarin.
        Chinese Nursing Management. 2019; 18 (Chinese): 1535-1539
        • Du X.
        • Guo L.
        • Xia S.
        • et al.
        Atrial fibrillation prevalence, awareness and management in a nationwide survey of adults in China.
        Heart. 2021; 107: 535-541
        • Tsamlag L.
        • Wang H.
        • Shen Q.
        • et al.
        Applying the information–motivation–behavioral model to explore the influencing factors of self-management behavior among osteoporosis patients.
        BMC Public Health. 2020; 20: 1-8
        • Fisher W.A.
        • Fisher J.D.
        • Harman J.
        The information-motivation-behavioral skills model: A general social psychological approach to understanding and promoting health behavior.
        Soc Psychol Found Health Illn. 2003; 22: 82-106
        • Fisher J.
        • Fisher W.
        • DiClemente R.
        • Kegler C.
        The Information-Motivation-Behavioral Skills Model. Emerging Theories in Health Promotion Practice and Research.
        Jossey-Bass, San Francisco, CA2002
        • Jeon E.
        • Park H.-.A.
        Development of the IMB model and an evidence-based diabetes self-management mobile application.
        Healthc Inform Res. 2018; 24: 125-138
        • Chen Y.
        • Zou H.
        • Zhang Y.
        • Fang W.
        • Fan X.
        Family caregiver contribution to self-care of heart failure: an application of the information-motivation-behavioral skills model.
        J Cardiovasc Nurs. 2017; 32: 576-583
        • Matthews J.
        • Hall A.M.
        • Keogh A.
        Evaluating the effects of behavior change training on the knowledge, confidence and skills of sport and exercise science students.
        BMC Sports Sci Med. 2020; 12 (R): 1-10
        • Fisher CM.
        Adapting the information–motivation–behavioral skills model: predicting HIV-related sexual risk among sexual minority youth.
        Health Educ Behav. 2012; 39: 290-302
        • Nelson L.A.
        • Wallston K.A.
        • Kripalani S.
        • LeStourgeon L.M.
        • Williamson S.E.
        • Mayberry L.S.
        Assessing barriers to diabetes medication adherence using the Information-Motivation-Behavioral skills model.
        Diabetes Res Clin Pr. 2018; 142: 374-384
        • Akgün P.
        • Taştekin A.
        The effect of information–motivation–behavioral skills on breastfeeding success: a hypothetical model.
        J Transcult Nurs. 2020; 31: 378-386
        • Faul F.
        • Erdfelder E.
        • Lang A.-.G.
        • G* BA.
        Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences.
        Behav Res Methods. 2007; 39: 175-191
        • Kline R.B.
        Principles and Practice of Structural Equation Modeling.
        Guilford publications, 2015
      1. Kindig D.A., Panzer A.M., Nielsen-Bohlman L. Health literacy: a prescription to end confusion. 2004.

        • Desteghe L.
        • Engelhard L.
        • Raymaekers Z.
        • et al.
        Knowledge gaps in patients with atrial fibrillation revealed by a new validated knowledge questionnaire.
        Int J Cardiol. 2016; 223: 906-914
        • Nudelman G.
        • Kamble S.V.
        • Otto K.
        Using protection motivation theory to predict adherence to COVID-19 behavioral guidelines.
        Behav Med. 2021; : 1-10
        • Tripp C.
        • Gehi A.K.
        • Rosman L.
        • Anthony S.
        • Sears SF.
        Measurement of patient confidence in self-management of atrial fibrillation: initial validation of the confidence in atrial fibriLlation management (CALM) scale.
        J Cardiovasc Electr. 2021; 32: 1640-1645
        • Zimet G.D.
        • Dahlem N.W.
        • Zimet S.G.
        • Farley G.K.
        The multidimensional scale of perceived social support.
        J Pers Assess. 1988; 52: 30-41
        • Huang Y.
        • Wu R.
        • Wu J.
        • Yang Q.
        • Zheng S.
        • Wu K.
        Psychological resilience, self-acceptance, perceived social support and their associations with mental health of incarcerated offenders in China.
        Asian J Psychiatr. 2020; 52102166
        • Mackey L.M.
        • Doody C.
        • Werner E.L.
        • Fullen B.
        Self-management skills in chronic disease management: what role does health literacy have?.
        Med Decis Making. 2016; 36: 741-759
        • Chinn D.
        • McCarthy C.
        All aspects of health literacy scale (AAHLS): developing a tool to measure functional, communicative and critical health literacy in primary healthcare settings.
        Patient Educ Couns. 2013; 90: 247-253
        • Son Y.-.J.
        • Baek K.H.
        • Won M.H.
        • Hong H.C.
        Development and psychometric testing of the self-care scale for patients with chronic atrial fibrillation (AF-SCS-10).
        Eur J Cardiovasc Nur. 2020; 19: 619-628
        • Mosobalaje O.
        • Ajia M.
        • Orodu O.
        • Ogbe D.
        Ergodic and non-ergodic variogram uncertainty in Agbabu bitumen field porosity data.
        in: Proceedings of the IOP Conference Series: Materials Science and Engineering. 2019
        • Becker J.
        • Emmert-Fees K.M.
        • Greiner G.G.
        • et al.
        Associations between self-management behavior and sociodemographic and disease-related characteristics in elderly people with type 2 diabetes—New results from the population-based KORA studies in Germany.
        Prim Care Diabetes. 2020; 14: 508-514
        • Oh Y.H.
        • Hwang S.Y.
        Individualized education focusing on self-management improved the knowledge and self-management behaviour of elderly people with atrial fibrillation: A randomized controlled trial.
        Int J Nurs Pract. 2021; 27: e12902
        • Zou H.
        • Chen Y.
        • Fang W.
        • Zhang Y.
        • Fan X.
        Identification of factors associated with self-care behaviors using the COM-B model in patients with chronic heart failure.
        Eur J Cardiovasc Nur. 2017; 16: 530-538
        • McCabe P.J.
        • Stuart-Mullen L.G.
        • McLeod C.J.
        • et al.
        Patient activation for self-management is associated with health status in patients with atrial fibrillation.
        Patient Prefer Adher. 2018; 12: 1907
        • Sloand E.
        • Butz A.
        • Rhee H.
        • et al.
        Influence of social support on asthma self-management in adolescents.
        J Asthma. 2021; 58: 386-394
        • Matsuoka S.
        • Tsuchihashi-Makaya M.
        • Kayane T.
        • et al.
        Health literacy is independently associated with self-care behavior in patients with heart failure.
        Patient Educ Couns. 2016; 99: 1026-1032
        • Wijesurendra R.S.
        • Casadei B.
        Mechanisms of atrial fibrillation.
        Heart (British Cardiac Society). 2019; 105: 1860-1867
        • Čihák R.
        • Haman L.
        • Táborský M.
        2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS.
        Cor Vasa. 2016; 6: e636-e683