Trajectories of self-care agency and associated factors in lung transplant recipients over the first 12 months following transplantation

Abstract

Self-care agency (SCA), defined as one's ability and willingness to engage in self-care behaviors, can influence actual performance of self-care behaviors in lung transplant recipients (LTRs). Understanding patterns of SCA over time may inform the design of interventions to promote self-care in LTRs. Using group-based trajectory modeling, we sought to identify patterns and correlates of SCA among 94 LTRs over the first 12 months post-transplant. Baseline measures of sociodemographic, clinical, and psychosocial factors, and longitudinally assessed psychological distress were examined for their associations with predicted trajectory group membership. Three distinct stable (ie, zero slope) SCA trajectories were identified as follows: persistently low, persistently moderate, and persistently high. Based on the final multivariate model, requiring a re-intubation after transplant (P=.043), discharged to a facility rather than home (P=.048), and reporting a higher level of baseline anxiety (P=.001) were significantly associated with lower SCA. Linear mixed models revealed that higher levels of anxiety and depression were associated with lower SCA in the persistently moderate and low SCA groups over the 12-month time period (Ps<.05). LTRs who require a re-intubation after transplant and are discharged to a facility other than home, and report high psychological distress, may need additional assistance to engage in post-transplant self-care behaviors.

Keywords: group-based trajectory modeling; lung transplant recipients; self-care; self-care agency; self-management.

Conflict of interest statement

CONFLICT OF INTEREST

None.

© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Figures

FIGURE 1

Trajectory groups for self-care agency (SCA) over the first 12 mo after discharge from lung transplant. Solid lines are based on actual SCA scores, and dashed lines are based on predicted values from group-based trajectory modeling

FIGURE 2

Levels of anxiety over 12 mo by self-care agency (SCA) groups

FIGURE 3

Levels of depression over 12 mo by self-care agency (SCA) groups