The relationship between disease perception, self-efficacy, coping style and self-regulatory fatigue in old adults patients with hypertension:A cross-sectional study

doi:10.21203/rs.3.rs-4938049/v1

Purpose:The old adults patients with hypertension need long-term self-control to maintain their blood pressure levels and delay the development of the disease. In the long run, the patient's self-control ability will be worn down, resulting in self-regulatory fatigue.However, no studies have shown the relationship between disease perception, self-efficacy,coping style, and self-regulatory fatigue.This study aimed to investigate the relationship between disease perception, self-efficacy,coping style and self-regulatory fatigue in old adults patients with hypertension.

Methods:A cross-sectional survey was conducted among 416 old adults patients with hypertension in the First Affiliated Hospital of Jinzhou Medical University, Liaoning Province by convenience sampling method.The general demographic questionnaire, brief illness perception questionnaire,general self-efficacy scale,medical coping modes questionnaire and self-regulatory fatigue scale were used to investigate.The mediation effect was analyzed by Amos23.0 software.

Results:Disease perception, avoidance, and acceptance-resignation can directly act positively on self-regulatory fatigue, while self-efficacy and confrontation can directly act negatively on self-regulatory fatigue. Disease perception can act on self-regulatory fatigue through the chain mediating effect between self-efficacy, confrontation, avoidance, and acceptance-resignation.

Conclusion:The old adults patients with hypertension had higher self-regulatoryfatigue level.Disease perception, avoidance and acceptance-resignation were positively correlated with self-regulatory fatigue, reducing patients' negative emotions about disease and improving their confidence in disease treatment can reduce patients' self-regulatory fatigue.

old adults

hypertension

ego-depletion

disease perception

self-efficacy

coping style

chain mediating

Hypertension is the main risk factor of cerebrovascular diseases, and its prevalence increases with the increase of age, so it is more common in the old population, which seriously threatens the life health and safety of the old adults(Yin et al.,2022;Guasti et al.,2022).Relevant studies have pointed out that a series of physiological reactions brought about by aging, including the increase of pulse stiffness, pulse pressure widening and other factors, will not only affect blood pressure but also cause related complications(Pont et al.,2017).Effective self-management can improve the control effect of blood pressure and reduce the occurrence of related complications, but the self-management behavior of old adults patients with hypertension in China was low, especially the exercise management ability(Zhang et al.,2020).It also indicated that the self-control ability of old adults patients with hypertension was relatively weak.According to the theory of self-control resources, Baumeister proposed the concept of ego-depletion (also known as self-regulatory fatigue).He believed that ego-depletion referred to the consumption of limited mental resources caused by an individual's self-regulation behavior, which may lead to a series of cognitive, emotional and behavioral problems(Baumeiste et al.,1998).Some scholars have pointed out that self-regulatory fatigue was a continuous fatigue state that occurred after the excessive consumption of self-control resources, and it was a kind of psychological resource consumption generated by patients when they cope with the problems caused by the disease for a long time, and it is difficult for patients to return to normal after this state(Nes et al.,2013).Previous studies have shown that self-regulatory fatigue was a common psychological experience for most patients with chronic diseases. Patients were under severe physical and psychological stress to endure the pain of physical illness and regulate their emotions, which quickly depleted the patient's resources for self-control(Li et al.,2022).Therefore, the self-regulatory fatigue of old adults patients with hypertension needed to be discovered and intervened to reduce the psychological burden of patients and improve the treatment effect.

Disease perception referred to the individual's perception of the disease, including the patient's experience, thoughts and beliefs about the disease, and the more negative the patient's expression of the current disease state, the higher the score(Hansen et al.,2021).Relevant studies have shown that disease cognition was a key factor in behavior orientation in disease management, and incorrect disease cognition can lead to health behavior disorders in patients(Maninet et al.,2023).Some scholars believed that patients were prone to negative experiences about the disease when receiving treatment, and then have wrong perceptions about the disease, which leads to the phenomenon of patients having bad emotions and weakened behavioral control(Xiong et al.,2023).Therefore, nursing staff should popularize the correct knowledge of the disease in time and improve the negative emotions of the disease while planning to improve the self-regulatory ability of patients and reduce their self-regulatory fatigue.

Self-efficacy referred to an individual's confidence in their ability to perform a task(Bandura et al.,2001).Yu et al(Yu et al.,2022)found that self-efficacy can promote physical activity by improving an individual's self-control ability.Therefore, when patients have a high sense of self-efficacy, their self-control ability is relatively high, and when they consume relatively less psychological resources in the face of difficulties brought by the disease, their self-regulatory fatigue degree will decrease.Kurt et al.(Kurt et al.,2022)found that the strongest symptom of cancer patients is fatigue, and the degree of fatigue will decrease with the increase of patients' self-efficacy level.It suggested that the improvement of self-efficacy had some value in reducing the fatigue caused by the patient's adaptation.

Coping style was an important psychological resource for individuals to cope with stress. During stressful encounters, it played a key role in the stressor and stress response(Li et al.,2021).Previous studies have shown that positive and appropriate coping styles can help patients manage their feelings and challenges and threats, so that patients can gain a sense of disease control(Wang et al.,2022).The positive coping style will reduce the psychological pressure of patients, consume less psychological resources, and reduce the fatigue degree of patients(Liu et al.,2020) pointed out that coping styles can regulate self-control and health outcomes,Individuals who adopt avoidant coping tend to show poor self-control(Lucke et al.,2023).Therefore, when patients adopt the negative coping style of avoidance and acceptance-resignation, the degree of self-regulatory fatigue was often more serious.It showed that coping style played an important role in self-regulatory fatigue.

In this study, the self-regulatory model was used as the theoretical basis for variable hypothesis.The self-regulatory model holded that the coping strategies adopted by individuals in the face of health threats depend on their perception of threats and personal beliefs, and then individuals will evaluate the strategies and behaviors adopted, and finally adjust their cognition and coping behaviors of diseases according to the evaluation results(Leventhal et al.,2016).Therefore, in this study, disease perception,self-efficacy and coping style were taken as factors that could affect self-regulatory fatigue to build a structural equation model, and it was assumed that disease perception could affect self-regulatory fatigue through the chain mediating of self-efficacy and coping style(Fig. 1).

Design and participants

This study was a cross-sectional investigation. A total of 416 old adults patients with hypertension from the Department of Cardiology and Geriatrics of the First Affiliated Hospital of Jinzhou Medical University in Jinzhou City, Liaoning Province, China were selected by convenience sampling method.The inclusion criteria of the subjects included: (1) Patients with hypertension who met the diagnostic criteria of the Chinese Guidelines for Hypertension Prevention and Treatment (2018 Revised Edition) [19]; (2)Participants aged 60 years or older.;(3)Participants were conscious and able to communicate normally; (4)Participants gave informed consent and volunteered to participate in the study. The exclusion criteria were: (1)Participants had hypertension combined with severe cardiovascular, brain, liver, and kidney dysfunction(2) Patients with mental illness and cognitive impairment.

According to the sample size requirements of Kendall multivariate analysis, the sample size of the influencing factor study is at least 5–10 times the number of variables(Kendall,1975). This study included a total of 16 variables and removed 20% of the loss, so the required sample size ranged from 96 to 192 cases. In addition, the construction of structural equation models requires a sample size of at least 200 cases(Jak et al.,2020). In order to make the representativeness of the research objects larger and ensure the reliability of the research results, the sample size of 416 cases was finally included in this study.

Measurements

General demographic questionnaire

On the basis of group discussion and literature review, the researchers determined that the content of general demographic data mainly included nine items: age, gender, education level, occupation, marital status, per capita monthly income of the family, number of years of hypertension, number of comorbidities, and chronic pain.

Self-regulatory fatigue scale(SRF-S)

The scale was compiled by Nes et al(Nes et al.,2013). It was translated into Chinese by Wang et al(Wang et al.,2015). The Chinese version of the scale included 3 dimensions and 16 items. Among them, cognitive control included 6 items,emotional control included 5 items, and behavior control included 5 items.Using Likert 5-level scoring method, the score from strongly disagree to strongly agree was 1–5, where items 1, 2, 5, 9 and 14 were reverse scoring questions, and the total score was 16–80. A higher score indicated a higher level of self-regulated fatigue in the patients. The Cronbach's α coefficient of the total scale in this study was 0.964.

Brief illness perception questionnaire(BIPQ)

The questionnaire was compiled by Broadbent et al(Broadbent et al.,2016). Mei et al(Mei et al.,2015). introduced it into China and verified the reliability and validity of the Chinese version of the scale in female breast cancer patients. The questionnaire was mainly used to assess patients' negative emotions towards the disease, including disease cognition, emotion and disease understanding with 9 items in 3 dimensions.The questionnaire adopted an 11-level scoring method (0–10), with a total score ranging from 0–80. The higher the score, the stronger the negative emotion of the patient towards the disease.The Cronbach's α coefficient of this questionnaire in this study was 0.872.

General self-efficacy scale(GSES)

The scale was compiled by Schwarzer et al(Schwarzer et al.,1997). Wang Cai-kang et.al(Wang et al.,2001).translated into Chinese. The single-dimension scale consisted of 10 items. Likert 4-level scoring method was used to score 1–4 points from completely incorrect to completely correct. The total score of the scale was 10–40. The higher the score, the higher the self-efficacy of an individual, the Cronbach's α coefficient of the scale in this study was 0.878.

Medical coping modes questionnaire(MCMQ)

The questionnaire was compiled by Feifel et al(Feifel et al.,1987). Shen et.al.(Shen et al.,2001)translated into Chinese. The questionnaire included 20 items in three dimensions

confronting, avoidance and submission. Likert 4-level scoring method was adopted. The total score of the confronting dimension was 18–32, the total score of the avoidance dimension was 7–28, and the score of the submission dimension was 5–20. The Cronbach's α coefficients of confronting, avoidance and submission in this study were 0.945, 0.856 and 0.813, respectively.

Ethical considerations and data Collection

This study was approved by the Ethics Committee of Jinzhou Medical University (number: JZMULL2023047), ) and conducted under ethical guidelines described in the Helsinki Declaration.This study was conducted in the First Affiliated Hospital of Jinzhou Medical University from November 2022 to March 2023. After obtaining the consent of the director of the geriatric Department, the director of the cardiology department and the head nurse, the clinical data were collected.The data collection process was carried out after the patients had completed treatment and was in a stable state. Before the formal investigation, the investigator explained the purpose and significance of the investigation to the research subjects to ensure that the patients were clear about the precautions of the study and voluntarily participated in the study.In the process of questionnaire collection, questionnaires were distributed one-to-one by investigators. All questionnaires were collected on the spot, the contents with gaps were completed on the spot, and invalid questionnaires were checked and eliminated.

Data analysis

SPSS25.0 software was used for descriptive statistical analysis. Mean and standard deviation was used for measurement data, and frequency or component ratio was used for counting data. Single factor One-way ANOVA or t test was used to compare the effects of different demographic data on self-regulated fatigue. The correlation analysis of Pearson was used to analyze the correlation among variables. Multiple stepwise linear regression analysis was used to analyze the influencing factors of self-regulation fatigue.AMOS23.0 software was used to construct structural equation models between disease perception, self-efficacy, coping styles, and self-regulatory fatigue.Bootstrap method was used to evaluate the model fitting effect and mediating effect, and P < 0.05 was considered as statistically significant.

Demographic characteristics

A total of 416 old adults patients with hypertension were recruited in this study, with an average age of (70.97±6.76) years old, ranging from 60 to 84 years old, including 215 males (51.7%), 32.5% of the old adults patients with hypertension with education in primary school or below, 78.4% of the patients were married.The remaining data are shown in Table 1.

Descriptive statistical analysis of self-regulatory fatigue, disease perception, self-efficacy, and medical coping style

In this study, the score of self-regulatory fatigue in old adults patients with hypertension was 55.36±14.91, which was at a medium-high level.The scores of cognitive control, emotional control and behavioral control were 20.59±5.78, 17.72±4.76 and 17.05±4.89, respectively.The total score of disease perception was 52.83±13.63, which was at a medium-high level.The total self-efficacy score was 25.46±5.73,which was in the middle level.The score for confrontation was 13.02±5.35, for avoidance coping 16.41±4.6, and for acceptance-resignation 12.05±3.12.Detailed results are shown in Table 2.

Correlations between variables

Pearson correlation analysis showed that self-regulatory fatigue was positively correlated with disease perception(r=0.684,p<0.001), negatively correlated with self-efficacy(-0.639,p<0.001), negatively correlated with confrontation, (-0.494,p<0.001),and positively correlated with avoidance(r=0.490,p<0.001) and acceptance-resignation(r=0.618,p<0.001). Disease perception was negatively correlated with self-efficacy(r=-0.402,p<0.001)and confrontation(r=-0.324), positively correlated with avoidance(r=0.362,p<0.001) and acceptance-resignation(r=0.484,p<0.001). Self-efficacy was positively correlated with confronting coping(r=0.345,p<0.001),negatively correlated with confrontation(r=-0.393,p<0.001)and acceptance-resignation(r=-0.434,p<0.001).The specific results are shown in Table 3.

The role of self-efficacy and coping style in the chain mediating between disease perception and self-regulatory fatigue

In this study, disease perception was an independent variable, and its three dimensions (disease cognition, emotion and disease understanding) were latent variables. The mediating variables were confrontation, avoidance, and acceptance-resignation. Self-regulatory fatigue was the dependent variable, and its three dimensions (cognitive control, emotional control and behavioral control) were latent variables. We used Amos23.0 software to build the structural equation model, as shown in Figure 2.

The maximum likelihood method was used to to fit the model,which showed that all path differences were statistically significant (P < 0.001).All fitting indexes of the model were within the acceptable range, which can be accepted(Table 4).The results showed that disease perception had a direct positive predictive effect on self-regulatory fatigue(β=0.422,p<0.001),Self-efficacy can directly and negatively predict self-regulatory fatigue(β=-0.275,p<0.001),confrontation can directly and negatively predict self-regulatory fatigue(β=-0.193,p<0.001),avoidance can directly and negatively predict self-regulatory fatigue(β=0.114,p<0.001),acceptance-resignation can directly and negatively predict self-regulatory fatigue(β=0.189,p<0.001).Self-efficacy played a partial mediating role between disease perception and self-regulatory fatigue,confrontation played a partial mediating role between disease perception and self-regulatory fatigue; confrontation played a partial mediating role between disease perception and self-regulatory fatigue,acceptance-resignation played a partial mediating role between disease perception and self-regulatory fatigue. Disease perception, confrontation, avoidance, and acceptance-resignation played a chain mediating role between disease perception and self-regulatory fatigue.The specific results are shown in Table 5.

This study investigated the current situation of the self-regulatory fatigue, disease perception, self-efficacy and coping style in the old adults patients with hypertension. It also revealed the chain mediating effect of self-efficacy and coping style between disease perception and self-regulatory fatigue.

Analysis of self-regulatory fatigue, disease perception, self-efficacy and coping style in old adults patients with hypertension

The results of this study showed that the self-regulatory fatigue level of the old adults patients with hypertension was higher than the domestic norm value and was at a higher level(Cui et al.,2021).It indicated that the old adults patients with hypertension have obvious self-regulatory fatigue, which may be related to the decline in self-management ability caused by the long illness time of hypertension patients, poor blood pressure control effect and long medication time, and then the psychological burden of patients, resulting in self-regulatory fatigue(Bosworth et al.,2010).As a chronic disease, old adults patients with hypertension have many complications, low control rate and poor prognosis. In addition to physical distress, in the long process of treatment, medical expenses, the threat of complications, and low family care will further have a certain impact on the mental health of old adults patients with hypertension(Rogers et al.,2021;Turana et al.,2021).In the long run, the patient's self-control ability and the ability to self-regulate the negative effects of the disease will decline, resulting in self-regulatory fatigue.It suggested that nursing staff should always pay attention to the psychological fatigue of patients in clinical practice, popularize disease knowledge to patients in a timely manner, introduce good cases of hypertension control, emphasize the importance of self-management, and help patients reduce the psychological burden.

In this study, the disease perception score of old adults patients with hypertension was higher, which was higher than that of Alfian et al.'s survey on disease perception of old adults with hypertension patients(Alfian et al.,2021). It suggested that the old adults patients with hypertension have higher negative emotion of disease.It may be related to the fact that this study investigated elderly hospitalized hypertensive patients, most of whom had multiple diseases and could not judge and analyze their disease status well(Shi et al.,2022).In addition, the old adults have aging phenomenon, memory decline, and the gradual degradation of various body functions, which leaded to their inability to deeply understand the mechanism of disease, lack of relevant experience in disease knowledge, and tend to have high negative emotions about the current situation of disease(Juan et al.,2019;Khan et al.,2014).Therefore, nursing staff should strengthen the psychological counseling of elderly hypertension patients in clinical work, and change their inherent ideas and wrong cognition of the disease.

In this study, the self-efficacy of middle-aged and old adults patients with hypertension was at a medium level, which was consistent with the results of Lu et al.(Lu et al.,2023).There was a negative correlation between self-efficacy and self-regulatory fatigue in old adults patients with hypertension (P < 0.001), indicating that the higher the patient's self-efficacy, the lower the degree of self-regulatory fatigue, which is consistent with the results of previous studies(Li et al.,2022).This also fully reflected the important role of individual belief in the process of disease management, which can effectively reduce patients' consumption of psychological resources and reduce patients' self-regulatory fatigue. Therefore, nursing staff should pay attention to enhance the belief of hypertensive patients against the disease, affirm their own ability, and help patients establish confidence to overcome the disease.

This study found that confrontation was the protective factor of self-regulated fatigue, and avoidance and acceptance-resignation was the risk factor of self-regulatory fatigue. In this study, middle-aged and old adults patients with hypertension were more inclined to avoidant coping styles. It suggested that medical staff should encourage patients to take a positive and positive way to cope with the disease, and play a positive role in the protection of self-regulatory fatigue.

Self-regulatory of the relationship between fatigue, disease perception, self-efficacy, and coping style

This study found that disease perception, avoidance and acceptance-resignation were positively correlated with self-regulatory fatigue, while self-efficacy and confrontation were negatively correlated with self-regulatory fatigue.It showed that when patients have a higher negative emotion of perception of disease, the degree of self-regulatory fatigue is more serious. Therefore, in nursing practice, scientific disease knowledge should be popularized to reduce the negative cognition of disease and help patients get out of bad emotions.At the same time, we should pay attention to the important role of self-belief in disease management, improve patients' confidence in disease treatment, help improve patients' self-regulation ability, and thus reduce self-regulatory fatigue.The positive coping style can reduce the negative emotions of patients, whereas the avoidance and acceptance-resignation will make patients lack of disease management experience and self-control ability, and patients are prone to self-regulation fatigue when they adjust various adverse effects of the disease(Boals et al.,2011).Therefore, nursing staff should formulate appropriate intervention measures according to the influence of illness emotion, self-efficacy and coping style on self-regulatory fatigue.

The role of self-efficacy and coping style in the chain mediation between disease perception and self-regulatory fatigue

The mediating effect results showed that disease perception not only directly and positively affected self-regulatory fatigue, but also affected self-regulatory fatigue through the chain mediating role of self-efficacy and confrontation, self-efficacy and avoidance,self-efficacy and acceptance-resignation. This may be because the perception of illness has a negative effect on self-efficacy. When patients have higher negative emotions about the disease, their belief in the treatment of the disease is reduced, and they choose to avoid or succumb to the disease, so the self-regulatory fatigue is higher(Liu et al.,2020). In addition, the perception of illness had a negative effect on faces, and a positive effect on avoidance and acceptance-resignation. This may be because when patients perceive the negative emotions brought by the disease, they are often unwilling to face the problems brought by the disease, and will choose to avoid or give in. At this point, the patient's ability to self-regulate will decrease, leading to fatigue.The results of this study also validate the conceptual framework of the self-regulation model. Therefore, in clinical work, while paying attention to the direct impact of disease perception on self-regulatory fatigue, it is also necessary to clarify the impact of self-efficacy and coping style on patients' self-regulatory state.

Disease perception can have a direct positive effect on self-regulation of fatigue, Disease perception can also influence self-regulatory fatigue through the chain mediating effects of self-efficacy and confrontation, self-efficacy and avoidance, and self-efficacy and acceptance-resignation.This study applied the concept of self-regulatory fatigue to old adults patients with hypertension for the first time, providing a theoretical basis for nursing staff to formulate intervention measures.In the future nursing practice, nursing staff should fully mobilize the protective effect of self-efficacy on self-regulatory fatigue, encourage patients to actively face the disease, strengthen the psychological, emotional and cognitive intervention of patients, adjust the status quo of self-regulatory fatigue in patients with hypertension as soon as possible, and then promote the ability of patients to self-manage the disease, and better promote the disease treatment process of patients with hypertension.

This study was conducted in only one Top three hospital in one city in China, thus the generalization of results requires further validation. Future studies should increase the sample size and conduct multi-center crosssectional investigations.

Data availability statement

The raw data supporting the conclusion of this article will be made available by the authors, without undue reservation.

Ethics statement

This study was approved by the Ethics Committee of Jinzhou Medical University(JZMULL2023046),All participants gave informed consent and volunteered to participate in this study.

Funding

This study was not funded.

Acknowledgments

The authors express their gratitude to all contributors for their diligent work on this study and all participants who voluntarily participated in the research.

Authors’ Contributions

All authors made important contributions to this study. TL and ZJ designed and wrote the article.YE revised and improved the manuscript.FQ and TJ participated in the collection and analysis of data. All authors contributed to the article and approved the submitted version.

Conflict of interest

There is no conflict of interest in this study.

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Table 1 Influence of different Social demography factors on self-regulatory fatigue in old adults patients with hypertension

variables

n(%)

score（`x±s）

Statistical value

P

Gender

Male

Female

21（51.7%）

20（48.3%）

54.54±14.91

56.24±14.88

t=-1.166

0.244

Age

60～69

70～79

≥80

19（47.4%）

17（42.5%）

42（10.1%）

51.97±15.51

58.20±13.84

59.31±13.06

F=10.197

＜0.001^*

Educational level

Primary and below

Junior high school

High school or technical secondary school

Bachelor degree or above

13（32.5%）

16（39.7%）

90（21.6%）

26（6.3%）

59.72±11.67

58.15±12.20

50.76±16.75

31.00±11.65

F=40.98

＜0.001^*

pre-retirement occupation

Peasant

Individual business

Unit staff

Other occupations

57（13.7%）

11（28.4%）

22（55.0%）

12（2.9%）

58.14±13.78

54.18±16.09

55.71±14.52

47.25±12.86

F=2.152

0.093

Marital status

Married

Unmarried

Divorced

Widowed

32（78.4%）

2（0.5%）

25（6.0%）

63（15.1%）

55.71±14.87

58.50±13.44

51.52±15.17

55.02±15.15

F=0.651

0.583

Per capita annual household income(yuan)

≤1000

1001-3000

3001-5000

＞5000

10（2.4%）

18（43.3%）

17（42.8%）

48（11.5%）

66.30±8.67

58.20±12.63

55.95±14.61

40.27±16.65

F=23.846

＜0.001^*

Years of hypertension(years)

＜5

5-10

11-15

≥16

55（13.2%）

12（30.8%）

13（31.7%）

10（24.3%）

42.33±16.24

53.90±15.58

58.68±12.17

59.98±12.04

F=23.864

＜0.001*

Number of complications(kinds of)

None

1

2

≥3

13（31.3%）

12（30.8%）

13（32.7%）

22（5.3%）

45.64±16.26

57.46±14.05

61.54±9.44

62.41±9.38

F=35.996

＜0.001*

Chronic pain

Yes

No

15（37.7%）

25（62.3%）

61.68±9.34

51.53±16.30

F=8.071

＜0.001*

Table 2 Scores of various scales in old adults patients with hypertension

Variable	Number of items (n)	Range	Mean ± SD ( `x± s)	Mean ± SD (`x± s) (each item)
Self-regulatory fatigue(total points)	16	16～80	55.36±14.91	3.46±0.93
Cognitive control	6	6～30	20.59±5.78	3.43±0.96
Emotional control	5	5～25	17.72±4.76	3.54±0.95
Behavior control	5	5～25	17.05±4.89	3.41±0.98
Disease perception	9	0～80	52.83±13.63	6.60±1.70
Disease cognition	5	0～50	33.30±8.54	6.66±1.71
Emotion	2	0～20	12.90±4.17	6.45±2.09
Disease understanding	1	0～10	6.63±2.48	6.63±2.48
Self-efficacy	10	10～40	25.46±5.73	2.55±0.57
confrontation	8	8～32	13.02±5.35	1.63±0.67
avoidance	7	7～28	16.41±4.57	2.34±0.65
Acceptance resignation	5	5～20	12.05±3.12	2.41±0.62

Table 3 Correlations between variables

	Self-regulatory fatigue	Disease perception	self-efficacy	confrontation	avoidance	acceptance-resignation
Self-regulatory fatigue	1.000
Disease perception	0.684^**	1.000
self-efficacy	-0.639^**	-0.402^**	1.000
confrontation	-0.494^**	-0.324^**	0.345^**	1.000
avoidance	0.490^**	0.362^**	-0.393^**	-0.163^*	1.000
acceptance-resignation	0.618^**	0.484^**	-0.434^**	-0.268^**	0.410^*	1.000

Note :** means P < 0.001, * means P < 0.05

Table 4 Model fitting index

x²

df

X²/df

RMSEA

GFI

AGFI

CFI

NFI

Model index

63.314

27

2.345

0.057

0.971

0.942

0.988

0.979

References index

<3

<0.08

>0.9

Table 5 Direct effect, indirect and total effect of variables (standardized)

Effect	Path	β	Effect size(n%)	95%CI
Direct effect	Disease perception→Self-regulatory fatigue	0.422	55.82	0.350～0.494
Indirect effect	Disease perception→self-efficacy→Self-regulatory fatigue	0.302	39.95	0.224～0.402
	Disease perception→confrontation→ Self-regulatory fatigue	0.124	16.40	0.065～0.202
	Disease perception→avoidance → Self-regulatory fatigue	0.082	10.85	0.037～0.145
	Disease perception→acceptance-resignation→ Self-regulatory fatigue	0.203	26.85	0.133～0.290
	Disease perception→self-efficacy→confrontation→ Self-regulatory fatigue	0.050	6.61	0.026～0.086
	Disease perception→self-efficacy→avoidance → Self-regulatory fatigue	0.034	4.50	0.012～0.065
	Disease perception→self-efficacy→acceptance-resignation→ Self-regulatory fatigue	0.052	6.88	0.029～0.087
Total effect	-	0.756	-	0.702～0.802

No competing interests reported.

The relationship between disease perception, self-efficacy, coping style and self-regulatory fatigue in old adults patients with hypertension:A cross-sectional study

Status:

Version 1

Abstract

Figures

Introduction

Materials and methods

Design and participants

Measurements

General demographic questionnaire

Self-regulatory fatigue scale(SRF-S)

Brief illness perception questionnaire(BIPQ)

General self-efficacy scale(GSES)

Medical coping modes questionnaire(MCMQ)

Ethical considerations and data Collection

Data analysis

Results

Discussion

Self-regulatory of the relationship between fatigue, disease perception, self-efficacy, and coping style

Conclusion

Limitations

Declarations

References

Tables

Additional Declarations

Status:

Version 1