Measurement of physical activity levels and self-efficacy during early recovery after acute myocardial infarction in Jordan

Background: Cardiovascular disease is responsible for over 17.1 million deaths annually worldwide. Secondary prevention plays a key role in reducing the burden of cardiovascular disease. The cardiac rehabilitation programme is an effective intervention that supports lifestyle behaviour change after acute myocardial infarction. Self-efficacy and regular physical activity are particularly important for improving of patients’ health outcomes. No studies have measured both cardiac self-efficacy and physical activity levels after acute myocardial infarction during the early recovery phase. Aims: To translate and cross-cultural adapt of a cardiac self-efficacy questionnaire into Arabic. To use this questionnaire to assess the changes in self-reported self-efficacy levels at baseline, after two weeks (T1) and after six weeks (T2), to assess changes in physical activity levels and patterns at T1 and T2, and to determine whether there is a relationship between self-efficacy and physical activity among patients with acute myocardial infarction in the early recovery phase. Study design: A descriptive study with a repeated measures design. Methods: Phase one: the study used a process recommended by the World Health Organisation, to produce an Arabic version of the cardiac self-efficacy questionnaire. Phase two: the study measured self-efficacy by an Arabic version of the self-reported cardiac self-efficacy questionnaire and administered at baseline, T1 and T2. Physical activity was objectively measured by body-worn activity monitor (activPAL3™) for 24 hours a day for a full seven consecutive days at T1 and T2. Sample and Setting: The study recruited a convenience sample of 100 patients from a single cardiac centre in Amman, Jordan, between February and December 2015. Participants did not have access to cardiac rehabilitation. Results: The study showed successful translation and cross-cultural adaptation of the cardiac self-efficacy questionnaire into Arabic. In addition, the findings showed that the Arabic version of the cardiac self-efficacy questionnaire is a valid and reliable version with Cronbach’s alpha of 84.6% and Intraclass Correlation Coefficient of 92.9%. Self-reported cardiac self-efficacy scores improved significantly between baseline and T1, and between T1 and T2 across all subscales (p<.05) and specifically for global cardiac self-efficacy (p<.05). There was no statistically significant difference in physical activity levels and patterns between T1 and T2. There was no statistically significant relationship between cardiac self-efficacy and physical activity level at T1 and T2. Conclusion: The cardiac self-efficacy questionnaire is suitable for administration to patients with coronary heart disease. Study participants had greater amounts of sedentary time than levels reported in healthy populations in the UK or the USA. The step count was below that recommended in guidelines. The health care system in Jordan needs to develop cardiac rehabilitation programmes for patients recovering from myocardial infarction to promote physical activity levels and thereby reduce sedentary time. In addition, this study showed that the increase in self-efficacy levels did not influence physical activity levels. There is a need to further investigation to understand the mechanisms that influence physical activity levels among patients with acute myocardial infarction in the early recovery phase such as socio-cultural context