Rural areas are the weak link in the prevention and treatment of heart and brain vascular diseases such as atrial fibrillation. However, there are relatively few studies on the self-management ability and influencing factors of atrial fibrillation patients in rural areas.

Based on the health ecology model, this study explores the factors influencing self-management ability and ability of each dimension among patients with atrial fibrillation, aiming to provide a basis for formulating personalized intervention strategies.

By combining convenience sampling and cluster sampling methods, a questionnaire survey was conducted among patients with atrial fibrillation in Jiangdu District of Yangzhou City and Suining County of Xuzhou City, Jiangsu Province. Based on the health ecology model, independent variables were included for single-factor analysis and multiple linear regression analysis.

Among the 431 respondents, 250 were male (58.0%) and 181 were female (42.0%); the majority were aged between 70 and 79 years old, with 236 individuals (54.8%); 172 had a health score of 71 or above (39.9%); 247 had paroxysmal atrial fibrillation (57.3%); 173 had the disease duration of no more than 5 years (40.1%). The average self-management ability score for atrial fibrillation patients was (3.17±0.56) points. Among the five dimensions, the score for managing bad habits was the highest at 5.00 (1.33); followed by emotional and social management at 3.50 (1.40), medical compliance behavior management at 3.29 (1.00), anticoagulant drug management at 2.33 (2.00), and disease prevention and monitoring management at 2.00 (1.25) points. The results of the multiple linear regression analysis showed that women is a protective factor for the management of bad habits [B (95%CI)=-1.500 (-2.939 to -0.061), P<0.001], and a risk factor for anticoagulant drug management [B (95%CI)=-1.500 (-2.939 to -0.061), P=0.041]; age is a protective factor for the management of bad habits [70-79 years old: B (95%CI)=1.605 (0.670 to 2.540), P<0.001;≥80 years old: B (95%CI)=1.400 (0.339 to 2.460), P=0.010]; health status scores is a protective factor for emotional and social management [60-70 scores: B (95%CI)=1.734 (0.129 to 3.340), P=0.034;≥71 scores: B (95%CI)=3.152 (1.414 to 4.890), P<0.001] and disease prevention and monitoring management [B (95%CI)=1.803 (0.435 to 3.171), P=0.010]; longer disease duration is a protective factor for medical compliance behavior management [B (95%CI)=2.311 (0.871 to 3.751), P=0.002], and a risk factor for bad habit management [B (95%CI)=-0.859 (-1.621 to -0.096), P=0.027); multiple chronic diseases is a protective factor for medical compliance behavior management [1 chronic condition: B (95%CI)=2.349 (0.659 to 4.038), P=0.007; three over chronic conditions: B (95%CI)=2.992 (1.133 to 4.850), P=0.002]; moderate to severe anxiety and depression is a risk factor for emotional and social management [B (95%CI)=-1.504 (-2.849 to -0.159), P=0.029], and a protective factor for disease prevention and monitoring management [B (95%CI)=1.156 (0.092 to 2.221), P=0.033]; not sure if anticoagulant drugs are being used is a risk factor for self-management ability [B (95%CI)=-10.349 (-19.206 to -1.491), P=0.022], while being currently using anticoagulant drugs is a protective factor for medical compliance management [B (95%CI)=2.718 (1.292 to 4.143), P<0.001] and anticoagulant drug management [B (95%CI)=1.571 (0.107 to 3.035), P=0.036]; receiving chronic disease management services through online tools is a protective factor for medical compliance behavior management [B (95%CI)=3.235 (1.803 to 4.667), P<0.001]; a higher level of education is a protective factor for disease prevention and monitoring management [B (95%CI)=2.140 (0.323 to 3.958), P=0.021]; not seeking medical treatment due to economic reasons is a risk factor for self-management ability [B (95%CI)=-5.816 (-11.169 to -0.463), P=0.033]; doctors adjusting health management plans is a protective factor for medical compliance behavior management [B (95%CI)=1.482 (0.110 to 2.853), P=0.034], anticoagulant drug management [B (95%CI)=1.453 (0.034 to 2.872), P=0.045], and disease prevention and monitoring management [B (95%CI)=1.081 (0.103 to 2.059), P=0.030].

The self-management ability of rural patients with atrial fibrillation is at a medium to low level. The overall and individual dimensions of their ability are affected by multiple factors such as gender, age, health status score, disease duration, number of chronic diseases, degree of anxiety and depression, whether they use anticoagulant drugs, whether they receive chronic disease management services through online tools, educational level, whether they do not seek medical treatment due to economic reasons, and whether their health management plans are adjusted by doctors. Policy designers and service providers should comprehensively consider multiple intervention targets and construct an integrated intervention strategy in order to enhance the self-management ability and health level of rural patients with atrial fibrillation.