الفهرس 
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Abstract
Summary
The coronavirus disease 2019 is a respiratory infection caused by a novel type of coronavirus it may take weeks to overcome. However, in some patients, symptoms persist even after the original infection. Post-COVID syndrome is the persistence of clinical symptoms for more than 12 weeks after infection with corona virus that cannot be attributed to by an alternative diagnosis. The most common post-COVID symptoms include fatigue, dyspnea, olfactory and gustatory dysfunction, chest pain, myalgia, and sleep and mental disorders. Symptoms may disrupt work activities and the quality of life of affected individuals (Maltezou, et al., 2021).
Self-efficacy as one’s perceived ability to perform a target behavior, could predict the general public’s intention to engage in social distancing during a simulated pandemic caused by COVID-19. Furthermore, higher self-efficacy levels have been linked to taking other preventive measures such as hand washing, respiratory hygiene, and wearing a mask when having symptoms. Poor adherence to therapeutic regimen may have a major impact on treatment outcomes, especially in patient with coronavirus infection, seriously affects the quality of life and at the same time increases the cost of health care (Hernández et al., 2020).
Aim of the study:
The current study aimed to assess relation between self-efficacy and adherence to therapeutic regimen among patients with post Covid-19 syndrome through the following:-
1. Assessing self- efficacy level among patients with post Covid-19 syndrome`.
2. Assessing adherence level to therapeutic regimen among patients with post Covid-19 syndrome.
3. Assessing relation between self- efficacy and adherence to therapeutic regimen among patients with post Covid-19 syndrome.
Research questions
This study answered the following questions:-
1. What is level of self- efficacy among patients with post covid-19 syndrome?
2. What is level of adherence to therapeutic regimen among patients with post covid-19 syndrome?
3. Is there relation between self- efficacy and adherence to therapeutic regimen among patients with post covid-19 syndrome?
Subjects and Methods:
Research design:
A descriptive correlational design was utilized to conduct this study
Setting:
The study was conducted in Chest Outpatient Clinic at El-Demerdash Hospital Affiliated to Ain Shams University Hospital.
Subject:
Convenience sample of 133 patients was included in the study.
Tools for data collection:
Tool I: Patients’ interviewing questionnaire
This tool was developed by the investigator in an Arabic language after reviewing the recent and relevant literatures (Ghosn et al., 2021 and Vanichkachorn et al., 2021) and included two parts:-
Part I: - Patients’ demographic characteristics:
It was used to assess demographic data of patients and included eight questions (age, gender, level of education, marital status, occupational status, residence, living status, and financial status).
Part II: -Patients’ clinical data:
It was used to assess medical data of the studied patients included 13 questions and divided into three parts: (I) Present history included five questions (Covid 19 onset of infection, symptoms, frequency of infection, hospital admission & received medication). (II) Past history included six questions (suffering from chronic diseases, receiving medications, receiving Covid 19 vaccine, other vaccinations such as seasonal influenza, pneumococcus, allergies and smoking status).(III) Family history included two questions (any family members suffering from chronic diseases and infected with Covid 19).
Tool II: - Self-Efficacy Survey:
It was developed by the investigator in an Arabic language after reviewing the recent and relevant literatures (Heo et al., 2021; Yang et al., 2021, Panc et al., 2012). It was used to assess the patient perceived self-efficacy in different areas of life and abilities to perform specific behaviors. It composed of 25 statements each statement had five responses (completely able, able, neutral, unable and unable completely). It divided into three domains Initiative (9 statements), effort (8 statements) and perseverance (8 statements). There were four negative statements in initiative domain (numbers 2, 4, 6 & 8).
Scoring system
Each statement contained a 5-point likert scale with 1 representing completely unable, 2 representing unable, 3 representing neutral, 4 representing able and 5 representing completely able. The higher score indicated the higher self-efficacy and vice versa with negative statements.
The total score was ranged from 25-125 grades and classified as the following
• Low self-efficacy <50% (score 25<63)
• Average self-efficacy 50<75% (score 63-94)
• High self-efficacy >75% (score 95-125)
Tool III:-Therapeutic regimen adherence tool:
It was developed by the investigator in an Arabic language after reviewing the recent and relevant literatures (Carlucci et al., 2020 and Fernandez-Lazaro et al., 2019), it was used to assess therapeutic regimen adherence level among the studied patients. It composed of 51 statements, each statement had five responses (never, rarely, sometimes, often and always). It included eight components; symptoms management (4 statements), prescribed medication (9 statements), precaution measures (9 statements), exercise and physical activities (6 statements), nutrition (10 statements), follow-up (6 statements), diagnostic tests (4 statements) and warning sign & symptoms (3 statements). There were four negative statements in prescribed medication component (numbers 4, 5, 8 & 9).
Scoring system
Each statement contained a 5-point likert scale with 1 representing never, 2 representing rarely, 3 representing sometimes, 4 representing often and 5 representing always. The higher score indicated higher adherence and vice versa with negative statements.
The total score was ranged from 51-255 grades and distributed as the following
• Low adherence <50% (score 51<127).
• Average adherence 50<75% (score 128-191).
• High adherence >75% (score 192-255).
Results:
The results of this study have shown the following:
- Less than one third (30.1%) of studied patients’ their age were ≥ 50 years with the mean age was 42.75±11.14, and 60.2% of them were females, As regards to marital status 63.9% of them were married, and 48.2% were highly educated.
- More than three quarters (76.7%) of patients’ exposed to Covid -19 infection ten weeks or more with the mean weeks was 10.88±2.61.
- Less than one third (30.8%) of studied patients had low initiative self-efficacy while 36.1% of them had average level of self-efficacy effort domain, and 39.8% of them had high level of perseverance domain.
- More than two fifths (42.1%) of the studied patients had high level of self-efficacy, 36.1% of them had average level of self-efficacy, and 21.8% had low self-efficacy.
- More than two fifths (44.4%) of the studied patients had high adherence level to the therapeutic regimen. 30.1% of them had low adherence level to the therapeutic regimen, and 25.6% of them had average adherence level to the therapeutic regimen.
- There were a highly statistically significant relation between patients’ level of self-efficacy and their educational level & residence place (P value <0.001).While, there were no statistically significant relation with the patients age, gander , marital status as well as occupational status, living status and family’s monthly income (P value > 0.05).
- There were a highly statistically significant relation between patients’ level of adherence to the therapeutic regimen and their educational level & residence place (P value <0.001).While, there were no statistically significant relation with the patients age, gander , marital status as well as occupational status, living status and family’s monthly income (P value > 0.05).
- There was highly positive significant correlation between total levels of self-efficacy and adherence to the therapeutic regimen among the studied patients at r = 0.572 at P value = 0.001.
Conclusion:
Based on this study finding, it can be concluded that, more than two fifths of the studied patients had high level of self-efficacy and around one third of them had average level of self-efficacy. Also, more than two fifths of the studied patients had high adherence level of therapeutic regimen and around one quarter of them had average adherence level of therapeutic regimen. There was highly positive significant correlation between total levels of self-efficacy and adherence to the therapeutic regimen among the studied patients with post Covid-19 syndrome.
Recommendations
Based on the results of the present study, the following recommendations are suggested:
• Developing health educational program for the patients with post Covid-19 syndrome based on their needs to improve their awareness, self-efficacy and adherence to therapeutic regimen.
• Suggesting evidence based guideline of post Covid-19 syndrome management to enhance the studied patient’s self-efficacy and adherence levels.
• Availability of a simplified and comprehensive Arabic booklet/ illustrated pamphlets about post Covid-19 syndrome and its management to improve the patients’ self-efficacy and adherence to therapeutic regimen.
• Continuously evaluating levels of self-efficacy and adherence to therapeutic regimen for the patients with post Covid-19 syndrome are recommended.
• Replication of the current study on a larger sample and in different hospital settings in order to generalization of the results.
• Further study for assessing factors affecting the patients’ self-efficacy and adherence to therapeutic regimen post Covid-19 syndrome.
• Further study to evaluate the impact of implementing health education/ evidence based suggested guideline about post Covid-19 syndrome management on the patients’ self-efficacy and adherence levels.