Assessing perceived social support in atrial fibrillation: development and validation of an instrument to inform nursing care development

Outi Kähkönen; Juha Hartikainen; Anne-Mari Hekkala; Ville Hautamäki; Signe Stelling Risom; Tone Merete Norekvål; Ying Lau; Anneli Vauhkonen

doi:10.1016/j.apnr.2026.152111

Assessing perceived social support in atrial fibrillation: development and validation of an instrument to inform nursing care development

Outi Kähkönen
, Juha Hartikainen
, Anne-Mari Hekkala
, Ville Hautamäki
, Signe Stelling Risom
, Tone Merete Norekvål
, Ying Lau
, Anneli Vauhkonen

University of eastern Finland (FI)
Kuopio University Hospital
The Finnish Heart Association
Haukeland University Hospital
University of Bergen
Li Ka Shing Institute of Health Sciences

Research output: Contribution to journal › Journal article › Research › peer-review

Abstract

Background
Atrial fibrillation (AF) is associated with a significant clinical and psychosocial burden. It requires adequate informational, emotional, and functional support in addition to evidence-based treatment. Existing social support measures are largely generic and do not address the specific needs of AF care.
Aim
To develop and psychometrically validate the Social Support for Patients with Atrial Fibrillation Instrument (SSAFI).
Methods
A methodological, cross-sectional validation study was conducted among 265 adults with AF in Finland. Data were collected using an online survey. Item characteristics were examined using descriptive statistics and correlation analyses. Exploratory factor analysis (EFA) was applied to examine empirical clustering patterns, followed by confirmatory factor analysis (CFA) to test a theoretically derived hierarchical model. Model fit, internal consistency, and construct validity were evaluated using established psychometric criteria.
Results
EFA suggested source-influenced clustering, whereas CFA supported a hierarchical model with informational, emotional, and functional support domains, showing acceptable fit (χ2/df = 2.29; CFI = 0.936; TLI = 0.926; IFI = 0.937; RMSEA = 0.077). Standardized loadings ranged from 0.301 to 0.864 with weaker loadings interpreted cautiously according to the predefined retention criterion, second-order loadings were strong (λ = 0.928–0.963), and reliability and validity indices supported the multidimensional structure.
Conclusions
The SSAFI demonstrated satisfactory psychometric properties and provides a disease-specific tool for assessing perceived informational, emotional, and functional support. At the group and service levels, the instrument may provide nursing services and healthcare systems with a structured means to identify perceived gaps in patient education and support, informing the development of nurse-led AF care pathways.

Original language	English
Article number	152111
Journal	Applied Nursing Research
Volume	90
Number of pages	10
ISSN	0897-1897
DOIs	https://doi.org/10.1016/j.apnr.2026.152111
Publication status	Published - Aug 2026

Keywords

disease, health science and nursing
Atrial fibrillation
Social support
nursing
psychometrics
questionnaires
surveys

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10.1016/j.apnr.2026.152111Licence: CC BY

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@article{89b512c67c3d47f6b4ab3bf105d03288,

title = "Assessing perceived social support in atrial fibrillation: development and validation of an instrument to inform nursing care development",

abstract = "Background Atrial fibrillation (AF) is associated with a significant clinical and psychosocial burden. It requires adequate informational, emotional, and functional support in addition to evidence-based treatment. Existing social support measures are largely generic and do not address the specific needs of AF care. Aim To develop and psychometrically validate the Social Support for Patients with Atrial Fibrillation Instrument (SSAFI). Methods A methodological, cross-sectional validation study was conducted among 265 adults with AF in Finland. Data were collected using an online survey. Item characteristics were examined using descriptive statistics and correlation analyses. Exploratory factor analysis (EFA) was applied to examine empirical clustering patterns, followed by confirmatory factor analysis (CFA) to test a theoretically derived hierarchical model. Model fit, internal consistency, and construct validity were evaluated using established psychometric criteria. Results EFA suggested source-influenced clustering, whereas CFA supported a hierarchical model with informational, emotional, and functional support domains, showing acceptable fit (χ2/df = 2.29; CFI = 0.936; TLI = 0.926; IFI = 0.937; RMSEA = 0.077). Standardized loadings ranged from 0.301 to 0.864 with weaker loadings interpreted cautiously according to the predefined retention criterion, second-order loadings were strong (λ = 0.928{\textendash}0.963), and reliability and validity indices supported the multidimensional structure. Conclusions The SSAFI demonstrated satisfactory psychometric properties and provides a disease-specific tool for assessing perceived informational, emotional, and functional support. At the group and service levels, the instrument may provide nursing services and healthcare systems with a structured means to identify perceived gaps in patient education and support, informing the development of nurse-led AF care pathways.",

keywords = "disease, health science and nursing, Atrial fibrillation, Social support, nursing, psychometrics, questionnaires, surveys",

author = "Outi K{\"a}hk{\"o}nen and Juha Hartikainen and Anne-Mari Hekkala and Ville Hautam{\"a}ki and Risom, \{Signe Stelling\} and Norekv{\aa}l, \{Tone Merete\} and Ying Lau and Anneli Vauhkonen",

note = "Publisher Copyright: {\textcopyright} 2026 The Authors.",

year = "2026",

month = aug,

doi = "10.1016/j.apnr.2026.152111",

language = "English",

volume = "90",

journal = "Applied Nursing Research",

issn = "0897-1897",

publisher = "Elsevier",

}

TY - JOUR

T1 - Assessing perceived social support in atrial fibrillation

T2 - development and validation of an instrument to inform nursing care development

AU - Kähkönen, Outi

AU - Hartikainen, Juha

AU - Hekkala, Anne-Mari

AU - Hautamäki, Ville

AU - Risom, Signe Stelling

AU - Norekvål, Tone Merete

AU - Lau, Ying

AU - Vauhkonen, Anneli

PY - 2026/8

Y1 - 2026/8

N2 - Background Atrial fibrillation (AF) is associated with a significant clinical and psychosocial burden. It requires adequate informational, emotional, and functional support in addition to evidence-based treatment. Existing social support measures are largely generic and do not address the specific needs of AF care. Aim To develop and psychometrically validate the Social Support for Patients with Atrial Fibrillation Instrument (SSAFI). Methods A methodological, cross-sectional validation study was conducted among 265 adults with AF in Finland. Data were collected using an online survey. Item characteristics were examined using descriptive statistics and correlation analyses. Exploratory factor analysis (EFA) was applied to examine empirical clustering patterns, followed by confirmatory factor analysis (CFA) to test a theoretically derived hierarchical model. Model fit, internal consistency, and construct validity were evaluated using established psychometric criteria. Results EFA suggested source-influenced clustering, whereas CFA supported a hierarchical model with informational, emotional, and functional support domains, showing acceptable fit (χ2/df = 2.29; CFI = 0.936; TLI = 0.926; IFI = 0.937; RMSEA = 0.077). Standardized loadings ranged from 0.301 to 0.864 with weaker loadings interpreted cautiously according to the predefined retention criterion, second-order loadings were strong (λ = 0.928–0.963), and reliability and validity indices supported the multidimensional structure. Conclusions The SSAFI demonstrated satisfactory psychometric properties and provides a disease-specific tool for assessing perceived informational, emotional, and functional support. At the group and service levels, the instrument may provide nursing services and healthcare systems with a structured means to identify perceived gaps in patient education and support, informing the development of nurse-led AF care pathways.

AB - Background Atrial fibrillation (AF) is associated with a significant clinical and psychosocial burden. It requires adequate informational, emotional, and functional support in addition to evidence-based treatment. Existing social support measures are largely generic and do not address the specific needs of AF care. Aim To develop and psychometrically validate the Social Support for Patients with Atrial Fibrillation Instrument (SSAFI). Methods A methodological, cross-sectional validation study was conducted among 265 adults with AF in Finland. Data were collected using an online survey. Item characteristics were examined using descriptive statistics and correlation analyses. Exploratory factor analysis (EFA) was applied to examine empirical clustering patterns, followed by confirmatory factor analysis (CFA) to test a theoretically derived hierarchical model. Model fit, internal consistency, and construct validity were evaluated using established psychometric criteria. Results EFA suggested source-influenced clustering, whereas CFA supported a hierarchical model with informational, emotional, and functional support domains, showing acceptable fit (χ2/df = 2.29; CFI = 0.936; TLI = 0.926; IFI = 0.937; RMSEA = 0.077). Standardized loadings ranged from 0.301 to 0.864 with weaker loadings interpreted cautiously according to the predefined retention criterion, second-order loadings were strong (λ = 0.928–0.963), and reliability and validity indices supported the multidimensional structure. Conclusions The SSAFI demonstrated satisfactory psychometric properties and provides a disease-specific tool for assessing perceived informational, emotional, and functional support. At the group and service levels, the instrument may provide nursing services and healthcare systems with a structured means to identify perceived gaps in patient education and support, informing the development of nurse-led AF care pathways.

KW - disease, health science and nursing

KW - Atrial fibrillation

KW - Social support

KW - nursing

KW - psychometrics

KW - questionnaires

KW - surveys

U2 - 10.1016/j.apnr.2026.152111

DO - 10.1016/j.apnr.2026.152111

M3 - Journal article

SN - 0897-1897

VL - 90

JO - Applied Nursing Research

JF - Applied Nursing Research

M1 - 152111

ER -

Assessing perceived social support in atrial fibrillation: development and validation of an instrument to inform nursing care development

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