Relationship Between Negative Emotions and Disease Management Self-Efficacy in Patients with Acute Myocardial Infarction: The Mediating Role of Illness Perception in a Structural Equation Model

Abstract

This study aimed to examine the relationship between negative emotions and disease management self-efficacy and to determine the mediating role of illness perception among patients with acute myocardial infarction. This fundamental, descriptive-correlational study employed structural equation modeling. The statistical population comprised patients with acute myocardial infarction attending Imam Reza Hospital and cardiology clinics in Mashhad during 2025–2026. Initially, 330 patients were recruited through convenience sampling; after excluding 30 incomplete or invalid questionnaires, data from 300 participants were analyzed. Data were collected using the negative affect subscale of the Positive and Negative Affect Schedule, the Cardiovascular Management Self-Efficacy Scale developed by Steca et al., and the Brief Illness Perception Questionnaire developed by Broadbent et al. Data were analyzed using SPSS 22 and LISREL 8.8 through Pearson correlation, confirmatory factor analysis, and structural equation modeling, with statistical significance set at p<0.05. Negative emotions had a significant negative direct effect on illness perception (β=-0.46, p<0.01), whereas their direct effect on disease management self-efficacy was negative but nonsignificant (β=-0.14, p>0.05). Illness perception had a significant positive direct effect on disease management self-efficacy (β=0.34, p<0.01). The indirect effect of negative emotions on self-efficacy through illness perception was negative and significant (β=-0.16, p<0.01), as was the total effect (β=-0.30, p<0.01). The modified model demonstrated satisfactory fit (χ²=44.65, df=25, RMSEA=0.054, GFI=0.97, CFI=0.99, NFI=0.97, IFI=0.99). Negative emotions explained 20% of the variance in illness perception, while the model variables explained 15% of the variance in disease management self-efficacy. Negative emotions appear to influence disease management self-efficacy primarily through patients’ perceptions of their illness, identifying illness perception as an important mediating mechanism. Interventions targeting maladaptive cognitive and emotional representations of illness may therefore strengthen self-efficacy and improve disease-management capacities among patients recovering from acute myocardial infarction.