Validity Evidence for Indicators of the Nursing Diagnosis Ineffective Health Self‐Management in People With Sickle Cell Disease During the COVID‐19 Pandemic

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Abstract
Objective: To evaluate validity evidence for the defining characteristics of the clinical construct of the nursing diagnosis, ineffective health self‐management in people with sickle cell disease (SCD) during the COVID‐19 pandemic. Methods: This diagnostic accuracy study included 312 people with SCD living in Brazil and was conducted from November 2022 to April 2023. We investigated the presence of five defining characteristics of the ineffective health self‐management diagnosis. We also estimated the prevalence of the diagnosis, the sensitivity, the specificity, and the area under the ROC curve of the defining characteristics using the latent class analysis. A Research Ethics Committee approved the study under the regulations of the Brazilian National Health Council. Results: All indicators showed satisfactory validity evidence. The estimated model yielded a prevalence of 46.2% for ineffective health self‐management. The most accurate indicator was difficulty reading and/or understanding prescriptions from healthcare professionals because it showed the highest sensitivity and specificity simultaneously and the largest area under the ROC curve. The most sensitive indicators were deteriorated SCD signs and symptoms; difficulty reading and/or understanding prescriptions from healthcare professionals; and missed appointments at health services for SCD follow‐up. The most specific indicators were abandonment of treatment leading to health‐threatening outcomes; difficulty making decisions regarding health or SCD treatment; and difficulty reading and/or understanding prescriptions from healthcare professionals. Conclusion: SCD may trigger indicators that point to the presence of ineffective health self‐management. These findings may support more accurate nursing care that is better targeted to the needs of people with SCD.

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