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

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: /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.