Research On Self-Efficacy,Stroke Health Knowledge,Self-Management Status And Their Relationship Of Stroke Patients Based On Chronic Illness Trajectory

Objective:To understand the characteristics of the self-efficacy,stroke health knowledge literacy,and self-management behavior of first-onset stroke survivors at the acute hospitalization,early rehabilitation,continuous rehabilitation and semi-stable stage based on Chronic Illness Trajectory Framework,analyze their influencing factors,explore the correlation between the three factors and possible mediating effects,and provide a reference for the construction of individualized self-management programs for stroke patients..Methods:This study is a cross-sectional study,that is,the current situation and influencing factors of stroke patients’ self-efficacy,stroke health knowledge,and self-management behavior in different periods.From September 2020 to April 2021,a stratified convenience sampling method was used to select 362 first-onset stroke patients who met the inclusion and exclusion criteria from two 3A-grade hospitals in Chengdu to conduct investigation.The questionnaire included The Self-Designed General Information Questionnaire,Self-efficacy Scale for Chronic Disease Management,Stroke Health Knowledge Questionnaire,Stroke Patients Self-management Behavior Rating Scale.SPSS22.0 was used to descriptively analyze the sociological data and questionnaire data of the subjects;and t-test or variance analysis was used for measurement data and group comparison;multiple stepwise regression analysis was used to determine the influencing factors in self-efficacy,stroke health knowledge,and self-management behavior of patients in different periods;the Bootstrap(model 4 and model 6)in SPSS PROCESS v2.16.3 was used to test the mediating effect.Result:1.A total of 362 first-onset stroke patients were collected,including 91 in acute hospitalization and early rehabilitation,respectively.90 in continuous rehabilitation and semi-stable stage,respectively.The self-efficacy,stroke health knowledge,and self-management levels of 362 first stroke patients were medium,poor,and medium.The self-efficacy,stroke health knowledge,and self-management levels of patients in the four periods were as follows: medium,poor,medium;medium,poor,medium;medium,medium,medium;good,medium,medium.2.There were differences in the scores of patients’ self-efficacy,stroke health knowledge and self-management in different periods.In addition to self-efficacy,there were significant differences between the different staged groups on the scores of stroke health knowledge(P<0.001,F=14.31)and self-management(P<0.001,F=20.35).3.Based on the regression equation,it could be considered that self-management,educational levels,and family monthly income levels were the independent influencing factors of the self-efficacy(P<0.001,F=32.799)and stroke health knowledge(P<0.001,F=32.642);Self-efficacy,stroke health knowledge,educational levels,occupation and comorbidity(with or without hypertension,hyperlipidemia)were the independent influencing factors of patients’ self-management behavior(P<0.001,F=44.443).The influencing factors of patients’ self-efficacy,stroke health knowledge and self-management behavior were not the same in different periods.4.There is a positive correlation between participants’ self-efficacy,stroke health literacy,and self-management health behavior indicators(R value=0.46;0.43;0.27;P<0.01).Stroke health knowledge played a partial mediating role between self-efficacy and self-management,with an effect value of 1.90,accounting for 23.14% of the total effect(P<0.001).Conclusion:1.The levels of self-efficacy,stroke health knowledge,self-management behaviors and their influencing factors vary among patients with different stroke disease stages based on the chronic disease trajectory framework.Thus,the management of stroke patients should implement dynamic management interventions from an individual perspective and according to their staged health behavior characteristics,develop appropriate care goals and plans,so as to improve individual health outcomes.,2.The relationship between self-efficacy,knowledge literacy,and self-management,and results of mediation model test have shown that management intervention aimed at improving the level of any one of the three indicators of self-efficacy,knowledge literacy,and self-management behavior of stroke patients could,to a certain extent,promote the improvement of another indicator of them and achieve a virtuous circle.