| Objectives1.To gain insights into the existing status of supportive care demands and targeted intervention strategies during the home-based rehabilitation phase for rural patients with ischemic stroke,and to explore the demands of these patients and analyze the factors influencing them.2.To develop a tailored supportive care intervention program for rural patients with ischemic stroke.3.To validate the effectiveness of the supportive care intervention program for rural patients with ischemic stroke.Methods:1.We used a mixed-methods research approach to investigate the professional care demands of rural patients with ischemic stroke during their home-based rehabilitation,taking into account a multidisciplinary perspective.(1)Quantitative Research Phase:Convenience sampling was used to select 572 cases of patients with ischemic stroke from all administrative villages within a specific township area in Henan Province.The participants completed a series of questionnaires,including Personal Information Form,Mishel Uncertainty in Illness Scale(MUIS),the Professional Care Demands Questionnaire,Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS),Fatigue Severity Scale(FSS),Barthel Index,the Social Support Rating Scale(SSRS),Morisky Medication Adherence Scale and Stroke-Specific Quality of Life Scale(SS-QOL).Statistical analysis,including descriptive statistics,univariate analysis,correlation analysis,and regression analysis,was conducted to explore the current state of supportive care and its influencing factors.(2)Qualitative Research Phase:Purposeful sampling was employed to select key informants,including rural patients with ischemic stroke,doctors,nurses,rehabilitation therapists,village doctors,and caregivers,for semi-structured in-depth interviews.Through these interviews,the researchers explored the supportive care demands and targeted intervention strategies during the home-based rehabilitation process from a multidisciplinary perspective.By integrating the findings from both quantitative and qualitative research,the researchers comprehensively analyzed the supportive care demands of rural patients with ischemic stroke,prioritized the most urgent and significant demands,and proposed targeted intervention strategies.This analysis provided empirical and reference evidence to inform the development of a supportive care intervention program.2.Constructed a Supportive Care Intervention Program for Rural Patients with Ischemic StrokeA multidisciplinary collaborative team was established to construct a supportive care intervention program for rural patients with ischemic stroke based on the importance ranking of supportive care demands and targeted intervention strategies identified in the first part of the mixed-methods research and the multidisciplinary perspective.Guided by the theoretical frameworks of disease uncertainty and supportive care demands,and in conjunction with the results of literature review,a preliminary supportive care intervention program for rural patients with ischemic stroke was developed.The program was further validated and revised through expert meetings and pre-experiments,resulting in the final supportive care intervention program for rural patients with ischemic stroke.3.Empirical Study of the Supportive Care Intervention Program for Rural Patients with Ischemic Stroke(1)Employed a non-randomized controlled trial design.Seventy rural patients with ischemic stroke who had been treated in two tertiary hospitals were selected as the study subjects using convenience sampling.They were randomly divided into a control group(35 cases)and an intervention group(35 cases).The intervention group received an 8-week supportive care intervention,while the control group received regular follow-up for 8 weeks.Surveys were conducted at pre-intervention(TO),immediately after the intervention(T1),and one month after the intervention(T2)using measures such as anxiety scales,depression scales,post-stroke fatigue scales,disease uncertainty scales,quality of life scales,Barthel Index,and specialized care demands scales.Generalized Linear Mixed Model(GLMM)analysis was used to compare the differences in anxiety,depression,post-stroke fatigue,disease uncertainty,quality of life,Barthel Index,and specialized care demands between the two groups at different time points,evaluating the intervention effectiveness.(2)Employed purposeful sampling to select patients and intervention providers from the intervention group as research subjects for semi-structured in-depth interviews.Explored the experiences and perceptions of patients and intervention providers during the intervention process,and analyzed barriers and facilitators for the implementation of the supportive care intervention program,laying the foundation for further improvement and dissemination of the intervention program.Results:1.Results of a Quantitative Survey on the Demands of Rural Patients with Ischemic Stroke(1)A total of 572 questionnaires were distributed,and 560 were collected,resulting in a response rate of 97.9%.The total score for the specialized care demands of rural patients with ischemic stroke was(84.59±34.75).The scores for each dimension were as follows:professional knowledge and skills dimension(29.56±11.47),sequelae and complications care dimension(19.10±9.57),activities of daily living dimension(18.68 ±9.27),and social support care dimension(17.24±11.12),with the professional knowledge and skills dimension ranking the highest.The total score for patient’s quality of life was(190.54±29.34).The uncertainty in illness score in rural patients with ischemic stroke was 66.88±15.34,and the scores for the dimensions of the unpredictability and complexity were 41.23±9.96 and(25.65±6.16),respectively.The of fatigue severity rural patients with ischemic stroke was 4.46±1.62 and had post-stroke fatigue.The score of anxiety was 58.72±9.77.The score of depression was 62.62±11.97,and the patient’s depression level was mild level.The medication adherence score of rural patients with ischemic stroke was 5.51±2.24,which was at a low level.The total social support score of rural patients with ischemic stroke was 38.13±6.38,and the scores of subjective support,objective support and utilization of society were 22.09±3.80,8.81±2.17 and 7.24±2.72,respectively.(2)Using the specialized care demands of rural patients with ischemic stroke as the dependent variable and general information as independent variables,a univariate analysis was conducted.The results showed statistically significant differences in professional care demands between payment method,duration of illness,source of health knowledge,type of taking medication,and BI score(P<0.05).Correlation analysis among patients’ professional care demands and other variables showed that professional care demands were positively correlated with anxiety,depression,fatigue severity,and uncertainty in illness(P<0.01),and negatively correlated with social support,stroke-specific quality of life,and Barthel index(P<0.01).(3)The regression analysis results showed that gender,primary caregiver,Barthel Index score,anxiety,depression,uncertainty in illness,fatigue,and quality of life entered the regression equation(F=62.326,R2=0.431,adjusted R2=0.449).2.Qualitative Interview Results on the Demands of Rural Patients with Ischemic Stroke from a Multidisciplinary PerspectiveBy analyzing the interview data of patients and other key informants,a total of 6 categories,28 themes,and 57 sub-themes were identified.The demands were ranked as follows:(1)Disease related information demands:This includes eight main themes treatment information,relapse risk related information,rehabilitation related information,medication related information,diet related information,daily exercise related information,social return information,and help channel information(8 themes);(2)Rehabilitation demands:This includes three main themes professional guidance for rehabilitation,form,frequency,and reinforcement of rehabilitation knowledge;(3)Psychological and emotional demands:This includes three main themes including the demand for self-worth realization,the demand for self-adjustment ability enhancement,and the demand for social interaction;(4)Psychological demands:This includes three main themes:the demand for self-worth realization,the demand for self-adjustment and improvement,and the demand for respect;(5)Social interaction demands:This includes two main themes:the demand for social participation and the demand for economic support and interpersonal relationships;(6)Practical demands:This includes four main themes:the demand for daily living activities,the demand for child-rearing,the demand for shopping,and the demand for household chores.The following are suggestions for intervention strategies and forms:(1)A combination of online and offline forms that are easily accessible and manageable for patients and caregivers,with guidance and assessment from professionals.(2)Integration of various forms of health education content(printed health brochures,scanning QR codes to access videos,etc.)and standardized rehabilitation videos;(3)Combination of universality and personalization,with a focus on physical rehabilitation.Patients hope to receive feedback,guidance,and evaluation from professionals when providing feedback based on the videos;(4)Provision of continuous support for specialized care.3.Construction of a Supportive Care Intervention Plan for Rural Patients with Ischemic Stroke.A multidisciplinary collaboration team consisting of 10 members is formed.By integrating quantitative research results and qualitative interviews from multiple disciplines,based on literature review,an initial intervention plan is formed,which includes three intervention modules:the demand for disease-related information and health education brochures,the intervention for physical rehabilitation exercise demands,and the intervention for psychological and emotional demands.A total of 11 experts were invited to participate in the expert group meeting,resulting in five expert opinions.The supportive care intervention plan for rural patients with ischemic stroke was improved.Combining with pre-experimental results,the intervention plan was validated,further improved,and the final intervention plan for rural patients with ischemic stroke was formed.The intervention duration was 8 weeks,5 days per week,with each intervention session lasting no more than 60 minutes.4.Evaluation of the Application Effect of the Supportive Care Intervention Plan for Rural Patients with Ischemic Stroke.Before the intervention,the control group of patients with stroke had an average anxiety score of 68.86±4.17,a depression level score of 71.07±10.21,a uncertainty in illness score of 75.94±3.07,a post-stroke fatigue score of 4.55±0.5,and a quality of life score of 147.86±5.43.The intervention group of patients with stroke had an anxiety score of 68.04±2.88,a depression score of 68.89±3.53,a uncertainty in illness score of 76.11±3.45,a post-stroke fatigue score of 4.70±0.29,and a quality of life score of 149.77±4.09.There were no statistically significant differences between the two groups at baseline(P>0.05).After the intervention:(1)Generalized Linear Mixed Models(GLMM)were used for analysis,and the results showed that:① The intervention effect and interaction effect were statistically significant(P<05)in terms of anxiety,depression,post-stroke fatigue,illness uncertainty,quality of life,and specialized care demands.This indicates that the intervention effects vary with the intervention time.②Anxiety:The anxiety levels in the intervention group at T1 and T2 were significantly lower than those in the control group(P<0.05).The differences at the three time points in the control group were not statistically significant(P>0.05),indicating that the intervention group had better effects than the control group.③ Depression:There were no statistically significant differences in the depression levels between the control group patients after the intervention and one month after the intervention(P>0.05).The depression levels of the intervention group patients were significantly lower at T1 and T2 compared to before the intervention(TO)(P<0.05).④Post-stroke fatigue:There were no differences in the severity of fatigue between the two groups before the intervention(T0)(P>0.05).Comparing the two groups immediately after the intervention(T1)and before the intervention(T0),there were no statistically significant differences in the severity of fatigue scores(P>0.05).However,at one month after the intervention(T2),the fatigue severity scale scores of the intervention group were significantly lower than those of the control group(P<0.05),indicating that the intervention group had better effects than the control group,but a longer intervention time was needed.⑤ Uncertainty in illness:Immediately after the intervention(T1)and one month after the intervention(T2),the levels of illness uncertainty in both groups were lower than before the intervention(TO)(P<0.05).However,at T1 and T2,the reduction in illness uncertainty levels in the intervention group was higher than that in the control group(P<0.05).This indicates that both interventions can reduce patients’ illness uncertainty,but the intervention group had better effects than the control group.⑥ Quality of life:Compared to the TO time point,the quality of life scores for both groups at T1 and T2 were higher than before the intervention(P<0.05).There was no difference in the quality of life between the two groups at T1(P>0.05),but at T2,the quality of life for the intervention group patients was significantly higher than that of the control group(P<0.05).This indicates that the intervention group had better effects than the control group,but it takes a longer time to highlight the effects.⑦Specialized care demands:In the control group,the specialized care demands at both T1 and T2 were lower than at TO(P<0.05),but the difference between T and T2 was not statistically significant(P>0.05).In the intervention group,there was a gradual decrease in specialized care demands at TO,T1,and T2,and the differences were statistically significant(P<0.05).However,at T1 and T2,the intervention group had higher specialized care demands than the control group(P<0.05).(2)Formative evaluation results:Qualitative interview results extracted five themes:Strong acceptance of offline rehabilitation guidance combined with online video check-ins.Reduction of negative emotions and improvement in patients’enthusiasm and initiative to participate.The establishment of WeChat groups enhanced communication among patients with stroke and provided support through peer education and role modeling.Factors hindering and promoting the implementation of supportive care intervention programs:Hindering factors include patients’ low educational level,limited economic conditions,and inadequate family support.Promoting factors include patients’ self-efficacy,trust and support from patients and their families,continuous follow-up by multidisciplinary teams,accessible rehabilitation resources,the power of peer role models,and financial support,all of which contribute to the promotion of the intervention program.The full utilization of volunteers’ efforts and continuous follow-up support for supportive interventions is necessary.Conclusion:1.Rural patients with ischemic stroke have extensive supportive care demands.Among them,the top three demands are disease-related information,physical rehabilitation exercises,and psychological support.These demands urgently require supportive care interventions to be provided to the patients.2.The intervention program developed in this study is based on mixed methods research and a multidisciplinary perspective.It has been validated and improved through expert group meetings and pre-experiments.It demonstrates a certain level of scientific rigor,systematicity,feasibility,and specificity.3.The supportive care intervention program for rural patients with ischemic stroke,as developed in this study,effectively reduces anxiety,depression,post-stroke fatigue,and illness uncertainty levels in patients.It meets the patients’ demands and improves their quality of life. |
