The status quo and influence of self-management behaviors in convalescent stroke patients

A total of 450 stroke recovery patients from nine hospitals of the Fujian province were selected. The inclusion criteria were cerebrovascular disease diagnosis of the fourth diagnostic criteria by brain computed tomography (CT) or magnetic resonance imaging (MRI) in stroke patients; the period of stable disease, with “restore” being the guiding principle of clinical research on new drugs of traditional Chinese medicine treatment for stroke in the recovery period, 15 days–6 months after the onset of stroke; clear consciousness; ability to use text or language communication; Barthel Index (BI) score >20; absence of swallowing dysfunction; and the ability to participate voluntarily. The exclusion criteria were the mental scale assessment for dementia or mental illness; association with other serious diseases, such as heart, kidney and liver insufficiency; and the complete loss of activity ability. The sample size of this study was eight times the number of items in the survey tool, “stroke self-management behavior scale”, considering a 10% falling rate, with the final sample of 450 cases.

A questionnaire was distributed after a unified training study to meet the inclusion criteria for stroke recovery inpatients and to obtain informed consent. The patient was told how to fill out the survey, and if in doubt, a unified survey language was used to explain it. The patient himself or herself filled out the questionnaire on the spot, and if the patient could not fill it out alone, the researcher assisted the patient and avoided introducing words during this period. After being completed, the questionnaire was recovered on the spot to ensure the integrity of the data. A total of 450 questionnaires were issued and recovered, among which 440 were valid; thus, the effective participation rate was 97.78%.

Data collection was conducted with an Excel database, using IBM SPSS Statistics 20.0 statistical software for the descriptive statistics of general demographic data; data were counted as percentage (%), data were measured as mean and standard deviation (descriptive) and comparison between groups were carried out using a t-test and single factor analysis of variance (P<0.05). The knowledge score for stroke prevention and treatment was graded according to score: >80% as good, 60%–80% as medium and <60% as not good. Pearson correlation analysis and multiple linear regression analysis were used to evaluate self-management in stroke patients and recovery factors; P<0.01 was considered as statistically significant.

The self-management behavior score in the stroke recovery stage ranged from 75 to 211, with a mean of 151.95±23.58. The seven latitudes were sorted according to the scoring index from high to low: dietary management, safe medication management, social functioning and interpersonal relationships, daily life management, emotion management, rehabilitation exercise management and disease management. For the Fujian province, the five regions of the self-management of patients with the stroke recovery score were statistically significant (P=0.000, P<0.05); there were significant differences in the four latitudes: disease management, medication management, food safety management and rehabilitation management. See Tables 1 and 2 for details.

Table 1

Scores of self-management dimensions in the stroke recovery stage (n=440).

Table 2

Self-management behavior scores of Mindong, Minxi, Minnan, Minbei, and Minzhong, Fujian province (n=440).

There was a significant effect (P<0.05) found for stroke recovery score of self-management behavior differences in the single-factor analysis of self-management level by age, gender, educational level and family income per month; no statistically significant differences were found for the scores of other projects (P>0.05). The scores are presented in Table 3.

Table 3

Single-factor analysis of demographic data of patients in the stroke recovery stage (n=440).

The score for prevention and control knowledge of stroke recovery patients was (26.80±7.78), and the overall score of patients was medium, among which stroke treatment and risk factors were the lowest. The scores from diet, daily life, exercise, blood pressure monitoring, stroke symptoms, medication, risk factors, and stroke treatment followed from high to low. See Table 4 for details.

Table 4

Stroke prevention and treatment knowledge score in the stroke recovery stage (n=440).

Because the variables were continuous and continued to have a normal distribution, Pearson’s correlation analysis was performed The results showed that the level of stroke knowledge, social support and educational level were positively related to self-management behaviors, and the correlation coefficients were r=0.252, r=0.193 and r=0.863, respectively. The difference was statistically significant, P<0.01.

According to the results of the single-factor analysis, we selected educational level, stroke knowledge level, and social support level as independent variables and self-management score as the dependent variable for use in the multiple linear stepwise regression analysis. The collinearity diagnostic tolerance of the regression equation was 0.953–0.976 (>0.1), and the variance inflation factor (VIF) was 1.024–1.049 (<10). It can be considered that there was no multicollinearity between the three independent variables, which accords with basic multiple linear regression assumptions. The results show that the education level, stroke knowledge level, and social support level are the factors that influence the self-management behaviors of stroke patients in recovery. Three of the total load contributions of size are as follows: educational level, social support level, stroke knowledge level, and a common interpretation of self-management behavior level. The variance is 75.8% (Table 5).

Table 5

Influencing factors of self-management in the stroke recovery stage (n=440).

In this group of patients in stroke recovery, the total mean score of patient self-management was 151.95±23.58, higher than that of Mu et al.,12 and this group is included in the study on the recovery of stroke patients, self-cognition and behavior for knowledge management attention; this score is higher than in the group of first-stroke patients. Self-management has seven dimensions according to the score, from high to low: dietary management, drug safety management, social functioning and interpersonal relationships, life management, emotion management, and rehabilitation of disease management. The highest scores for patients were for dietary management and drug safety management, because the subjects of this study was in the period of hospitalization, health care provider continue to provide health education to patients with disease, and are in compliance during hospitalization regarding good medication and diet, which influence, to a certain extent, the two latitude scores. Patients with poor performance in rehabilitation exercise management and disease management behavior had the worst disease management behavior, which is consistent with the studies of Wang et al.13 and Liu et al.14 who analyzed a number of factors that may be related to disease rehabilitation in the long term: lack of perseverance, imperfect rehabilitation equipment, lack of knowledge and skills for rehabilitation, medical expenses, etc.; the authors suggest strengthening the rehabilitation training of patients with guidance and helping patients build self-confidence with disease monitoring.

The self-management behavior scores for the five regions of the Fujian province were statistically significant, and there were significant differences in disease management, safe medication management, dietary management and rehabilitation exercise management. The two regional scores for Minnan and Minzhong were higher than the others, and the analysts believed that this outcome was related to economic integration, as these areas represent the political, economic, cultural and scientific research centers of the Fujian province.