BACKGROUND:Stroke is a leading cause of long-term disability globally, substantially impairing quality of life (QoL) in survivors. While maladaptive metacognitive beliefs is regarded as a potentially influential factor, the underlying mechanism through which it influences QoL remains unclear. AIMS:To investigate QoL among stroke survivors, identify its influencing factors, and explore the mediating role of rehabilitation motivation between maladaptive metacognitive beliefs and QoL as well as the moderating role of education level. METHODS:In this cross-sectional study, 772 convalescent stroke survivors were recruited from four Grade A tertiary hospitals in Henan Province, China, between October 2024 and August 2025. Data were collected using general characteristics questionnaire, the Metacognition Questionnaire, the Stroke Rehabilitation Motivation Scale, the Short-Version Stroke-Specific Quality of Life Scale, and the Barthel Index. Model 7 in process version 4.1 was used to test the moderated mediation model. RESULTS:QoL was significantly correlated with occupation, residential status, stroke family history, stroke type, activities of daily living (ADL), metacognition, and rehabilitation motivation. The moderated mediation model involving rehabilitation motivation and education level for explaining how metacognition was associated with QoL was validated. Specifically, the mediating pathway through rehabilitation motivation was stronger among stroke survivors with higher education compared with those with lower education. CONCLUSION:Among stroke survivors, the association of metacognition with QoL is mediated by rehabilitation motivation, with this association being amplified by education level. For stroke survivors with varying education levels, interventions such as metacognitive therapy may improve metacognitive abilities, enhance rehabilitation motivation, and thereby promote QoL.

BACKGROUND:Collaborative management has been proposed as an effective strategy to enhance disease management. Common coping, positive illness perceptions, and strong resilience are crucial to enhancing collaborative management. The relationship between these variables is still unclear. AIMS:This study aimed to explore the influence of common coping on collaborative management among spousal caregivers, and to examine the mediating role of illness perception and the moderating effect of resilience. METHODS:This study was conducted on spousal caregivers of stroke survivors between May 2024 and September 2024 in Zhengzhou. Self-reported questionnaires were used to assess general information, illness perception, resilience, common coping, and collaborative management. Data analysis was performed using SPSS version 27.0. Pearson correlation and multiple linear regression analyses were conducted to examine relationships among the variables. Mediation and moderated mediation models were tested using PROCESS macro. RESULT:A total of 578 dyads completed the questionnaire. Spousal caregivers' collaborative management was at a moderate level. A significant association was found between common coping and collaborative management. Illness perception significantly mediated this relationship, while resilience moderated the path from illness perception to collaborative management. Notably, the mediating effect of illness perception was not significant among spousal caregivers with high resilience. CONCLUSION:Among spousal caregivers of stroke survivors, common coping directly influenced collaborative management. This relationship was partially mediated through illness perception, with resilience moderating the association between common coping and collaborative management. Interventions targeting common coping, illness perception, and resilience may enhance collaborative management among spousal caregivers.

BACKGROUND:The cognitive and physical impairments often experienced by stroke survivors make health care decisions challenging for both survivors and their caregivers. Although poststroke care decision-making involves complex factors such as health literacy and decision self-efficacy, research on the interactions among health literacy, decision self-efficacy, and decisional conflict within stroke survivor-caregiver dyads remains limited. PURPOSE:This study was designed to explore the inter-relationships among health literacy, decision self-efficacy, and decisional conflict in stroke survivor-caregiver dyads. METHODS:This cross-sectional study, conducted from September 2023 to April 2024, included 305 pairs of Chinese stroke survivor-caregiver dyads. The All Aspects of Health Literacy Scale, Decision Self-Efficacy Scale, and Decisional Conflict Scale were used to collect data from both stroke survivors and their caregivers. A dyadic analysis was conducted using the actor-partner interdependent mediation model. RESULTS:In terms of actor effects, decision self-efficacy was found to respectively mediate health literacy and decisional conflict in stroke survivors (β = -0.511, p < .001) and their caregivers (β = 0.212, p = .006). In terms of the partner effect, caregiver decision self-efficacy was found to relate negatively to survivor decisional conflict and to mediate the relationship between caregiver health literacy and survivor decisional conflict (β = -0.236, p = .019). CONCLUSIONS:The results of this study indicate that, in stroke survivors, higher health literacy has a direct reducing effect on perceived decisional conflict. In light of this, dyadic-based intervention strategies should be developed. Examples include joint workshops designed to improve stroke survivor-caregiver shared information interpretation and comprehension, and the development of dyadic-oriented decision aids to help both dyad partners achieve information symmetry and consensus in their health care decision-making.

BackgroundStroke remains a leading cause of long-term disability and mortality worldwide, the early identification and evaluation of rehabilitation effectiveness are of great significance. Facial expression recognition (FER), a computer vision technology, offers potential for early screening and monitoring in many conditions. However, its application in stroke remains underexplored.AimsTo offer insights into how the FER can be used in stroke identification and rehabilitation monitoring.MethodsWe systematically searched four databases, including PubMed, Web of Science, CNKI, and WanFang, for studies on FER applications in stroke, from database inception to January 2025.ResultsA total of 1,855 studies were identified, of which nine met the inclusion criteria (e.g., 8 diagnostic studies and 1 rehabilitation trial). Eight studies demonstrated FER’s diagnostic utility for stroke, achieving accuracies ranging from 82 to 98% through facial asymmetry analysis during standardized tasks in public/private datasets. Specific tasks such as KISS, SPREAD, and non-speech movements were particularly effective. One study achieved 99.81% accuracy in monitoring rehabilitation intensity by classifying real-time facial expressions to tailor training intensity. The data sources included images (66.7%) and clinical patients database (55.6%).ConclusionFER technology exhibits substantial potential as an auxiliary tool in stroke diagnosis and emerging rehabilitation applications by enabling precise analysis of mandibular and facial movements. Nevertheless, FER models face considerable challenges in real-world clinical translation. Future research could integrate multimodal data and in-the-wild databases to facilitate the clinical implementation of FER technology, thereby improving care delivery for both patients and clinicians and reducing patient mortality and disability.

AIMS:This work aimed to explore the relationship between disability and quality of life (QoL) among young- to middle-aged stroke couples; with benefit finding and mutuality as mediators, a longitudinal actor-partner interdependence mediation model was employed. DESIGN:This study was an observational longitudinal study. METHODS:The data for this study were derived from a longitudinal study conducted in China from October 2021 to July 2022. The data collection occurred at four time points: 1-2 days before discharge, and 1, 3 and 6 months post-discharge. A total of 203 young- to middle-aged stroke couples were recruited. The severity of disability in stroke survivors, along with benefit finding, mutuality and QoL in stroke couples, was measured. A longitudinal actor-partner interdependence mediation model was used to analyse the relationships between disability, benefit finding, mutuality and QoL in stroke couples. RESULTS:Benefit finding 1 month post-discharge mediated the relationships between survivors' disability before discharge and their physical and mental QoL at 6 months post-discharge, as well as the spouse's mental QoL. Additionally, stroke survivors' benefit finding 1 month post-discharge and the mutuality of stroke couples at 3 months post-discharge mediated the relationship between survivors' disability before discharge and the spouse's physical QoL in a chain manner. Survivors' benefit finding 1 month post-discharge and spouses' mutuality at 3 months post-discharge mediated the relationship between survivors' disability before discharge and the survivors' physical QoL in a chain manner. CONCLUSIONS:Stroke survivors' benefit finding and the mutuality of stroke couples can mitigate the impact of survivors' disability on both the physical and mental QoL of the couple. Therefore, interventions targeting benefit finding and mutuality should be considered, treating stroke survivors and their spouses as a unified whole in the intervention process.

OBJECTIVE:This study aimed to explore stroke survivors' interoceptive and emotional experiences. Interoception, defined as the perception and interpretation of internal bodily states, may influence emotional regulation after stroke. DESIGN:This study employed a descriptive phenomenological study. METHODS:This study was conducted in the Neurology and Rehabilitation Departments of a tertiary hospital in Zhengzhou, China. Semi-structured interviews were undertaken with stroke survivors receiving rehabilitation services. Sixteen stroke survivors were recruited through purposive sampling and conducted face-to-face semi-structured in-depth interviews. Data collection and analysis were conducted simultaneously, and the Colaizzi seven-step analysis method was used to code and extract themes from the transcripts. RESULTS:A total of five themes and 13 sub-themes were summarised, including: (1) Physical 'disconnection'-interoceptive experience disorders; (2) Interconnected bodily sensations and emotional experiences; (3) Gradually learning to understand and regulate bodily sensations; (4) Perceptual regulation empowerment and limitations in social relationships; (5) The Social-Cultural context of expressing internal feelings. CONCLUSION:Stroke survivors may frequently experience significant interoceptive dysfunction, which is closely related to emotional state, cultural cognition, and social support. REPORTING METHOD:This study followed the Consolidated Criteria for Reporting Qualitative Research checklist. PATIENT OR PUBLIC CONTRIBUTION:Stroke survivors participated through semi-structured interviews, and four survivors reviewed the interview guide before data collection to improve question clarity and relevance. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE:The findings of this study have important implications for clinical practice and nursing education. Healthcare providers should pay greater attention to stroke survivors' bodily perceptions and emotional experiences during rehabilitation. Interoceptive awareness strategies, such as mindfulness, breathing exercises, and body awareness training, could be incorporated into rehabilitation programmes to help patients better regulate emotions. In addition, nursing education could strengthen training related to emotional assessment and interoceptive awareness to promote more holistic and patient-centred care.

AIM:To investigate stroke survivors' preferences and preference heterogeneity regarding mental health services in China. DESIGN:A cross-sectional study design was employed. METHODS:A discrete choice experiment was conducted to elicit preferences for mental health services among 322 stroke survivors recruited from three tertiary hospitals in Henan Province. Six key attributes were identified through literature review, qualitative interviews and expert consultation: service content, delivery method, group size, provider type, session duration and out-of-pocket expenses. Mixed logit and latent class models were used to analyse preferences and explore heterogeneity. REPORTING METHOD:This study followed the STROBE checklist. RESULTS:Patients showed a strong preference for less expensive services, smaller group sizes and shorter session durations. Services provided by clinical nurses and delivered face-to-face were also preferred, although delivery mode was less influential overall. Emotion regulation was the most favoured content type. Latent class analysis revealed three distinct preference groups: a general-oriented group, a face-to-face prioritized group (primarily older patients) and a personalization-focused group (primarily higher-income patients). Patient age, income level and prognosis were significant factors influencing preference heterogeneity. CONCLUSION:Mental health service preferences among Chinese stroke survivors vary considerably. Out-of-pocket costs, group size and session length are key determinants of choice. Tailoring service delivery to reflect patient preferences, such as offering nurse-led, cost-effective and flexible interventions may enhance acceptance and adherence. Policymakers and healthcare administrators should integrate preference-based strategies into stroke care planning to improve psychological outcomes. PATIENT OR PUBLIC CONTRIBUTION:Stroke patients were involved as participants in this study for data collection. IMPACT:Mental health service content, delivery method, group size, service providers, duration of each session and out-of-pocket expenses have an impact on mental health service preferences of stroke patients. Mental health services whose content is emotion regulation, face-to-face, small group (3-5 participants), provided by clinical nurses and with a single session lasting 15 to 30 min are more likely to be accepted by patients. There is heterogeneity in mental health services for stroke patients, and this study highlights the importance of tailored mental health services.

Objective: The purpose of this study was to explore the impact of disability on dyadic quality of life (QoL) among stroke survivors and to examine the mediating role of social support in this process. Methods: Outcome measures were collected at four time points: baseline, 1 month, 3 months, and 6 months post-discharge. The Actor–Partner Interdependence Mediation Model was used to analyze the dyadic data. Results: A significant association was observed between a higher degree of disability and more severe depressive symptoms in stroke survivors (β = 0.626) and their spouses (β = 0.426). Survivors’ disability had a negative impact on their own physical health (β = −3.731) and indirectly affected the physical health of the spouse caregiver through the spouse caregiver’s depression (β = −0.198). In addition, disability affects the survivor’s own mental health through depression and social support (β = −0.231) and indirectly through the spouse caregiver’s depression and their own social support (β = −0.156). Conclusions: Survivor disability has a major impact on depression and QoL in couples with stroke. It is recommended that healthcare providers should identify disability early in stroke survivors and then target interventions to improve the QoL of couples affected by stroke who are at high risk of negative emotions.

Background: Exercise rehabilitation is a crucial component of stroke recovery, particularly for patients transitioning to home or community settings. However, there is currently a lack of self-reported scales designed to measure the level of engagement in exercise rehabilitation among patients with stroke. Objective: To develop and validate psychometric properties of the Engagement in Exercise Rehabilitation Scale for patients with stroke. Methods: The initial item pool was extracted from a literature review and a semi-structured interview with patients with stroke. The development and refinement of the items underwent expert consultation and cognitive interviews with patients with stroke. The items primarily covered patients’ perceptions, emotional attitudes, and specific engagement behaviors regarding exercise rehabilitation in home or community settings. A total of 260 patients with stroke were selected to test the reliability and validity. The psychometric proprieties test included construct validity, content validity, criterion-related validity, exploratory factor analysis, internal consistency reliability, test–retest reliability, and split-half reliability. Results: The final version of the Engagement in Exercise Rehabilitation Scale comprised 20 items. The scale’s content validity index was determined to be 0.976, while the item-content validity indices ranged from 0.833 to 1.000. Results from exploratory factor analysis indicated that this scale is unidimensional, with a cumulative variance contribution rate of 79.3%. The test–retest reliability of the scale was found to be 0.879, its split-half reliability was measured at 0.980, and its Cronbach’s α coefficient was calculated to be 0.986. Conclusion: The Engagement in Exercise Rehabilitation Scale for patients with stroke demonstrates accepted reliability and validity. The accuracy and generalizability of this scale necessitate further validation through additional large-sample studies involving diverse populations across multiple centers.

AIMS:To explore the mediating role of relationship satisfaction between communication patterns and benefit findings in stroke couples using the actor-partner interdependence mediation model. METHODS AND RESULTS:A cross-sectional study was conducted from October 2022 to April 2023 in China. Based on the actor-partner interdependence mediation model, we used structural equation modelling to explore the mediating role of relationship satisfaction of stroke patients and their spouses in communication patterns and benefit findings. A total of 381 stroke couples (patients, 61.4% male, mean age 54.06; caregivers, mean age 53.58) were included in the data analysis. Actor effects showed that stroke couples' relationship satisfaction mediated each of their own three communication patterns (constructive communication, demand/withdraw communication, and mutual avoidance) and benefit findings. In addition, patients' relationship satisfaction mediated patient demand-spouse withdraw and spouses' benefit findings. Partner effect showed that patients' relationship satisfaction mediated the association between their own three communication patterns and spouses' benefit findings. Patients' relationship satisfaction mediated the association between patient demand-spouse withdraw and patients' benefit findings. Moreover, spouses' relationship satisfaction mediated the association between the two communication avoidance patterns exhibited by patients (spouse demand-patient withdraw and mutual avoidance) and the spouses' benefit findings. CONCLUSION:The results have demonstrated a reciprocal influence on benefit findings between stroke patients and their spouses. The communication patterns within these couples have impacted not only their own benefit findings but also those of their spouses, with relationship satisfaction playing a mediating role.

To explore the potential classification of anxiety symptoms in stroke patients' spouses and analyze the characteristics of each category. From November 2019 to August 2020, a total of 224 stroke patients in the department of neurology of a tertiary hospital in Henan Province, and 224 spouse caregivers were conveniently selected. The general information questionnaire, Generalized Anxiety Disorder 7-item, the Patient Health Questionnaire 9-item scale, and modified Rankin Scale was used to assess patient and caregiver general information, anxiety, depression and patient prognosis, respectively. Latent profile analysis was used to analyze stroke patients' spouse anxiety symptoms, and polynomial logistic regression analysis was performed to assess factors associated with each category. The mean age of the patients were 62.54 years and the patients' spouses were 62.23 years. The patients' spouse anxiety symptoms were categorized into four groups: high anxiety-worry (13.4%); high anxiety-adaptive (58.9%); medium anxiety-high toughness (7.6%); anxiety-low risk (20.1%). There is heterogeneity in the anxiety symptoms of spouse caregivers of stroke patients, and nurses should develop targeted interventions based on the anxiety characteristics of different potential categories of spouse caregivers and their influencing factors in order to improve their anxiety symptoms.

Objectives To explore the impact of health literacy on nutritional self-efficacy in older adults and the chain-mediated effects of perceived social support and positive mental health between the two. Methods A total of 265 older adults who met the inclusion criteria in five communities in Zhengzhou City, Henan Province, from July to December 2024 were selected as survey respondents. Questionnaires were administered using the General Information Questionnaire, the short-form Mandarin Health Literacy Scale (s-MHLS), the Nutritional Self-Efficacy Questionnaire Chinese version (NSEQ), the Perceived Social Support Scale (PSSS), and the Positive Mental Health Scale Chinese version (PMHS). Spearman correlation analysis was used to explore the correlation between the variables, AMOS 24.0 software was used to construct the chain mediation model, and the Bootstrap method was used to test the chain mediation model. Results The nutritional self-efficacy score of older adults was (100.28 ± 18.59), and there was a correlation between health literacy, nutritional self-efficacy, perceived social support, and positive mental health (P < 0.001). The mediation model showed that the direct effect of health literacy on nutritional self-efficacy was significant in older adults, and health literacy also indirectly affected nutritional self-efficacy through perceived social support (β = 0.136, P < 0.001) and positive mental health (β = 0.077, P < 0.001). Perceived social support and positive mental health acted as chain mediators between health literacy and nutritional self-efficacy (β = 0.051, P < 0.001), with the total indirect effect accounting for 34.73% of the total effect. Conclusion Nutritional self-efficacy among older adults is at an intermediate level. Perceived social support and positive mental health play a mediating role between health literacy and nutritional self-efficacy in older adults. Healthcare professionals and related personnel should pay attention to educating the elderly on health literacy, popularizing knowledge of diseases, and improving their nutritional self-efficacy by enhancing their ability to appreciate social support and maintain positive mental health.

Objective Self-advocacy is associated with positive health outcomes, which is a central issue in chronic disease management. This study attempted to define self-advocacy operationally and conduct a mixed-methods analysis of self-advocacy among stroke patients in China.Design Schwartz-Barcott and Kim’s method was used to clarify the concept of self-advocacy.Setting Two hospitals in Zhengzhou and Luoyang City, Henan Province, China.Participants A total of 12 stroke patients were recruited and interviewed face to face from October 2023 to December 2023.Outcomes A three-phase method (theoretical phase, fieldwork phase and final analysis phase) was employed to conduct the mixed concept analysis. In the theoretical phase, a literature search was conducted using PubMed, Web of Science, EBSCO, Embase, PsycINFO, CNKI, Wanfang database, VIP database and CBMdisc. 38 articles in databases were evaluated without time limits up to August 2023. In the fieldwork phase, semistructured interviews were used to interview the 12 participants who were chosen using purposive sampling. In the final analysis phase, the results from both the initial and second phases were integrated.Results The review of literature in the theoretical phase determined the attributes of the concept, including ‘self-cognition’, ‘self-decision making’, ‘effective communication’, ‘social connection’. In the field study phase, attributes such as ‘self-awareness’, ‘self-care knowledge and abilities’ and ‘seeking support’ were added. In the final analysis phase, self-advocacy was finally defined as five attributes: ‘self-awareness’, ‘self-care level’, ‘self-decision-making’, ‘effective communication’ and ‘seeking support’.Conclusions Self-advocacy was defined as the capacity of stroke patients to comprehend and articulate their personal needs and care preferences, make proactive and meaningful decisions, engage in effective communication with healthcare providers and derive strength by seeking support from others.

Background As one of the important evaluation indicators of rehabilitation effect in stroke survivors,social participation has gradually attracted attention.Understanding the cognition and experience of social participation in stroke survivors is beneficial in helping stroke survivors recover quickly,return to families and reintegrate into society.However,the results of single qualitative studies may not be generalisable and representative.Objective To systematically review the qualitative studies on cognition and experience of social participation in stroke survivors by meta-synthesis methods,so as to provide a reference for further improving the rehabilitation effect of stroke survivors.Methods PubMed,Web of Science,Cochrane Library,Embase,PsycINFO,CINAHL,JBI evidence-based health care database,CNKI,Wanfang Data,VIP and CBM were searched by computers to screen qualitative studies on cognition and experience of social participation in stroke survivors from inception to November 2022.Pooled meta-integration method was used to perform the meta-synthesis of research themes,implications,classifications and so on.Results A total of 14 papers were included,involving 183 stroke survivors,and 26 findings were derived from meta-synthesis,which were summarized into 8 new categories,and 3 integrated findings were finally synthesized,including cognition and experience of social participation in stroke survivors,multiple social participation were limited in stroke survivors by multiple factors,multiple support for social participation was essential in stroke survivors.Conclusion Stroke survivors have new insights into social participation,and it is necessary to correct and eliminate the self-identification disorder and limiting factors of social participation,and focus on multi-party support of social participation in stroke survivors.

Engagement in exercise-based rehabilitation is crucial for patients with stroke to improve well-being and quality of life. This study aimed to explore the attitudes, perceptions, and experiences of community-dwelling patients with stroke related to engagement in exercise-based rehabilitation. Using the Patient Health Engagement (PHE) model as a theoretical framework, we conducted interviews with patients with stroke. A purposive sampling technique was used to recruit the participants. Data were analyzed using a deductive thematic analysis approach. A total of 20 patients with stroke participated in this study. Based on participant perspectives, four major themes and twelve subthemes were identified. The major themes were: Blackout, Arousal, Adhesion, and Eudaimonic Project. These four stages represent a shift in patient engagement in exercise rehabilitation, from initial disconnection due to denial or unawareness of rehabilitation options to long-term commitment to rehabilitation aligned with identity and future goals. This study demonstrated that engagement in exercise-based rehabilitation for patients with stroke is both a process and a state. Future research should enhance the evaluation and implementation of interventions for patients with stroke engagement in exercise-based rehabilitation.

ABSTRACT Aim To investigate the level of ethical leadership among head nurses and its relationship with nurses' perceived organisational justice. Design A cross‐sectional study. Methods This cross‐sectional study was conducted with a convenience sample of 501 clinical nurses from four tertiary‐level hospitals in Zhengzhou, Henan Province of China, in May 2023. The Ethical Leadership at Work Questionnaire and the Organisational Justice Scale were used as data collection instruments. Multiple stratified linear regression was used to analyse the relationships. Results The mean score of ethical leadership of head nurses was 4.13 ± 0.46, which is at a high level. Marital status, department and monthly income were the influencing factors of nurses' perceived ethical leadership. Head nurses' ethical leadership was positively correlated with nurses' organisational justice (r = 0.513, p < 0.01). Stratified linear regression analysis showed that the people orientation, power sharing and sustainability dimensions explained 23.0% of the variance in nurses' organisational justice (p < 0.05). Head nurses' ethical leadership plays a critical role in helping nurses improve their sense of organisational justice. Nurse managers need to pay more attention to nurses' personal development and needs, give them more opportunities to participate in decision‐making and strengthen their organisational justice. Patient or Public Contribution We would like to thank the nurses who were recruited and the hospital administrators who supported the study in the research process. Our study utilised the online questionnaire star platform to conduct an online questionnaire survey. After obtaining the consent of the hospital administrators, a nurse in the selected department was contacted as a research investigator, and after clarifying the purpose, methodology, significance and precautions for completing the questionnaire, the investigator distributed the electronic questionnaire in the form of a web link using a uniform guideline to nurses in the department who met the inclusion criteria.

Self-advocacy is essential for self-management in stroke patients. However, a validated scale to assess the level of self-advocacy in this population is lacking. This study aimed to develop a self-advocacy scale for stroke patients and validate its psychometric properties. This cross-sectional study involved instrument development and psychometric testing, conducted in three stages. In stage 1, dimensions and items were generated through concept analysis, semi-structured interviews, and refined through a Delphi survey. Stage 2 focused on content and face validity assessment. Stage 3 evaluated psychometric properties. A total of 565 stroke patients participated in the items selection from August 2024 to November 2024. The self-advocacy scale was assessed through content validity, construct validity, internal consistency, and test-retest reliability. The study adhered to the STROBE checklist for reporting. From an initial 40-item pool, 24 items were retained after expert consultation and item analysis. The scale demonstrated a content validity index of 0.967. Exploratory factor analysis revealed a five-factor structure, explaining 68.285% of the total variance. Confirmatory factor analysis supported this structure with acceptable fit indices. The scale’s overall Cronbach’s α coefficient was 0.936, with the dimensions’ Cronbach’s α values ranging from 0.816 to 0.898. Split-half reliability was 0.874, and test-retest reliability was 0.885 (2-week interval). The 24-item self-advocacy scale for stroke patients demonstrated robust psychometric properties, providing a valid tool for clinical and research applications.

AIM:To examine the effects of depression on dyadic self-care in stroke patients and their caregivers, as well as the potential mediating role of self-efficacy in this relationship. DESIGN:A multi-centre cross-sectional study design was employed. METHODS:From May to September 2022, stroke patients and their caregivers were recruited from China using a multi-centre stratified sampling method. Data analysis was conducted using a structural equation model based on the Actor-Partner Interdependence Model extended to include mediation. Depression in patients and caregivers was assessed using the Patient Health Questionnaire-9. The self-care self-efficacy scale was utilised to measure patient self-efficacy, while the caregiver self-efficacy in contributing to patient self-care scale was used for caregivers. Patient self-care was evaluated with the Self-Care of Stroke Inventory and caregiver contributions to self-care were assessed using the Caregiver Contributions to Self-Care of Stroke Inventory. REPORTING METHOD:This study followed the STROBE checklist. RESULTS:306 patient-caregiver dyads were enrolled. The direct effect between depression and dyadic self-care was not confirmed in stroke patients and their caregivers (p > 0.05). Patient self-efficacy had significant indirect actor effects on self-care maintenance (β = -0.173, p < 0.001), monitoring (β = -0.146, p < 0.001) and management (β = -0.186, p < 0.001). Caregiver self-efficacy had an indirect actor effect on caregiver contributions to self-care maintenance (β = -0.096, p < 0.001), monitoring (β = -0.073, p < 0.001) and management (β = -0.106, p < 0.001). The partner effect analysis showed caregiver self-efficacy plays a potential mediating role in the relationship between patient depression and caregiver contributions to self-care maintenance (β = -0.037, p = 0.036), monitoring (β = -0.028, p = 0.032) and management (β = -0.040, p = 0.036). Caregiver depression reduced caregiver self-efficacy, lowering patient self-care monitoring (β = -0.040, p = 0.004) and management (β = -0.047, p = 0.002) levels. CONCLUSION:The findings indicate interactive effects between depression, self-efficacy and dyadic self-care among stroke patients and their caregivers. Therefore, the development of targeted dyadic interventions to address depression and enhance self-efficacy in both patients and caregivers should be considered.

ABSTRACTBehavioral management is essential to preventing recurrence after stroke, but its adherence is limited worldwide. We aimed to assess the impact of the behavior intervention based on the Recurrence risk perception and Behavioral decision Model for ischemic stroke patients' health behavior. This study was a single‐blind, randomized, controlled trial with a 3‐month follow‐up. The outcome measures were the perception of the risk of stroke recurrence, behavioral decision, and health behavior. A total of seventy participants were randomized to the intervention group (n = 35) or control group (n = 35). The former received a twelve‐week theory‐based intervention in addition to the routine education, while the control group received only the routine education. The generalized estimating equations results indicated that the intervention group had significantly greater improvements in perception of the risk of stroke recurrence compared to the control group at all T1 (B = 0.13, 95% CI: 0.03 to 0.23), T2 (B = 0.18, 95% CI: 0.07 to 0.28), and T3 (B = 0.16, 95% CI: 0.07 to 0.25) after adjusting for stroke frequency. Statistically significant improvements were found in behavioral decision for the intervention group compared with the control group at T2 (B = 0.25, 95% CI: 0.09 to 0.41) and T3 (B = 0.26, 95% CI: 0.10 to 0.43). Results also showed a significantly higher increase in health behavior at T1 (B = 0.29, 95% CI: 0.09 to 0.48) and T2 (B = 0.22, 95% CI: 0.04 to 0.40). The intervention can improve the perception of the risk of stroke recurrence, behavioral decision, and health behavior in ischemic stroke patients.ImplicationsThis study provides a reference point for promoting healthy behaviors in patients with ischemic stroke. A recurrence risk perception and behavioral decision model‐based intervention was deemed to be feasible and useful in practice.Patient or Public ContributionPatients and their caregivers agreed to participate in the study and shared their experiences of participating in research with us.