Plow Matthew, Moore Shirley M, Sajatovic Martha, Katzan Irene
School of Nursing, Case Western Reserve University, Cleveland, OH, United States of America.
Department of Psychiatry and of Neurology, Neurological and Behavioral Outcomes Center, Case Western Reserve University, Cleveland, OH, United States of America.
PeerJ. 2017 May 23;5:e3210. doi: 10.7717/peerj.3210. eCollection 2017.
Individuals with stroke often have multiple cardiovascular risk factors that necessitate promoting engagement in multiple health behaviors. However, observational studies of individuals with stroke have typically focused on promoting a single health behavior. Thus, there is a poor understanding of linkages between healthy behaviors and the circumstances in which factors, such as stroke impairments, may influence a single or multiple health behaviors.
We conducted a mixed methods convergent parallel study of 25 individuals with stroke to examine the relationships between stroke impairments and physical activity, sleep, and nutrition. Our goal was to gain further insight into possible strategies to promote multiple health behaviors among individuals with stroke. This study focused on physical activity, sleep, and nutrition because of their importance in achieving energy balance, maintaining a healthy weight, and reducing cardiovascular risks. Qualitative and quantitative data were collected concurrently, with the former being prioritized over the latter. Qualitative data was prioritized in order to develop a conceptual model of engagement in multiple health behaviors among individuals with stroke. Qualitative and quantitative data were analyzed independently and then were integrated during the inference stage to develop meta-inferences. The 25 individuals with stroke completed closed-ended questionnaires on healthy behaviors and physical function. They also participated in face-to-face focus groups and one-to-one phone interviews.
We found statistically significant and moderate correlations between hand function and healthy eating habits ( = 0.45), sleep disturbances and limitations in activities of daily living ( = - 0.55), BMI and limitations in activities of daily living ( = - 0.49), physical activity and limitations in activities of daily living ( = 0.41), mobility impairments and BMI ( = - 0.41), sleep disturbances and physical activity ( = - 0.48), sleep disturbances and BMI ( = 0.48), and physical activity and BMI ( = - 0.45). We identified five qualitative themes: (1) Impairments: reduced autonomy, (2) Environmental forces: caregivers and information, (3) Re-evaluation: priorities and attributions, (4) Resiliency: finding motivation and solutions, and (5) Negative affectivity: stress and self-consciousness. Three meta-inferences and a conceptual model described circumstances in which factors could influence single or multiple health behaviors.
This is the first mixed methods study of individuals with stroke to elaborate on relationships between multiple health behaviors, BMI, and physical function. A conceptual model illustrates addressing sleep disturbances, activity limitations, self-image, and emotions to promote multiple health behaviors. We discuss the relevance of the meta-inferences in designing multiple behavior change interventions for individuals with stroke.
中风患者通常有多种心血管危险因素，这就需要促进他们参与多种健康行为。然而，对中风患者的观察性研究通常只关注促进单一的健康行为。因此，对于健康行为之间的联系以及诸如中风损伤等因素可能影响单一或多种健康行为的情况，我们了解甚少。
我们对25名中风患者进行了一项混合方法的收敛平行研究，以探讨中风损伤与身体活动、睡眠和营养之间的关系。我们的目标是进一步深入了解促进中风患者多种健康行为的可能策略。由于身体活动、睡眠和营养在实现能量平衡、维持健康体重和降低心血管风险方面的重要性，本研究聚焦于这些方面。定性和定量数据同时收集，前者优先于后者。优先收集定性数据是为了建立中风患者参与多种健康行为的概念模型。定性和定量数据分别进行分析，然后在推理阶段进行整合以形成元推理。25名中风患者完成了关于健康行为和身体功能的封闭式问卷。他们还参加了面对面的焦点小组讨论和一对一的电话访谈。
我们发现手部功能与健康饮食习惯之间存在统计学上显著的中度相关性（r = 0.45），睡眠障碍与日常生活活动受限之间存在相关性（r = -0.55），体重指数（BMI）与日常生活活动受限之间存在相关性（r = -0.49），身体活动与日常生活活动受限之间存在相关性（r = 0.41），行动障碍与BMI之间存在相关性（r = -0.41），睡眠障碍与身体活动之间存在相关性（r = -0.48），睡眠障碍与BMI之间存在相关性（r = 0.48），以及身体活动与BMI之间存在相关性（r = -0.45）。我们确定了五个定性主题：（一）损伤：自主性降低；（二）环境因素：照顾者和信息；（三）重新评估：优先事项和归因；（四）恢复力：找到动力和解决方案；（五）消极情感：压力和自我意识。三个元推理和一个概念模型描述了各种因素可能影响单一或多种健康行为的情况。
这是第一项针对中风患者的混合方法研究，详细阐述了多种健康行为、BMI和身体功能之间的关系。一个概念模型说明了如何解决睡眠障碍、活动受限、自我形象和情绪问题以促进多种健康行为。我们讨论了元推理在为中风患者设计多种行为改变干预措施中的相关性。
