Nursing School, Second Military Medical University, Shanghai, China.
Head of Department: Clinical Nursing, Nursing School, Second Military Medical University, Shanghai, China.
J Adv Nurs. 2021 Mar;77(3):1293-1303. doi: 10.1111/jan.14670. Epub 2020 Nov 29.
To explore the level and associated factors of perceived participation and autonomy among stroke survivors in Shanghai, China.
Cross-sectional explorative study.
From January to December 2018, 431 patients presenting at the neurology departments of three hospitals with a confirmed diagnosis of stroke were recruited. Impact on Participation and Autonomy Questionnaire, modified Rankin Scale, Self-efficacy for Managing Chronic Disease six-item Scale, Medical Coping Modes Questionnaire and Multidimensional Scale of Perceived Social Support were applied to measure their participation, physical function, self-efficacy, coping styles, and social support.
The average score of perceived participation and autonomy was 41.30 (SD 21.22); and 54.3%, 46.9%, 21.6%, and 7.7% of the participants reported poor participation in social relations, family role, autonomy indoors, and autonomy outdoors. Age, physical function, self-efficacy, friend support, and knowledge of stroke were predictors of post-stroke participation. Physical function and self-efficacy were the most relevant factors of nearly all domains of participation except autonomy outdoors, while predictors of autonomy outdoors were social support, resignation coping style, and knowledge of stroke.
The stroke patients experienced insufficient participation compared with previous studies in western countries. Patients' physical function and self-efficacy were particularly important and contributed to their participation, while the patient's age, perceived social support, coping styles, and knowledge of stroke also played a role in formulating participation.
The results may be used to provide nurses with a better understanding of the participation among stroke patients and assist them in promoting the post-stroke participation. Nurses should pay special attention to those with older age, worse physical function, lower self-efficacy, less support, little stroke-related knowledge, or who applied resignation coping style since those patients might experience lower participation in their daily life. It needs further studies to explore the causal effects of self-efficacy, coping styles, and social support on post-stroke participation.
探索中国上海脑卒中幸存者的感知参与和自主水平及其相关因素。
横断面探索性研究。
2018 年 1 月至 12 月，从三家医院的神经内科招募了 431 名经确诊为脑卒中的患者。采用参与和自主问卷、改良 Rankin 量表、慢性病自我效能管理量表 6 项、医学应对方式问卷和多维感知社会支持量表评估他们的参与度、身体功能、自我效能、应对方式和社会支持。
感知参与和自主的平均得分为 41.30（SD 21.22）；54.3%、46.9%、21.6%和 7.7%的参与者报告在社会关系、家庭角色、室内自主和室外自主方面的参与度较差。年龄、身体功能、自我效能、朋友支持和对脑卒中的了解是脑卒中后参与的预测因素。身体功能和自我效能是除室外自主外所有参与领域的最相关因素，而室外自主的预测因素是社会支持、应对方式和对脑卒中的了解。
与西方国家的既往研究相比，脑卒中患者的参与度较低。患者的身体功能和自我效能尤为重要，有助于他们的参与，而患者的年龄、感知社会支持、应对方式和对脑卒中的了解也在制定参与度方面发挥作用。
研究结果可用于为护士提供更好地了解脑卒中患者的参与度，并帮助他们促进脑卒中后的参与度。护士应特别关注年龄较大、身体功能较差、自我效能较低、支持较少、对脑卒中相关知识了解较少或采用应对方式的患者，因为这些患者在日常生活中可能参与度较低。需要进一步研究以探讨自我效能、应对方式和社会支持对脑卒中后参与度的因果影响。
