Zhao Zhixin, Lin Beilei, Zhang Zhenxiang, Zhang Chunhui, Mei Yongxia, Liu Zhiwei, Jiang Hu, Wang Xiaoxuan
School of Nursing and Health, Zhengzhou University, Henan, 450000, China.
School of Nursing, Inner Mongolia Medical University, Hohhot, Inner Mongolia, 010000, China.
BMC Health Serv Res. 2025 Mar 18;25(1):396. doi: 10.1186/s12913-025-12563-6.
Self-advocacy can help stroke patients actively participate in disease management and maximize health benefits, which is a central issue in chronic disease management. The aim of the study was to explore the influencing factors of self-advocacy in stroke patients from multiple perspectives.
A descriptive qualitative interview study was performed. Semi-structured in-depth interviews were conducted with 19 stroke patients, 6 caregivers, and 8 medical staff from two hospitals in Henan province between October 2023 to February 2024. This study analyzed interview data using a Social Ecological Model (SEM) and content analysis strategies.
Factors associated with stroke patients' self-advocacy were categorized using the social ecological model: (1) individual factors: influence of individual cognitive and psychological factors (weak sense of autonomy, insufficient disease cognition, severity of the disease, self-perceived burden, concerns about deteriorating doctor-patient relationship). (2) interpersonal factors: influence of family, peers and medical staff (insufficient family support, lack of peer support, authority of medical staff dominates). (3) community factors: influence of socio-environmental factors (shortage of medical staff, incomplete rehabilitation equipment, limited channels for information). (4) policy-economic factors: influence of existing policy (insufficient support from medical insurance, long-term financial burden).
This study's application of a social ecological model helped to illuminate the complex and multilevel factors that may influence self-advocacy in stroke patients. Stroke patients' self-advocacy was influenced by the patients themselves, interpersonal relationships, community factors, and policy-economic factors. These findings can be used to guide the development of a multi-pronged intervention strategy to increase the level of self-advocacy for stroke patients in the self-management process.
自我倡导有助于中风患者积极参与疾病管理并最大化健康效益，这是慢性病管理中的核心问题。本研究旨在从多个角度探讨中风患者自我倡导的影响因素。
进行了一项描述性定性访谈研究。2023年10月至2024年2月期间，对河南省两家医院的19名中风患者、6名护理人员和8名医务人员进行了半结构化深度访谈。本研究使用社会生态模型（SEM）和内容分析策略分析访谈数据。
使用社会生态模型对与中风患者自我倡导相关的因素进行了分类：（1）个体因素：个体认知和心理因素的影响（自主意识薄弱、疾病认知不足、疾病严重程度、自我感知负担、对医患关系恶化的担忧）。（2）人际因素：家庭、同伴和医务人员的影响（家庭支持不足、缺乏同伴支持、医务人员的权威占主导）。（3）社区因素：社会环境因素的影响（医务人员短缺、康复设备不齐全、信息渠道有限）。（4）政策经济因素：现有政策的影响（医疗保险支持不足、长期经济负担）。
本研究对社会生态模型的应用有助于阐明可能影响中风患者自我倡导的复杂和多层次因素。中风患者的自我倡导受到患者自身、人际关系、社区因素和政策经济因素的影响。这些发现可用于指导制定多管齐下的干预策略，以提高中风患者在自我管理过程中的自我倡导水平。
