Title : Rehabilitation motivation and health self-management in stroke survivors: The mediating roles of psychological resilience and exercise behavior regulation
Abstract:
Background: The Global Burden of Disease Report indicates that the lifetime risk of stroke in China is 39.9%, the highest worldwide. Stroke patients often show weak health management awareness and limited initiative in health behaviors. Promoting proactive awareness and sustained engagement in healthy behaviors is essential for improving health outcomes. Health self-management refers to individuals’ active participation in managing their health through targeted behaviors. Social cognitive theory further posits that individuals with higher levels of psychological resources and effective behavioral execution are more likely to develop stable health behavior patterns. In contrast, when individuals perceive insufficient self-regulatory capacity or lack the ability to implement behaviors, this may lead to behavioral discontinuity or inadequate health management. Therefore, rehabilitation motivation does not directly influence health self-management behaviors; rather, it exerts indirect effects through an individual pathway (psychological resilience) and a behavioral pathway (exercise behavior). This process reflects the continuity of cognition–behavior interactions within the theoretical framework, as well as their variability across different individual conditions.Social cognitive theory suggests that behaviors are shaped by dynamic interactions among individual, behavioral, and environmental factors. Rehabilitation motivation may enhance health self-management by influencing psychological resources and behavioral engagement.
Objective: This study proposes a mechanism model in which rehabilitation motivation affects health self-management through the dual pathways of psychological resilience and exercise behavior, aiming to elucidate the underlying mechanisms of health behavior formation in stroke survivors.
Methods: A cross-sectional study was conducted among 500 stroke survivors. Data on rehabilitation motivation, psychological resilience, exercise behavior regulation, and health self-management were collected using validated scales and analyzed using mediation analysis.
Results: Rehabilitation motivation was positively associated with health self-management (β = 0.629, p < 0.05). Psychological resilience (a1 = 0.164, b1 =0.642, p < 0.001) and exercise behavior regulation (a2 =1.005, b2 = 0.231, p < 0.01) significantly mediated this relationship.
Conclusion: Rehabilitation motivation influences health self-management in stroke survivors through psychological resilience and exercise behavior regulation. Interventions targeting these factors may help improve self-management outcomes.
