Influencing factors of self-advocacy in stroke patients from multiple perspectives: a qualitative study
Zhixin Zhao, Beilei Lin, Zhenxiang Zhang, Chunhui Zhang, Yongxia Mei, Zhiwei Liu, Hu Jiang, Xiaoxuan Wang
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.