Study On The Influencing Factors And Pathway Of Readiness For Return To Work Of Young And Middle-aged Stroke Patients Based On COM-B Model

Objective:This study aimed to investigate the current status of readiness for return to work in young and middle-aged stroke patients.And to clarify the influence and mechanism of general information,stroke-related health,positive psychological capital,family resilience,and comprehension of social support on readiness for return to work,and to provide a theoretical reference for the formulation of relevant interventions to improve patients’readiness to return to work.Methods:The cross-sectional research method was used to facilitate the selection of 333 young and middle-aged stroke patients from the Department of Neurology of two third-class hospitals in Suzhou as the survey subjects,and we conducted them in the form of questionnaires.Survey tools include the general information questionnaire,the disease acceptance scale,the stroke-related health behavior scale,the positive psychological capital questionnaire,the family resilience scale,the comprehension social support scale,and the return to work readiness scale.The statistical analysis was done with IBM SPSS Statistics 26.0 and IBM SPSS Amos 26.0.The sociodemographic data,disease-related data,and scores of young and middle-aged stroke patients were descriptively analyzed,and the measurement data that conformed to the normal distribution were expressed by mean ± standard deviation;otherwise the median and quartile were used.Counting data is expressed in frequency and composition ratio.The rank-sum test was used to analyze the distribution differences of sociodemographic data and disease-related data in each dimension of return to work.Spearman correlations were used to analyze the association between disease acceptance,stroke health behaviors,positive psychological capital,family resilience,comprehension of social support,and readiness to return to work.Ordered logistic regression and binary logistic regression were used to further explore the important influencing factors of stroke patients’ return to work.The path analysis method was used to explore the action paths and coefficients of each influencing factor.Results:1.This study finally included 305 young and middle-aged stroke patients,including 217 males and 88 females,with an average age of(45.85±8.60)years.139 patients did not return to work,and 166 patients returned to work,with a success rate of 54.43%.The patients who were in the stages of pre-work readiness,intention,action preparation-assessment,action preparation-action,uncertain maintenance,and active maintenance accounted for 5.57%,33.11%,4.59%,2.30%,32.79%and 21.64%,respectively.The overall disease acceptance level was(26.22±6.81)points,the stroke health behavior level was(69.12±12.79)points,the positive psychological capital level was(118.98±28.55)points,the family resilience level was(68.50±16.23)points,and the comprehension social support level was(54.08± 13.5 8)points.2.Univariate analysis showed that among patients who did not return to work,there were significant differences in the stage of readiness for return to work between different ages,religious beliefs,place of residence,occupation type,stroke type,medical payment method,current Rankin score,and whether or not to undergo professional rehabilitation training(P<0.05);Among patients who had returned to work,there were statistically significant differences in the stage of readiness for return to work between patients with different education levels,medical payment methods,current Rankin scores,insomnia symptoms,and stroke-related knowledge(P<0.05).3.The results of ordered logistic regression analysis showed that age,current place of residence,medical payment method,occupation type,current Rankin score,and participation in rehabilitation training were the main factors affecting readiness for return to work in young and middle-aged stroke patients who had not returned to work(P<0.05).The results of binary logistic regression analysis show that education level,current Rankin score,medical payment method,and stroke related-knowledge were the main factors affecting readiness for return to work in young and middle-aged stroke patients who had returned to work(P<0.05).4.Correlation analysis showed that disease acceptance,positive psychological capital level,stroke health behavior,family resilience,and comprehension of social support were positively correlated with readiness for return to work in young and middle-aged stroke patients,and the correlation coefficients were r=0.408,r=0.553,r=0.507,r=0.218,and r=0.618 respectively.In young and middle-aged stroke patients who had returned to work,the correlation coefficients were r=0.356,r=0.441,r=0.188,r=0.292,and r=0.433,respectively.5.Path analysis display:χ~2/df=1.255,RMSEA=0.029,GFI=0.918,AGFI=0.900,IFI=0.974,CFI=0.973,and the fitting indicators are up to standard.(1)Disease acceptance can directly predict the return to work stage,and the standardized effect value is(β=0.136,P<0.01);(2)Stroke health behavior can directly predict the return to work stage,and the standardized effect value is(β=0.251,P<0.01);(3)Family resilience can directly predict the return to work stage,and its standardized effect value is(β=0.204,P<0.01);(4)Comprehension of social support can directly predict the return to work stage,and its standardized effect value is(β=0.301,P<0.01);(5)Positive psychological capital can directly predict the return to work stage,and its standardized effect value is(β=0.218,P<0.01);(6)Family resilience indirectly acts on the return to work stage through positive psychological capital,and positive psychological capital exerts a mediating effect(β=0.056,P<0.01);(7)Comprehension social support indirectly acts on the return to work stage through positive psychological capital,and positive psychological capital exerts a mediating effect(β=0.121,P<0.01).Conclusions:1.The success rate of returning to work of middle-aged and young stroke patients in China needs to be improved,and the proportion of middle-aged and young stroke patients who have not returned to work is in the intention stage,and the overall level of readiness for return to work is low.The proportion of patients who have returned to work is in the uncertain maintenance stage,and the RRTW level needs to be improved.2.Age,current place of residence,medical payment method,occupation type,current Rankin score,and participation in rehabilitation training were the main factors affecting readiness for return to work in young and middle-aged stroke patients who had not returned to work.Education level,current Rankin score,medical payment method,and stroke-related knowledge are the main factors affecting readiness for return to work in young and middleaged stroke patients who have returned to work.3.Family resilience and social support can directly affect the readiness of young and middle-aged stroke patients to return to work,and can also act on the readiness of young and middle-aged stroke patients to return to work through positive psychological capital,and positive psychological capital plays part of the mediating effect.