| ObjectivesThis study aims to clarify the concepts of stroke recurrence risk perception and behavioral decision making,develop relevant scales,explore the relationship and action path among recurrence risk perception,behavioral decision making and health behavior,and develop a situational specific theory of recurrence risk perception and behavioral decision making.In order to promote stroke patients’ health behavior management,then to provide a new theoretical and practice framework.Methods1.Study of the development of Recurrence risk perception and Behavioral decision-making Model(RBM)of stroke patients.Following the development process of theoretical models in nursing disciplines,based on the integration strategy,we used literature research,theoretical analysis,and qualitative methods to develop a preliminary model of stroke recurrence risk perception and behavioral decision-making,including core concepts,propositions,and model boundaries.Descriptive qualitative research method was used in qualitative study section.2.Study of the examination of RBM.Firstly,the Recurrence Risk Perception Scale and the Behavioral Decision-making Scale for stroke patients were developed and 327 stroke patients were recruited to test the scales’ reliability and validity.Secondly,419 stroke patients were selected to complete the survey,the relationships among the variables of recurrence risk perception,behavioral decision-making,selfefficacy,social support,and health behavior were examined by regression analysis,mediation model,and neural network predictive model,to confirm the formal RBM in stroke patients.IBM SPSS Statistic 21.0 was used,and all P-values were 2-tailed,the level of significance was set at α=0.05.3.Study of the application of RBM.RBM was used as an intervention development framework for this section,and a preliminary health behavior intervention protocol was constructed based on the Intervention Mapping for ischemic stroke patients.A quasi-experimental study was conducted.Seventy-four ischemic stroke patients were selected and randomly divided into intervention and control groups by unit.Data were collected at baseline(T0).The intervention effects were evaluated immediately after intervention(T1),one month(T2),and three months(T3)after intervention,with the main objectives of improving the perceived risk of recurrence,promoting healthy behaviors,and preventing recurrence.Statistical analyses were conducted with IBM SPSS Statistic 21.0.Data were analyzed using descriptive statistics,t-test,chi-square test,rank sum test,repeated data were analyzed using ANOVA measures and generalized estimating equation model.The level of significance was set at α=0.05.Results1.Draft RBM for stroke patients was developed.First,a model of the relationship between chronic disease risk perception and behavior was initially developed based on the literature analysis,including the emotional pathway,behavioral intention pathway,and self-efficacy pathway.Second,three themes including "perceived susceptibility of recurrence","perceived severity of recurrence",and "perceived risk factors of recurrence" were abstracted from qualitative data to explain recurrence risk perception.Five themes including "motivation to change behavior","intention to change behavior","decision uncertainty","behavioral decision facilitators" and "behavioral decision barriers" were abstracted to explain behavioral decision-making.Third,a theoretical analysis strategy was used to provide theoretical support for the establishment of interconcept relationships in the model.The first draft of the RBM included six core concepts,one core hypothesis,and three bridge hypotheses,and the scope of the model was clarified as well.2.A final model of RBM was tested and formulated.The Recurrence Risk Perception Scale and the Behavioral Decision-making Scale for stroke patients were found to be reliable and valid for measuring the recurrence risk perception and behavioral decision-making.According to results of data analysis,the model was modified,which is a situational theoretical model with six variables,one core path,and three bridge paths,including "recurrence risk perception→behavioral decision-making→health behavior",and the three bridge pathways refer to "social support→recurrence risk perception → behavioral decision-making → health behavior","recurrence risk perception → self-efficacy → behavioral decision-making → health behavior",and "recurrence risk perception→(self-efficacy)→recurrence worry→behavioral decisionmaking→health behavior".3.An empirical study of the application of RBM.A total of 82 ischemic stroke patients were recruited and 8 cases were lost,with an overall attrition rate of 9.76%.38 patients in the intervention group with a mean age of(60.66±10.77)years and 36 in the control group with a mean age of(65.14±8.49)years,the analysis showed no statistically significant difference in age(P>0.05).The results of the study showed that the perceived risk of recurrence,behavioral-decision making and health behavior of participants in the intervention group were significantly improved and the effects were maintained until 1 and 3 months after the intervention;and the scores of the perceived risk of recurrence,behavioral decision-making and health behavior of patients in the intervention group were significantly higher than those of the control group at three time points after the intervention(P<0.05).Further analysis showed that the intervention based on RBM could significantly improve the scores of exercise,nutrition,and health responsibility dimensions in the intervention group,and the effect lasted until 3 months,and the difference between the two groups was statistically significant(P<0.05)as well.However,in terms of improving individual blood pressure monitoring,medication taking,and smoking or alcohol cessation,although the scores of the intervention group were significantly increased(P<0.05),the comparison analysis between the two groups did not show significant effects(P>0.05).Regarding the effect of the intervention program on self-efficacy,social support,and quality of life,the results showed that the self-efficacy and social support utilization scores of the intervention group were significantly higher(P<0.05),but the long-term effects were not optimistic;and the effects in the intervention group were not significantly better than the control group in improving patients’ self-efficacy,subjective support,objective support and self-rated health status(P>0.05).Finally,the practical efficacy and theoretical value of the model are complementary interpreted and analyzed based on the results of the intervention study.Conclusions1.The Recurrence Risk Perception Scale and the Behavioral Decision-making Scale were found to be reliable and valid for measuring the recurrence risk perception and behavioral decision-making in stroke patients.2.The RBM includes six core concepts,four assumptions,and it can be used to guide health behavior management among stroke patients.This model enriches the theoretical content of stroke health behavior research,which may provide a new theoretical perspective for further research on stroke patients’ health promotion and recurrence prevention.3.The health behavior promotion program based on RBM can improve stroke patients’ awareness of recurrence risk,motivate health behavior decisions,and significantly promote exercise,nutritional behaviors,and health responsibility.But further study is needed to test the effect of improving stroke patients’ blood pressure monitoring,medication taking,and smoking and alcohol cessation behaviors.The results of the study may provide new practical evidence for further development of stroke health behavior management based on types of behaviors. |
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