| Objective1.To understand the current situation of compliance of swallowing function exercise in stroke patients by using cross-sectional survey,and apply the "Health Ecological Model" to preliminarily analyze the factors affecting compliance of swallowing function exercise in stroke patients.2.To further explore the relevant factors affecting the compliance with swallowing function exercise among stroke patients by using semi-structured interviews with stroke patients with dysphagia,.Method1.Using consecutive sampling method,a survey was conducted on 199 stroke patients with swallowing problems in the Rehabilitation Medicine Department of a tertiary first-class hospital in Qingdao from October 2021 to August 2022.The swallowing function exercise compliance scale was used to investigate the current status of patients’ swallowing function exercise compliance.Based on the Health Ecological Model,the possible influencing factors of compliance were included hierarchically.The general information questionnaire,the deglutition disorder rating scale,the emotional and social dysfunction scale,the Pittsburgh sleep quality index(PSQI),the ability of daily living scale(Barthel index),the general self-efficacy scale,the social support rating scale and medical behavior perception scale were administered among stroke patients with swallowing disorders.SPSS26.0 software was employed for further statistical analysis.Frequency and proportion was used to describe the categorical variables in the general information of the participants.Mean±standard deviation was used to describe the numerical variables that conforms to normal distribution.The quartile method was applied to describe the numerical variables of non normal distribution.Independent sample t-test,one-way ANOVA,Pearson or Spearman correlation analysis,and multiple linear regression analysis were used to analyze the influencing factors of swallowing function exercise compliance in stroke patients.2.Using the purposive sampling method,a semi-structured interview was conducted on 13 stroke patients with dysphagia in the Rehabilitation Medicine Department of a tertiary first-class hospital in Qingdao from September 2021 to February 2022,in order to gain a deeper understanding of the impact of relevant factors on the compliance of stroke patients with swallowing function exercise.The interview data were analyzed by using Braun&Clarke’s six step thematic analysis method to generate themes and subthemes.Results1.Compliance status of swallowing function exercise in stroke patientsThis study showed that the average score of swallowing function exercise compliance of stroke patients was(48.24±7.37)points,the compliance rate was(70.94±10.84)%,and the average score of the total items in the scale was(2.84±0.43)points.The average score of items in each dimension was ranked from high to low,and the order was swallowing rehabilitation exercise compliance(2.99±0.45),exercise monitoring compliance(2.69±0.57),and initiative seeking advice compliance(2.44±0.80).2.Influencing factors of swallowing function exercise compliance of stroke patients(1)Univariate analysis showed that the duration of disease,type of medical insurance,grade of dysphagia,sleep status and ability of daily living of patients had significant effects on the compliance of swallowing function exercise(P<0.05).(2)Pearson correlation analysis showed that patients’ emotional and social dysfunction were negatively correlated with swallowing function exercise compliance(r=-0.422,P<0.01),and patients’ social support was positively correlated with swallowing function exercise compliance(r=0.217,P<0.01).Spearman correlation analysis showed that patients’ general self-efficacy(r=0.122,P<0.01),and the perception of medical behavior(r=0.056,P<0.05)were positively correlated with compliance with swallowing function exercise.(3)Based on the health ecology model,multiple linear regression analysis shows that the influencing factors of swallowing function exercise compliance in stroke patients include: individual psychological,behavioral,lifestyle level emotional and social dysfunction(β=-0.174,P=0.008),sleep status(β=-0.397,P<0.001),social support at the interpersonal network level of the family community(β= 0.138,P=0.007),the daily living ability of individuals at the level of work and living conditions(β= 0.354,P<0.001),resident medical insurance in the local,national,and global policy environment levels of medical insurance types(β= 0.163,P=0.026),employee medical insurance(β= 0.162,P=0.027)and off-site medical insurance(β= 0.165,P=0.013).3.By organizing and analyzing interview data,five themes that affect the compliance of swallowing function exercise in stroke patients were extracted:(1)swallowing disorders lead to malnutrition and decreased physical endurance in patients;(2)Multiple rehabilitation projects lead to patient fatigue;(3)Swallowing rehabilitation exercise leads to pain and discomfort in patients;(4)Rehabilitation therapist factors;and(5)Swallowing rehabilitation effect.Conclusions1.The compliance of swallowing function exercise of stroke patients was at the middle level,and the compliance of swallowing function exercise needs to be improved.2.The factors affecting the compliance of swallowing function exercise of stroke patients from the largest to the smallest were: sleep,activities of daily living,emotional and social dysfunction of patients,medical insurance type,and social support.3.The compliance of swallowing function exercise in stroke patients is also influenced by factors such as the patient’s nutritional status,physical endurance,fatigue,pain,the techniques and communication skills of rehabilitation therapists,the patient’s rehabilitation confidence,and the effectiveness of swallowing rehabilitation. |
