Explore the vast range of titles available.

BackgroundStroke is still the main cause of death and disability worldwide, numerous studies of recurrence risk have been reported, while systematic estimates of stroke recurrence risk in the last 10 years are variable. This review aims to estimate the cumulative stroke recurrence risk in the last 10 years for secondary prevention management in future.MethodsA systematic search from January 2009 to March 2019 was conducted through PubMed, EMBASE, Web of Science, Wan-fang, and CNKI. Search terms were in English and Chinese.ResultsA total of 37 studies involving 1,075,014 stroke patients were included. The pooled stroke recurrence rate was 7.7% at 3 months, 9.5% at 6 months, 10.4% at 1 year, 16.1% at 2 years, 16.7% at 3 years, 14.8% at 5 years, 12.9% at 10 years, and 39.7% at 12 years after the initial stroke. In addition, the pooled recurrence rate of 32 studies including stroke patients over 50 years only at seven time points except for subgroup of 10 years was 7.7%, 9.5%, 11.2%, 16.1%, 19.3%, 18.1%, and 39.7%, respectively. Meta-regression showed that the time points explained 23.02% of the variance among studies, while regions, age, and stroke types showed no significant contribution to heterogeneity.ConclusionsThe risk of stroke recurrence varies greatly from 3 months to over 10 years and increases significantly over time in both young and old subgroup. The heterogeneity may be explained by follow-up time, regions, age, methodology differences, and stroke types, which was needed further exploration in future.

Background Multimorbidity has a significant impact on public health and primary care. Medication adherence is recognized as the most effective measure for managing and preventing multimorbidity. Studies have shown that medication literacy has a positive effect on medication adherence in patients with multimorbidity. However, limited knowledge exists regarding the underlying mechanisms of this relationship in older adults with multimorbidity. Therefore, the aim of this study was to investigate the mediating role of self-efficacy in the association between medication literacy and medication adherence in this population. Methods This study employed a cross-sectional design and convenience sampling method to survey older patients with multimorbidity in six communities in Zhengzhou, China, from July 12, 2021, to December 15, 2021. Participants were assessed using a demographic questionnaire, the Chinese Version of the Medication Literacy Scale (C-MLS), the Self-Efficacy for Appropriate Medication Use Scale (SEAMS), and the Chinese Version of the Morisky Medication Adherence Scale-8 (C-MMAS-8). Data were analyzed using descriptive statistics, t-tests, one-way analysis of variance, Pearson correlation analysis, and mediation analysis. Results A total of 350 elderly patients met the inclusion criteria, and 328 valid questionnaires were collected. The mean age of the participants was 74.90 ± 7.37 years, with a slightly higher proportion of males (55.8%) than females (44.2%). The mean score for medication adherence was 4.85 ± 1.57, indicating poor medication adherence among the participants. Medication adherence scores varied significantly among participants of different ages, education levels, employment statuses and kinds of medication (p < 0.01). Scores for medication literacy and self-efficacy showed a significant positive correlation with medication adherence scores (all p < 0.001). The standardized coefficient for the total effect and direct effect of medication literacy on medication adherence was 0.268 (95% CI: 0.201, 0.335) and 0.187 (95% CI: 0.123, 0.252), respectively. After introducing self-efficacy into the model, the standardized coefficient for the indirect effect was 0.081 (95% CI: 0.049, 0.120), indicating that self-efficacy partially mediated the relationship between medication literacy and medication adherence, accounting for 30.22% of the total effect. Conclusion This study might suggest that medication literacy indirectly affected medication adherence in older people with multimorbidity through self-efficacy. Health care providers should be aware of the importance of improving medication literacy and implement strategies aimed at increasing self-efficacy to achieve the goal of improving medication adherence in older adults with multimorbidity.

Health literacy is the ability of individuals to access, process, and understand health information to make decisions regarding treatment and their health on the whole; it is critical to maintain and improve public health. However, the health literacy of urban and rural populations in China has been little known. Thus, this study aims to assess the status of health literacy and explore the differences of its possible determinants (e.g., socio-economic factors) among urban and rural populations in Henan, China. A cross-sectional study, 78,646 participants were recruited from a populous province in central China with a multi-stage random sampling design. The Chinese Resident Health Literacy Scale was adopted to measure the health literacy of the respondents. In the participants, the level of health literacy (10.21%) in central China was significantly lower than the national average, and a big gap was identified between urban and rural populations (16.92% vs. 8.09%). A noticeable difference was reported in different aspects and health issues of health literacy between urban and rural populations. The health literacy level was lower in those with lower levels of education, and a significant difference was identified in the level of health literacy among people of different ages and occupations in both urban and rural areas. Note that in rural areas, as long as residents educated, they all had higher odds to exhibit basic health literacy than those uneducated; in rural areas, compared with those aged 15 to 24 years, residents aged 45 to 54 years (OR = 0.846,95% CI (0.730, 0.981)), 55 to 64 years (OR = 0.716,95% CI (0.614, 0.836)) and above 65 years (OR = 0.679, 95% CI (0.567, 0.812)) were 84.6%, 71.6%, and 67.9%, respectively, less likely to exhibit basic health literacy. Considering the lower health literacy among rural residents compared with their urban counterparts, a reorientation of the health policy-making for Chinese rural areas is recommended. This study suggests that urban–rural disparity about health literacy risk factors should be considered when implementing health literacy promotion intervention.

Promoting self-care is the core response strategy of the global health system to the burden of stroke. Although self-care in stroke represents a dyadic phenomenon, the dyadic self-care experience of stroke survivors and their caregivers is often overlooked in clinical practice. The aim of this study was to explore the dyadic self-care experience of stroke survivors and their caregivers. A descriptive qualitative design was used to conduct the study. The Consolidated Criteria for Reporting Qualitative Research was used for study reporting. A total of 21 stroke survivor-caregiver dyads were recruited for this study between May 2022 and September 2022. Data were collected through semistructured interviews and analyzed using thematic analysis. In this study, four themes were identified: (1) poor relationship quality of the dyads, (2) dyadic incongruence in managing stroke, (3) a slow and tiring dyadic self-care process and (4) happy cooperation in coping with dyadic self-care. Healthcare professionals should give greater consideration to the contradictions and disparities that may arise between stroke survivors and caregivers during the self-care process. It is crucial for them to provide personalized and tailored support and interventions that can assist these individuals in achieving a more optimal balance in their dyadic self-care. Patients were involved in the formulation of interview questions for this study. No members of the public were involved in this study.

Background Compassion is closely linked to psychological well-being, and several assessment tools have been developed and studied to assess the level of compassion in different populations and for more precise measurement. There is currently a scarcity of comprehensive knowledge about compassion-related assessment tools, and our research provides an overview of these tools. Aims To identify scales used to measure compassion from different flows, and to assess their measurement properties and quality. Methods Focusing on compassion assessment tools, the authors conducted a thorough search of 10 Chinese and English databases from their establishment until August 14, 2022. Data extracted included the author, year, country, objectives, target population, as well as the primary evaluation content. Using the COSMIN checklist, the methodological quality and measurement properties of the included studies were appraised. This scoping review was registered with the Open Science Framework and followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. Results There were 15,965 papers searched, and 36 compassion-related measurement tools were identified in this study. None of the 36 studies provided possessed all nine psychometric properties, as outlined by the COSMIN criteria. On the basis of a systematic evaluation of quality, measurement qualities were ranked. The results for internal consistency and content validity were relatively favorable, whereas the results for structural validity were variable and the results for the remaining attributes were either uncertain or negative. A Venn diagram was used to illustrate the overlapping groups of compassion measurement tools based on the three-way flow of compassion. An overview of the reference instrument and theoretical basis for the included studies was provided, and half of them did not contain any theoretical or scale-based evidence. Conclusion In this study, 36 compassion-related measuring instruments were identified, and the methodological quality and measurement properties of the included studies were acceptable. The included measurements were consistent with flows of compassion. A further focus of further research should be on developing theories in the compassion domain and developing instruments for measuring compassion that are multidimensional, multi-populations, and culturally relevant.

Depression represents a challenging neuropsychiatric issue following strokes and conceptualized as a network of individual symptoms that could affect each other in network theory. Clinical characteristics of depression are influenced by mutuality of stroke survivors and their spouses. No relevant research has examined the structure of depression network and how mutuality is related to depression among Chinese stroke survivors. This study aimed to investigate the structure of the depression network model, identify the pivotal symptoms influencing depression and explore the nodes that bridge depression and mutuality among Chinese stroke survivors. A sample of 847 stroke survivors in Henan Province, China, were invited to complete a survey that included the Patient Health Questionnaire (PHQ-9) and the 15-item Mutuality Scale (MS), which assessed depressive symptoms and mutuality, respectively. Results indicated that within the network of depressive symptoms, sadness (PHQ2) emerged as the central symptom. Getting help from spouse (MS6), attachment relationship (MS5), and concentration (PHQ7) were identified as the pivotal nodes bridging the connection between mutuality and depressive symptoms. Conversely, suicide ideation (PHQ9) and sleep disorders (PHQ3) were among the symptoms demonstrating the lowest predictability, indicating that their variance was less likely influenced by other depressive symptoms within the network. This is among the first studies investigating the inter-relationships between mutuality and depressive symptom from the network approach. Our findings provide an empirically-based perspective on the significance of dyadic interventions, with potential clinical implications for alleviating depressive symptom among stroke survivors.

Background Self-efficacy is a significant predictor of return to work and affects the confidence of survivors to return to work after illness. The Return-to-work self-efficacy (RTW-SE) questionnaire is a self-report questionnaire to assess confidence in returning to work with good reliability and validity. The aim of this study was to translate and cross-culturally adapt the RTW-SE questionnaire into Chinese and examine the psychometric properties among young and middle-aged stroke survivors using Rasch model analysis. Methods The cross-cultural adaptation and translation procedures followed a dual-translation approach. The psychometric properties of the RTW-SE questionnaire were examined using Rasch model analysis by Winsteps software. The unidimensionality and local independence were analyzed by principal component analysis of the residuals (PCAR) and standardized residual correlations.Category diagnostics were performed for scale function, and the item fit, reliability, and separation were also validated. Item-person maps were used to examine the distribution and matching of item’s location and person ability. Finally, the differential item functioning (DIF) was used to measure gender-related group equivalence. Results A total of 366 participants aged 23–59 years were recruited from three communities in Zhengzhou. The RTW-SE questionnaire demonstrated unidimensionality and a 5-point Likert rating scale was more appropriate to investigate young and middle-aged stroke survivors’self-efficacy. There was a good fit for the items with both person and item reliabilities greater than 0.8 and separation indices of 3.75 and 3.94, respectively. The item location was identified from the item-person map as not covering person ability, but the scale did not have an age-related DIF. Conclusions The results confirm evidence of appropriate psychometric properties of the RTW-SE questionnaire and can be used as a reliable and validated instrument for measuring self-efficacy to return to work in young and middle-aged Chinese patients with stroke.

Self-advocacy is essential for self-management in stroke patients. However, a validated scale to assess the level of self-advocacy in this population is lacking. This study aimed to develop a self-advocacy scale for stroke patients and validate its psychometric properties. This cross-sectional study involved instrument development and psychometric testing, conducted in three stages. In stage 1, dimensions and items were generated through concept analysis, semi-structured interviews, and refined through a Delphi survey. Stage 2 focused on content and face validity assessment. Stage 3 evaluated psychometric properties. A total of 565 stroke patients participated in the items selection from August 2024 to November 2024. The self-advocacy scale was assessed through content validity, construct validity, internal consistency, and test-retest reliability. The study adhered to the STROBE checklist for reporting. From an initial 40-item pool, 24 items were retained after expert consultation and item analysis. The scale demonstrated a content validity index of 0.967. Exploratory factor analysis revealed a five-factor structure, explaining 68.285% of the total variance. Confirmatory factor analysis supported this structure with acceptable fit indices. The scale’s overall Cronbach’s α coefficient was 0.936, with the dimensions’ Cronbach’s α values ranging from 0.816 to 0.898. Split-half reliability was 0.874, and test-retest reliability was 0.885 (2-week interval). The 24-item self-advocacy scale for stroke patients demonstrated robust psychometric properties, providing a valid tool for clinical and research applications.

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.

Background: Exercise rehabilitation is a crucial component of stroke recovery, particularly for patients transitioning to home or community settings. However, there is currently a lack of self-reported scales designed to measure the level of engagement in exercise rehabilitation among patients with stroke. Objective: To develop and validate psychometric properties of the Engagement in Exercise Rehabilitation Scale for patients with stroke. Methods: The initial item pool was extracted from a literature review and a semi-structured interview with patients with stroke. The development and refinement of the items underwent expert consultation and cognitive interviews with patients with stroke. The items primarily covered patients’ perceptions, emotional attitudes, and specific engagement behaviors regarding exercise rehabilitation in home or community settings. A total of 260 patients with stroke were selected to test the reliability and validity. The psychometric proprieties test included construct validity, content validity, criterion-related validity, exploratory factor analysis, internal consistency reliability, test–retest reliability, and split-half reliability. Results: The final version of the Engagement in Exercise Rehabilitation Scale comprised 20 items. The scale’s content validity index was determined to be 0.976, while the item-content validity indices ranged from 0.833 to 1.000. Results from exploratory factor analysis indicated that this scale is unidimensional, with a cumulative variance contribution rate of 79.3%. The test–retest reliability of the scale was found to be 0.879, its split-half reliability was measured at 0.980, and its Cronbach’s α coefficient was calculated to be 0.986. Conclusion: The Engagement in Exercise Rehabilitation Scale for patients with stroke demonstrates accepted reliability and validity. The accuracy and generalizability of this scale necessitate further validation through additional large-sample studies involving diverse populations across multiple centers.