Association Between Stroke-Related Knowledge and Self-Management Behaviours in Patients With Ischemic Stroke: Serial Mediation by Health Beliefs and Depression.
Among patients with ischemic stroke, stroke-related knowledge was significantly associated with self-management behaviours, with health beliefs and depressive symptoms serving not only as separate mediators but also as a significant serial mediation pathway.
Key Findings
Results
Stroke-related knowledge was positively associated with self-management behaviours in patients with ischemic stroke.
Total effect of stroke-related knowledge on self-management behaviours: B = 2.448, 95% CI [1.925, 3.015]
The direct effect remained statistically significant after accounting for mediators: B = 1.124, 95% CI [0.552, 1.696]
382 patients with ischemic stroke were enrolled from a tertiary hospital in Henan Province between June 2024 and March 2025
Spearman correlation analysis and structural equation modelling with robust maximum likelihood estimation were used
Results
The total indirect effect of stroke-related knowledge on self-management behaviours through health beliefs and depressive symptoms was statistically significant, accounting for over half of the total effect.
Total indirect effect: B = 1.324, 95% CI [0.966, 1.752]
The total indirect effect accounted for 54.08% of the total effect
Serial mediation was examined using structural equation modelling with the lavaan package (version 0.7-2)
Results
Health beliefs alone served as a significant independent mediator in the relationship between stroke-related knowledge and self-management behaviours.
Indirect effect through health beliefs: B = 0.594, 95% CI [0.238, 0.970]
Data were collected using the Health Belief Scale
This pathway was one of three statistically significant indirect pathways identified
Results
Depressive symptoms alone served as a significant independent mediator in the relationship between stroke-related knowledge and self-management behaviours.
Indirect effect through depressive symptoms: B = 0.419, 95% CI [0.236, 0.683]
Depression was measured using the Self-Rating Depression Scale
This pathway was statistically significant independent of the health beliefs pathway
Results
Health beliefs and depressive symptoms together formed a significant serial mediation pathway from stroke-related knowledge to self-management behaviours.
Serial indirect effect through health beliefs then depressive symptoms: B = 0.311, 95% CI [0.176, 0.510]
This serial pathway was statistically significant, indicating that higher stroke-related knowledge may improve health beliefs, which in turn reduces depressive symptoms, thereby improving self-management
All three indirect pathways (health beliefs alone, depression alone, and serial) were simultaneously statistically significant
Methods
The study used a cross-sectional design enrolling 382 ischemic stroke patients from a single tertiary hospital using five validated questionnaires.
Data collected from June 2024 to March 2025 at a tertiary hospital in Henan Province
Instruments included the Stroke Knowledge Questionnaire, Health Belief Scale, Self-Rating Depression Scale, and Self-Management Behaviour Scale
Study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines
A general information questionnaire was also administered to capture demographic and clinical characteristics
What This Means
This research suggests that ischemic stroke patients who have greater knowledge about stroke tend to engage in better self-management behaviors — such as taking medications, following dietary advice, and attending rehabilitation. The study enrolled 382 stroke patients from a hospital in China and found that this relationship is not just direct; it is also explained by two psychological factors. Patients with more stroke knowledge appear to develop stronger health beliefs (a sense that their actions can positively affect their health), and those stronger health beliefs are linked to lower levels of depression, which in turn supports better self-management. All three indirect pathways — through health beliefs alone, through depression alone, and through health beliefs leading to lower depression — were statistically significant and together accounted for about 54% of the overall relationship between knowledge and self-management.
This research suggests that simply educating stroke patients about their condition may not be sufficient on its own. The pathways through health beliefs and depression mean that how patients think and feel about their health matters greatly in determining whether they translate knowledge into action. Patients who remain depressed or who do not believe their efforts will make a difference may struggle to manage their condition effectively, even if they are well-informed.
The findings point toward the value of combining stroke education with psychological support and assessments of patients' health beliefs during rehabilitation nursing. Individualized approaches that address both the informational and emotional needs of stroke patients may offer more comprehensive support for self-management than education alone.
Li Y, Li L, Wang X, Lin B, Guo Z, Tang Q, et al.. (2026). Association Between Stroke-Related Knowledge and Self-Management Behaviours in Patients With Ischemic Stroke: Serial Mediation by Health Beliefs and Depression.. Nursing open. https://doi.org/10.1002/nop2.70845