Distress disclosure was strongly associated with health behaviours among patients with stroke, and this association was accompanied by significant indirect statistical associations via social support, self-efficacy, and self-management, supporting an expression-support-efficacy-management framework.
Stroke patients in this sample demonstrated a moderate level of health behaviour.
Distress disclosure was strongly and positively correlated with health behaviours in stroke patients.
The total effect of distress disclosure on health behaviours was statistically significant, with the majority of the effect operating indirectly through mediators.
Social support, self-efficacy, and self-management each independently and significantly mediated the relationship between distress disclosure and health behaviours.
The full serial indirect pathway through social support, self-efficacy, and self-management in sequence was statistically significant.
The findings support an expression-support-efficacy-management framework that may inform communication-centred and self-management-oriented nursing interventions.
This research suggests that stroke patients who are more willing to openly share their emotional distress tend to engage in healthier behaviours related to managing their condition. In a sample of 473 stroke patients from a hospital in Inner Mongolia, China, researchers found a very strong positive relationship between distress disclosure — how openly someone shares their worries and emotional struggles — and health behaviours such as taking medications, exercising, and following medical advice. Importantly, only a small portion of this relationship was direct; the majority appeared to work through a chain involving social support, self-confidence in managing stroke (self-efficacy), and active self-management behaviours. The study found that social support was the single most important pathway linking distress disclosure to better health behaviours, accounting for about 36% of the total association. The research also confirmed a sequential chain: when stroke patients openly express their distress, they tend to receive more social support, which boosts their confidence in managing their condition, which in turn improves their self-management behaviours and overall health behaviours. All three mediators — social support, self-efficacy, and self-management — also showed significant effects on their own. This research suggests that encouraging stroke patients to openly communicate their emotional distress — rather than keeping it to themselves — may be an important starting point for improving health behaviours. Nursing and rehabilitation programs that focus on facilitating distress expression, strengthening social support networks, and building patients' confidence in self-care may together help stroke patients better manage their health. Because this was a cross-sectional study (a snapshot in time at one hospital), future studies with longer follow-up periods and more diverse populations would be needed to confirm whether these relationships are causal.
Yang X, Han Y, Liu Y, Fan H, Wang J, He Y, et al.. (2026). Distress disclosure and health behaviours in patients with stroke: a theory-informed serial mediation model of social support, self-efficacy, and self-management.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1896437