Financial toxicity is significantly associated with exercise adherence among stroke patients, with self-efficacy and perceived social support serving as parallel mediators in this relationship.
Key Findings
Results
Financial toxicity, self-efficacy, perceived social support, and exercise adherence were all significantly intercorrelated among stroke patients.
All pairwise correlations among the four variables were statistically significant at p < 0.01
362 stroke patients were surveyed using convenience sampling from September 2024 to July 2025
Instruments included the Comprehensive Scores for Financial Toxicity Based on Patient-Reported Outcome Measures, Stroke Self-Efficacy Questionnaire, Perceived Social Support Scale, and Questionnaire of Exercise Adherence
Pearson correlation analysis was used to examine associations
Results
Financial toxicity had a significant direct effect on exercise adherence in stroke patients.
The direct effect of financial toxicity on exercise adherence was 0.279 (95% CI [0.199, 0.359])
The structural equation model fit well and all main paths were statistically significant (p < 0.05)
Bootstrap methods were used to estimate direct and indirect effects
Structural equation modeling was applied to test the overall model
Results
Self-efficacy significantly mediated the relationship between financial toxicity and exercise adherence.
The indirect effect of self-efficacy in the financial toxicity–exercise adherence relationship was 0.152 (95% CI [0.103, 0.208])
The confidence interval did not include zero, confirming significant mediation
Self-efficacy was measured using the Stroke Self-Efficacy Questionnaire
This was the larger of the two indirect (mediation) effects identified
Results
Perceived social support significantly mediated the relationship between financial toxicity and exercise adherence.
The indirect effect of perceived social support was 0.063 (95% CI [0.035, 0.094])
The confidence interval did not include zero, confirming significant mediation
Perceived social support was measured using the Perceived Social Support Scale
This indirect effect was smaller in magnitude than the self-efficacy mediation effect (0.063 vs. 0.152)
Results
The total effect of financial toxicity on exercise adherence was decomposed into a direct path and two parallel indirect paths through self-efficacy and perceived social support.
A parallel mediation model was tested with both self-efficacy and perceived social support as simultaneous mediators
Direct effect: 0.279; indirect effect via self-efficacy: 0.152; indirect effect via perceived social support: 0.063
Bootstrap confidence intervals were used to confirm all effects
The model supported the hypothesis that both mediators operate in parallel rather than sequentially
What This Means
This research suggests that stroke patients who experience greater financial toxicity — meaning the financial burden and stress caused by the costs of their illness — tend to have worse adherence to exercise programs. Studying 362 stroke patients in China, the researchers found that this relationship is not only direct but also works indirectly through two psychological and social pathways: a patient's confidence in their own ability to manage their health (self-efficacy) and the degree to which they feel supported by others around them (perceived social support). Patients with higher financial toxicity appeared to have lower self-efficacy and less perceived social support, which in turn was associated with poorer exercise adherence.
Among the two indirect pathways, self-efficacy played a notably larger mediating role (indirect effect of 0.152) compared to perceived social support (indirect effect of 0.063), though both were statistically meaningful. The direct effect of financial toxicity on exercise adherence (0.279) was also substantial, suggesting that financial burden affects exercise behavior both on its own and through these psychological channels.
This research suggests that healthcare providers working with stroke patients should consider addressing financial concerns alongside psychological and social factors when trying to improve patients' engagement in exercise rehabilitation. Interventions that boost patients' confidence in their ability to exercise and that strengthen their social support networks — such as peer support programs or family involvement — may help offset the negative impact of financial stress on exercise adherence, potentially improving long-term recovery outcomes.
Luo X, Peng Y, Zhao Q. (2026). Financial toxicity and exercise adherence in stroke patients: a parallel mediation model of perceived social support and self-efficacy.. Frontiers in public health. https://doi.org/10.3389/fpubh.2026.1814437