Depressive Symptoms in Young and Middle-Aged Stroke Patients: A Transition Analysis.

BACKGROUND: There is heterogeneity in depressive symptoms. However, latent classes of depressive symptoms and the transition and influences of these in young and middle-aged stroke patients are unclear. OBJECTIVES: The aim of this study was to identify the latent classes of depressive symptoms and their transition patterns over time and the influencing factors in young and middle-aged stroke patients from stabilization to 6 months after discharge. METHODS: This is a longitudinal study following the Strengthening the Reporting of Observational Studies in Epidemiology checklist. A total of 272 young and middle-aged stroke participants were recruited from a hospital neurology ward in Henan Province, China. Participants completed a questionnaire on sociodemographic and health information. Latent transition analysis was used to evaluate the transition pattern of latent classes from stabilization to 6 months after discharge and its influencing factors. RESULTS: One hundred seventy-nine participants were included in the analysis. Three latent classes of depressive symptoms were identified as "mild symptoms," "grief-sleep-fatigue symptoms," and "severe symptoms." Most participants remained in the original latent class from stabilization to 6 months after discharge (probability of 83.8%, 83.8%, and 88.8%). From 3 to 6 months after discharge, the participants with fewer complications were more likely to transition into the mild symptom class. DISCUSSION: The findings indicate that from stabilization to 6 months after discharge, depressive symptoms in young and middle-aged stroke patients in China transitioned gradually from the severe symptom class to the mild symptom. Patients with fewer numbers of poststroke complications were more likely to transition to the mild symptoms class. Future research should focus on depressive symptoms in early-stage stroke patients and provide sufficient psychological support to patients with a high number of complications.

E-health literacy in stroke patients: Latent profile analysis and influencing factors.

AIMS: This study sought to explore latent categories of electronic health (e-health) literacy among stroke patients and analyse its influencing factors. DESIGN: A cross-sectional, descriptive exploratory design with the STROBE reporting checklist was applied. METHODS: Between July and October 2020, 558 stroke participants from three tertiary care hospitals in Henan Province, China, were recruited using a convenience sampling method. A general information questionnaire and the Electronic Health Literacy Scale were used to collect their socio-demographic information and e-health literacy. Latent profile analysis was used to analyse latent categories of e-health literacy in stroke patients. Multiple logistic regression was used to analyse factors influencing latent categories of e-health literacy in stroke patients. RESULTS: Three latent categories of e-health literacy existed, including the low e-health literacy group, the low application-high decision-making group and the high literacy-low decision-making group. Multiple logistic regression showed that education level, presence of comorbidities, willingness to interact with people with mental illness, health information sources, frequency of Internet access, frequency of health information inquiry and willingness to receive remote care were predictors of the participants' latent categories of e-health literacy. CONCLUSION: Three latent categories of e-health literacy in stroke patients exist, and each latent category's characteristics should be considered while developing health education programmes. It is imperative that healthcare providers understand the requirement of creating tailored and efficient health education programmes for various categories of stroke patients to enhance their e-health literacy. IMPACT: It is imperative to improve Chinese stroke patients' overall e-health literacy. We categorized stroke patients' e-health literacy using advanced LPA. These findings hold implications for healthcare approaches, contributing to the enhancement of stroke patients' e-health literacy, enabling them to apply the acquired e-health information to manage and solve their own health issues. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

The Relationship Between Dyadic Coping and Mental Health in Stroke Survivors and Their Spouse Caregivers: An Actor-Partner Interdependence Model.

AIM: To investigate the relationship among dyadic coping, mental health and the individual and mutual influences on stroke survivors and their spouse caregivers. DESIGN: A cross-sectional descriptive study was conducted in China from November 2019 to August 2020. The STROBE checklist was used to report the present study. METHODS: The analysis included 224 dyads of stroke survivors and their spouse caregivers in China. Data on stroke survivors and their spouse caregivers were collected using the Dyadic Coping Inventory (DCI), the Patient Health Questionnaire nine-item scale (PHQ-9) and the Generalised Anxiety Disorder seven-item scale (GAD-7). The dyadic analysis was conducted based on the Actor-Partner Interdependence Model (APIM). RESULTS: Regarding actor effects, spouse caregivers' dyadic coping and perceived dyadic coping had a negative predictive effect on their own anxiety and depression. Stroke survivors' perceived dyadic coping had a negative effect on their own depression. Regarding partner effects, spouse caregivers' perceived dyadic coping also had a negative predictive effect on the depression of the patients. In contrast, stroke survivors' perceived dyadic coping was positively associated with spouse caregivers' anxiety and depression. These findings suggested that mental health of stroke survivors and their spouse caregivers was affected by various dyadic coping dimensions. CONCLUSIONS: Our research has the potential to contribute to the understanding dyadic coping and mental health of stroke survivor-spouse caregiver dyads. The findings reveal that the coping strategies employed by stroke couples are closely related to the mental health of both partners. IMPACT: This study provides evidence for the significant impact of dyadic coping on the psychological well-being of stroke survivors and their spouse caregivers. Therefore, dyadic interventions aiming at strengthening dyadic coping may have positive effects on their mental health. PATIENT OR PUBLIC CONTRIBUTION: This study directly involved the patients and family caregivers in hospital settings.

Translation and psychometric validation of the Patient Participation Culture Tool for healthcare workers in Chinese nursing context.

BACKGROUND: Promoting patient participation stands as a global priority in nursing care. Currently, there is a lack of a standardized tool to assess the culture of patient participation from the perspective of nurses in China. AIMS: To translate and examine the validity and reliability of the Patient Participation Culture Tool for healthcare workers (PaCT-HCW) on general hospital wards in Chinese nursing context. METHODS: A cross-sectional research study was conducted among 812 nurses. Brislin's recommendations were adhered to during the translation of the scale. Validity was assessed using construct validity, content validity, and face validity. Split-half reliability, test-retest reliability, and internal consistency reliability were used to evaluate dependability. The study was guided and reported following the STROBE checklist and recommendations for reporting the results of studies of instrument and scale development and testing. RESULTS: The Chinese version of PaCT-HCW (the PaCT-HCW-C) exhibits good face validity and content validity. A rigorous exploratory factor analyse verified a six-factor (competence, support, perceived lack of time, information sharing and dialogue, response to questions and acceptance of a new role) scale structure with a cumulative variance contribution of the factors with 44 items of 68.840%. With a Cronbach's α coefficient of 0.962, split-half reliability of 0.866, and intraclass correlation coefficients of 0.989, the instrument demonstrates great reliability. Confirmatory factor analysis results validated the consistency of the six factors with the structure of the PaCT-HCW-C scale. CONCLUSIONS: The 44-item PaCT-HCW-C is a valid and reliable instrument with satisfactory psychometric properties. It could serve as a tool for assessing the effectiveness of international programs aimed at fostering patient participation from the perspective of nurses, while also providing insights from China's practical experiences.

Subtypes of nursing students' volunteer motivation in COVID-19: a latent profile analysis.

BACKGROUND: One factor that influences nursing students' decision to engage in volunteer activities is volunteer motivation. It is important to understand the motivations of nursing students to volunteer. However, the majority of current studies have concentrated on the present level of nursing students' motivation to volunteer. OBJECTIVES: To identify subgroups of nursing students' volunteer motivation and its influential factors. METHODS: From January to February 2022, a cross-sectional online study was conducted, and 2569 nursing students from 10 provinces in China were recruited. Participants completed the General Information Questionnaire, Volunteer Functional Inventory (VFI), Perceived Stress Scale (PSS) and Perceived Social Support Scale (PSSS). We explore the categories and characteristics of volunteer motivation using latent profile analysis. Then, we determined factors that affect undergraduate nursing students' volunteer motivation using multinomial logistic regression. RESULTS: The volunteer motivation score of the nursing students was 77.65 (15.22). The study found that volunteer motivation could be divided into three categories: low-low protective volunteer motivation group (9.3%), general-high career values volunteer motivation group (37.5%), and high volunteer motivation group (53.2%). Perceived social support scale score, perceived stress scale score, gender, and grade significantly influenced the volunteer motivation of nursing students in different categories (both P < 0.05). Women were more likely to have higher motivation to volunteer than men, and fourth-year nursing students were more likely to be in general-high career values volunteer motivation group. CONCLUSIONS: The study highlights the significant heterogeneity in volunteer motivation among nursing students. Higher volunteer motivation was associated with higher perceived social support and lower perceived stress. In addition, gender and academic year were significant influencing factors. Nursing educators should develop targeted volunteer management plans based on the typological characteristics of the population to motivate nursing students to volunteer and promote the development of individual physical and mental health and social well-being. TRIAL REGISTRATION: The survey was approved by the Biomedical Ethics Committee of the Department of Medicine, Xi'an Jiaotong University (No. 2022-0006).

The caregiver contribution to self-care of stroke inventory (CC-SCSI): evaluation of psychometric characteristics.

BACKGROUND: The caregiver contribution to self-care plays an important role in improving the health outcomes of chronic patients, which needs urgent attention. However, it has been hindered by the lack of a tailored instrument that assesses the caregiver contribution to self-care of stroke. OBJECTIVES: To test the psychometric characteristics of the caregiver contribution to self-care of stroke Inventory (CC-SCSI) in health care practice. METHODS: Participants were recruited in Henan Province from March 2021 to October 2022, utilizing a multicenter stratified sampling approach. A 23-item self-report CC-SCSI with 3 separate scales measuring caregiver contribution to self-care maintenance of stroke, caregiver contribution to self-care monitoring of stroke and caregiver contribution to self-care management of stroke was tested for validity through discriminant validity, confirmatory factor analysis, concurrent validity and convergent validity. The reliability was tested by Cronbach's α coefficient and test-retest reliability. Qualitative data were analysed using thematic analysis. A STROBE checklist was used. RESULTS: The three scales of the CC-SCSI exhibited good discriminant validity. Confirmatory factor analysis supported the three-factor structure of the Caregiver Contribution to Stroke Self-Care Maintenance and Management scales and the one-factor structure of the Caregiver Contribution to Stroke Self-Care Monitoring scale. The moderate correlation between the CC-SCSI and the Self-Care of Stroke Inventory indicated acceptable concurrent validity. The moderate correlation between the CC-SCSI and the Caregiver Contribution to Self-Care of Chronic Illness Inventory indicated acceptable convergent validity. Cronbach's αs for the Caregiver Contribution to Self-Care Maintenance, Self-Care Monitoring, and Self-Care Management scales ranged from 0.876 to 0.974. Test-retest reliability showed average ICC values ranging from 0.828 to 0.903 (P < 0.001). CONCLUSIONS: The 23-item CC-SCSI presents good psychometric properties and could be used to explore the caregiver contribution to stroke self-care in health care practice and research.

The experience of mutual support during hospitalization of co-morbid couples with recurrent older stroke survivors - A descriptive phenomenological study.

The phenomenon of the experiences of mutual support of co-morbid couples of recurrent older stroke survivors during hospitalization is receiving increased interest from nursing scholars. However, little is known about how they support each other. The aim of this study was to explore the experiences of co-morbid couples of older stroke survivors with recurrent stroke who support each other during hospitalization. A descriptive phenomenology study was employed. 21 co-morbid couples with recurrent older stroke survivors were recruited. The interviews were analyzed with Colaizzi's descriptive analysis framework. Three themes emerged from the data analysis: (1) maintaining the couple's relationship through mutual support, (2) mutual support so as not to drag the children down, and (3) providing support while struggling between ideals and reality. It is crucial to provide them with individualized, tailored support and interventions that can help these couples achieve a more optimal balance in their mutual support.

Association between medication literacy and medication adherence and the mediating effect of self-efficacy in older people with multimorbidity.

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.

The dyadic self-care experience of stroke survivors and their caregivers: A qualitative descriptive study.

BACKGROUND: 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. OBJECTIVES: The aim of this study was to explore the dyadic self-care experience of stroke survivors and their caregivers. DESIGN: A descriptive qualitative design was used to conduct the study. RESULTS: 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. DISCUSSION AND CONCLUSION: 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. PATIENT/PUBLIC CONTRIBUTION: Patients were involved in the formulation of interview questions for this study. No members of the public were involved in this study.

A scoping review of the self-reported compassion measurement tools.

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.

Family function, self-efficacy, care hours per day, closeness and benefit finding among stroke caregivers in China: A moderated mediation model.

AIMS AND OBJECTIVES: The aim of this study was to explore the moderated mediation mechanism of the relationships among family function, self-efficacy, care hours per day, closeness and benefit finding in family caregivers of patients with stroke in China. BACKGROUND: Benefit finding can provide a new means of resolving depression among family members caring for an ill loved one. However, current research has paid little attention to the benefit finding of family caregivers of stroke patients in China. DESIGN: A cross-sectional study. METHODS: Three hundred fifty family caregivers of patients with stroke were recruited from community service centres and hospitals in Zhengzhou, China. The participants completed the family APGAR index, caregiver benefit finding scale and Chinese general self-efficacy scale during a study conducted in 2017. Descriptive analyses and a moderated mediation model were computed. Reporting adhered to the STROBE checklist. RESULTS: A total of 311 family caregivers completed this study. Closeness between family caregivers and patients with stroke moderated the relationship between family function and caregiver benefit finding. Self-efficacy partially mediated the relationship between family function and caregiver benefit finding; moreover, care hours per day moderated the mediation. CONCLUSION: This study shows important factors associated with benefit finding in family caregivers of patients with stroke. This indicates elements that could help improve benefit finding intervention programmes for family caregivers of patients with stroke. RELEVANCE TO CLINICAL PRACTICE: The findings in our study provide valuable information on benefit finding and indicate some interventions to improve the mental health of family caregivers of stroke patients.

Meaning in life among nursing students: a latent profile analysis.

BACKGROUND: Meaning in life, defined by an individual's understanding and appreciation of life, is a vital aspect of a positive psychological state, that has a significant influence on physical and mental health. Therefore, improving the sense of meaning in life among nursing students has emerged as a crucial concern in nursing education. This study aimed to clarify the profiles and influencing factors of meaning in life among nursing students. METHODS: A descriptive cross-sectional online survey was conducted among nursing students in China from November 16, 2022, to January 17, 2023. The demographic information questionnaire and the meaning in life questionnaire (MLQ) were used to collect data. Latent profile analysis (LPA) was used to identify groups exhibiting distinct levels of meaning in life. Additionally, univariate analysis and multinominal logistic regression analysis were used to investigate the factors influencing each group. The reporting of this study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. RESULTS: A total of 10,583 valid responses were received, and the analysis revealed four distinct profiles. The profiles identified were the medium meaning group (C1, 41.4%), medium fluctuation meaning-no motivation group (C2, 8.7%), lower meaning group (C3, 9.7%), and higher meaning group (C4, 40.2%). The univariate analysis revealed that age, gender, ethnicity, marital status, educational level, grade, university classification, student leadership experience, and political affiliation were factors that influenced the four latent profiles (P < 0.05). The multinomial logistic regression analysis showed that age, gender, ethnicity, education level, and student leadership experience were significant predictors of the various profiles (P < 0.05). CONCLUSION: There is heterogeneous in meaning in life among nursing students in China. Nursing educators need to provide tailored guidance based on the latent classification characteristics of meaning in life among nursing students, aiming at improving their meaning in life and promoting the development of the nursing workforce.

Professional calling among nursing students: a latent profile analysis.

BACKGROUND: One factor that influences nursing students' decision to pursue a nursing career is professional calling. It is important to comprehend nursing students' professional calling, which may have an impact on their career choice and career development. OBJECTIVES: To investigate possible calling types and contributing variables among nursing students. DESIGN: Cross-sectional descriptive study. PARTICIPANTS: A total of 10,583 nursing students were enrolled in this survey. METHODS: From November 16th, 2022, to January 17th, 2023, a cross-sectional study was carried out among nursing students using a convenient sampling. The subjects were given the Chinese Calling Scale and the General Demographic Information Questionnaire. Latent profile analysis (LPA) was used to separate nursing students' professional calling into a variety of subgroups. To find the variables connected to the prospective calling categories, we used ordinal and multinomial Logistic regression analysis. RESULTS: Respondents were divided into three calling groups, low (N = 3204), moderate (N = 4492), and high calling group (N = 2887), which accounted for 30.3%, 42.4%, and 27.3% of the total respondents, respectively, in accordance with the findings of the latent profile analysis. Across scale scores and dimensions for the three separate categories, three groups demonstrated statistically significant differences (both p < 0.001). Profile membership was predicted by 8 factors such as age, gender, location of origin, first volunteer experience, highest degree earned, marital status, student leadership experience, and political appearance. CONCLUSION: Three latent calling patterns were found, and there was calling variability across nursing students. Special care should be given to students with low calling. Nursing students must use professional education tools to help them develop their career calling and stabilize the nursing team.

Trajectories of intrusive and deliberate rumination in young and middle-aged stroke survivors: A growth mixture modeling approach.

This study aimed to explore the relationship between intrusive and deliberate rumination, to identify distinct trajectories of intrusive and deliberate rumination, and to examine their predictors in young and middle-aged stroke survivors. This study employed a longitudinal design in which 200 young and middle-aged stroke survivors were investigated at 1-week pre-discharge (T0), 1 month (T1), 3 months (T2), and 6 months (T3) post-discharge. The Event-Related Rumination Inventory, Simplified Coping Style Questionnaire, and Perceived Social Support Scale were used for data collection. The results showed that intrusive rumination was positively correlated with deliberate rumination at T0 and T1, and negatively correlated with deliberate rumination at T3. Growth mixture modeling identified three classes of intrusive rumination: Stable-low, Declined, and Elevated group, and two classes of deliberate rumination: High-level and Low-level group. Furthermore, number of children or dysfunctions, type of stroke, family history of stroke, negative coping, and social support were found to predict intrusive rumination. These findings can help healthcare providers timely intervene on survivors in the Elevated and Stable-low intrusive rumination groups, and the Low-level deliberate rumination group.

Effect of SGLT2 Inhibitors on Risk of Stroke in Diabetes: A Meta-Analysis.

BACKGROUND: The effect of sodium-glucose cotransporter 2 (SGLT2) inhibitors on reducing the risk of stroke in patients with type 2 diabetes mellitus (T2DM) remains unclear. Thus, we conducted this systemic review and meta-analysis of all relevant studies and trials to explore the role of SGLT2 inhibitors on the stroke prevention. METHODS: The present study included articles published before October 2021 and searched in Web of Science, PubMed databases. We used STATA 12.0 software to compute hazard ratio (HR) and 95% confidence interval (CI). RESULTS: Meta-analysis indicated that SGLT2 inhibitors showed no significant effects on risk of stroke in diabetes in randomized controlled trials with a fixed effects model (HR = 0.98; 95% CI: 0.88-1.09, I2 = 22.3%, p = 0.272). Compared to other glucose-lowering drugs (oGLD) and insulin, SGLT2 inhibitors alone significantly affected risk of stroke in diabetes in observational studies with a random effects model (HR = 0.87; 95% CI: 0.80-0.95, I2 = 72.2%, p < 0.001). CONCLUSIONS: In summary, this meta-analysis indicated that the use of SGLT2 inhibitors did not decrease the risk of stroke. And for some T2DM patients with high-risk factor of stroke, SGLT2 inhibitors therapy may be more suitable compared to some oGLD such as dipeptidyl peptidase-4 inhibitors. The results of this meta-analysis are necessary to be confirmed with further studies and clinical trials.

Assessing the psychometric properties of the Chinese return-to-work self-efficacy questionnaire using Rasch model analysis.

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.

Independent and combined effects of sleep quality and night sleep duration on health-related quality of life in rural areas: a large-scale cross-sectional study.

BACKGROUND: The combined effect of sleep quality and night sleep duration on health-related quality of life (HRQoL) remains unclear, especially in resource-limited countries and areas. This study aimed to explore the independent and combined effects of sleep quality and night sleep duration on HRQoL. METHODS: A total of 21,926 eligible participants from the Henan rural cohort study were selected. The Pittsburgh Sleep Quality Index was utilized to evaluate sleep quality and night sleep duration. The Tobit regression model, generalized linear model (GLM), and logistic regression model were performed to assess the associations of sleep quality and night sleep duration with HRQoL. The restricted cubic spline was applied to identify the dose-response relationships of sleep quality and night sleep duration with HRQoL. RESULTS: After multivariable adjustment, the Tobit regression and GLM indicated that the regression coefficients [95% confidence interval (CI)] for poor sleep quality were - 0.124 (- 0.133, - 0.114) and - 6.25 (- 6.71, - 5.78) on utility index and VAS score, respectively. Compared with the reference group (7 h-), participants with short sleep duration (< 6 h) or long sleep duration (≥10 h) reported a lower HRQoL. A U-shape relationship between night sleep duration and HRQoL was observed, along with a J-shape relationship between sleep quality and HRQoL (P for non-linear < 0.001). Furthermore, individuals with longer night sleep duration (≥10 h) and poorer sleep quality were strongly associated with lower HRQoL (utility index [odds ratio (OR) (95% CI)]: 6.626 (3.548, 8.920), VAS score [OR (95% CI)]: 2.962 (1.916, 4.578)). CONCLUSION: Poor sleep quality and extreme night sleep duration were independently and combinedly associated with low HRQoL, suggesting that maintaining good sleep quality and appropriate night sleep duration was important. CLINICAL TRIAL REGISTRATION: The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 06 July, 2015. http://www.chictr.org.cn/showproj.aspx?proj=11375 .

Qualitative study of Stroke Survivors' Perceptions of Secondary Prevention.

AIMS: To understand how survivors of stroke perceive secondary prevention and explore their perceived barriers and facilitators using the Theoretical Domains Framework. DESIGN: A qualitative descriptive study. METHODS: Nineteen survivors of stroke from three hospitals were recruited and interviewed from April 2019 to April 2020. The data were analysed deductively and inductively by content analysis strategies. RESULTS: Three main themes of perception of secondary prevention were identified, these being active treatment-seeking, attention to taking medications and negative attitude towards lifestyle changes. Using deductive analysis, eight domains of the Theoretical Domains Framework were reported to be relevant in the secondary prevention behaviour of survivors of stroke that mapped to five 'barrier' domains (i.e. knowledge, physical skills, beliefs about capability, beliefs about consequences and optimism) as well as six 'facilitator' domains (i.e. knowledge, interpersonal skills, beliefs about capability, intention, emotion and social influences). Using inductive analysis we identified two additional important factors not falling in the domains of the Theoretical Domains Framework. These comprised female spouses' support and patients' economic autonomy, both of which could be classified as a facilitator or barrier. CONCLUSION: Survivors of stroke perceive seeking treatment and using preventive medication as more important than modifying lifestyle behaviours. Knowledge and insight into the barriers and facilitators of secondary prevention in this specific context provides a theoretical and practical basis for the design of future secondary prevention interventions. IMPACT: Stroke survivors' perceptions of secondary prevention, barriers and facilitators were explored in the context of a developing country. These findings highlight the need to better communicate the importance of improving lifestyle modification and medication adherence, and provide evidence for designing relevant interventions for stroke management in the community.

The Influential Factors of Adherence to Physical Activity and Exercise among Community-Dwelling Stroke Survivors: A Path Analysis.

AIMS AND OBJECTIVES: To investigate the status of physical activity and exercise (PAE) adherence and identify its influential factors among community-dwelling stroke survivors. BACKGROUND: Regular PAE after stroke is essential for recovery and secondary prevention, while adherence to PAE and its influential factors are rarely studied. DESIGN: A cross-sectional descriptive study. METHODS: In total, 208 stroke survivors (70.25 ± 9.08 years) were randomly selected from three communities. The influential factors of PAE adherence and associations between these variables were explored using multiple linear regression and path analyses. This study adhered to the EQUATOR checklist, STROBE. RESULTS: The mean adherence rate was moderate (62.00%), and stroke survivors tended to be more adherent to PAE than monitoring and seeking advice (70.30%>53.50%>48.30%). The regression results revealed that seven factors were significantly associated with PAE adherence, including knowledge, attitude, self-efficacy, social support, self-care ability, community rehabilitation experience and times since stroke. Furthermore, the path analysis showed that knowledge had a significant indirect positive influence on adherence with self-efficacy as a mediator, while attitude and social support impacted both directly and indirectly with self-efficacy as the mediator. Moreover, self-efficacy had the most substantial direct effect on community-dwelling stroke survivors' PAE adherence. These four variables accounted for a total of 67.00% of the variance in PAE adherence among community-dwelling stroke survivors. CONCLUSIONS: The PAE adherence of community stroke survivors needs to be improved. Healthcare professionals should develop more effective interventions to promote PAE adherence through enhancing self-efficacy among this population. RELEVANCE TO CLINICAL PRACTICE: Adherence to the recommended regimen is the most challenging dimension of stroke physical activity and exercise. This study contributes to exploring status and influential factors of PAE adherence, and self-efficacy was found to be a significant determinant. The results could be used to inspire future community-based intervention programs for stroke survivors.

Effects of A Benefit-Finding Intervention in Stroke Caregivers in Communities.

Objectives: To verify the effectiveness and feasibility of a nine-week benefit-finding intervention on the burden, quality of life, and benefit finding of caregivers, as well as on the quality of life of stroke survivors.Methods: Benefit finding refers to the individual, social, psychological and spiritual benefits perceived by an individual experiencing stress or post-traumatic events. A randomized controlled trial was performed in which 68 stroke survivors and their caregivers were recruited from the Zhengzhou community, China, and randomly split into two groups. The intervention group included those having undergone a nine-week benefit-finding intervention, while the control group included those individuals having undergone a nine-week routine health education. At baseline and one-week post-intervention (after a 9-week intervention), the quality of life of stroke survivors and caregivers and the burden and benefit finding of caregivers were determined.Results: In comparison to the control group, caregiver benefit finding, quality of life, burden, and stroke survivor quality of life were significantly improved (P <.005).Conclusions: The intervention appears to be feasible for stroke patients and caregivers. The intervention is capable of improving the quality of life of caregivers and survivors, increasing the benefit finding of caregivers and reducing the burden of caregivers.Clinical Implications: The benefit-finding intervention is capable of improving the health condition of stroke patients and caregivers.