Deans' stroke musings: Distress disclosure and health behaviours in patients with stroke: a theory-informed serial mediation model of social support, self-efficacy, and self-management

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, October 5, 2026

Distress disclosure and health behaviours in patients with stroke: a theory-informed serial mediation model of social support, self-efficacy, and self-management

There would be NO distress if your patients had EXACT 100% recovery protocols!

Your patients will gladly do the millions of reps needed because they are looking forward to recovery! Can't see that? YOU'RE FIRED!

Doesn't anyone in stroke know how to think?

Distress disclosure and health behaviours in patients with stroke: a theory-informed serial mediation model of social support, self-efficacy, and self-management

Xiaoqin Yang ¹^†
Y
Yan Han ²^†
Yuntian Liu ¹^†
H
Huaqing Fan ³
J
Jie Wang ²
Y
Yan He ¹^*
F
Feipeng Li ⁴^*

1. Affiliated Baotou Clinical College of Inner Mongolia Medical University, Baotou, Inner Mongolia, China
2. Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China

Abstract

Aim:

To examine the association between distress disclosure and health behaviours among patients with stroke and to test whether social support, self-efficacy and self-management statistically mediate this association independently and in sequence.

Methods:

A convenience sample of 473 patients with stroke was recruited from the Department of Neurology, Baotou Central Hospital, Inner Mongolia, China, between August 2025 and March 2026. Participants completed a sociodemographic and clinical characteristics form, the Distress Disclosure Index, Social Support Rating Scale, Stroke Self-Efficacy Questionnaire, Stroke Self-Management Scale and Health Behaviour Scale for Stroke Patients. Descriptive statistics, Pearson correlations, hierarchical multiple linear regression and serial mediation analyses were conducted using IBM SPSS Statistics 29.0 and PROCESS macro version 5.0, Model 6. Age, stroke type, modified National Institutes of Health Stroke Scale (modified NIHSS) score and Barthel Index (BI) score were included as covariates.

Results:

The mean health-behaviour score was 60.65 (SD 12.32), indicating a moderate level. Distress disclosure was positively correlated with health behaviours (r = 0.828, p < 0.001) and remained a significant correlate after adjustment for covariates (B = 1.333, beta = 0.819, p < 0.001). The total effect of distress disclosure on health behaviours was 1.3327 (95% CI: 1.2494 to 1.4160), the direct effect was 0.2032 (95% CI: 0.0635 to 0.3429), and the total indirect effect was 1.1295 (95% CI: 0.9875 to 1.2884). Social support, self-efficacy and self-management each showed significant indirect statistical effects. The largest specific indirect effect was through social support alone (effect = 0.4749; 35.63% of the total effect). The full serial indirect association through social support, self-efficacy and self-management was also significant (effect = 0.0276; 95% CI: 0.0121 to 0.0479).

Conclusion:

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. The findings support an expression-support-efficacy-management framework that may inform the design and prospective evaluation of communication-centred and self-management-oriented nursing interventions.