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Xu ZX, Liu QH, Zhang XP, Deng CS, Wan LH. Factors Associated With Prehospital Delay in Acute Ischemic Stroke: A Comparative Study of First-Time and Recurrent Cases. West J Nurs Res 2025:1939459251340778. [PMID: 40411381 DOI: 10.1177/01939459251340778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2025]
Abstract
BACKGROUND Prehospital delay, defined as prehospital time (from symptom onset to hospital arrival) ≥3 hours, adversely affects outcomes in patients with acute ischemic stroke. It is prevalent both among patients with first-time and recurrent stroke, who differ in disease and psychological characteristics affecting their health-seeking behavior. However, comparative studies on delay-related factors between these groups are limited. OBJECTIVES We aimed to identify and compare factors influencing prehospital delay among patients with first-time and recurrent acute ischemic stroke. METHODS This 2-center, hospital-based, cross-sectional study enrolled 144 first-time and 142 recurrent patients with acute ischemic stroke in Guangzhou, China. Patients' prehospital times were recorded. Standardized questionnaires were used to assess stroke knowledge, family function, and stigma. Data were analyzed using univariate analysis and multiple logistic regression. RESULTS Emergency medical services utilization reduced prehospital delay in both groups (first-time: odds ratio [OR] = 0.173, 95% CI: 0.040-0.750; recurrent: OR = 0.100, 95% CI: 0.022-0.466). Poor family function increased the risk of delay (first-time: OR = 1.057, 95% CI: 1.003-1.113; recurrent: OR = 1.131, 95% CI: 1.039-1.230). Among patients with recurrent stroke, greater stroke knowledge was protective (OR = 0.983, 95% CI: 0.968-0.999), while higher stigma increased delay (OR = 1.053, 95% CI: 1.012-1.095). CONCLUSIONS Emergency medical services utilization and strong family function reduce prehospital delay in both patients with first-time and recurrent stroke, while increased stroke knowledge and reduced stigma specifically benefit patients with recurrent stroke. Targeted strategies addressing these factors are recommended.
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Affiliation(s)
- Zhi-Xuan Xu
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Qun-Hong Liu
- Department of Nursing, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University, Guangzhou, China
| | - Xiao-Pei Zhang
- Department of Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Cheng-Song Deng
- Department of Neurology and Stroke Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Li-Hong Wan
- School of Nursing, Sun Yat-sen University, Guangzhou, China
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Ma R, Qiao M, Zhou Y, Sun W, Lv Y, Zhou X, Wang Y, Wu X, Yu R. The Relationship Between Knowledge, Psychological Flexibility, Anxiety and Healthy Behaviour in Stroke Patients: A Chain Mediation Model. J Clin Nurs 2025. [PMID: 40329557 DOI: 10.1111/jocn.17820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2025] [Revised: 04/15/2025] [Accepted: 04/23/2025] [Indexed: 05/08/2025]
Abstract
AIMS To explore the mediating effects of psychological flexibility and anxiety between knowledge and health behaviour in stroke patients, and to provide a reference for improving the health behaviour of stroke patients. DESIGN A cross-sectional study. METHODS A convenience sampling method was used to recruit 219 stroke patients from a tertiary hospital in China from July to November 2024. Patients were surveyed using an electronic questionnaire containing demographic questions and validated scales for stroke knowledge, psychological flexibility, anxiety and health behaviour. IBM SPSS v26.0 software and PROCESS Process macro were used for data analysis. RESULTS The health behaviour score of stroke patients was 54.2 ± 3.8, and health behaviour was positively correlated with stroke knowledge and negatively correlated with psychological flexibility and anxiety. There was a significant chain-mediated effect of psychological flexibility and anxiety in the relationship between stroke knowledge and health behaviour. CONCLUSION Stroke knowledge not only directly predicts health behaviour in stroke patients, but also indirectly influences the health behaviour of patients through the chain mediation of psychological flexibility and anxiety. RELEVANCE TO CLINICAL PRACTICE This study highlights the importance of caregivers focusing on the interactions between patient knowledge, psychological flexibility, anxiety and health behaviour when caring for stroke patients. Comprehensive interventions aimed at enhancing stroke patients' knowledge, improving patients' psychological flexibility and reducing anxiety have the potential to improve patient health behaviour. PATIENT OR PUBLIC CONTRIBUTION Patients completed questionnaires. REPORTING METHOD The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies was applied to report the results.
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Affiliation(s)
- Ruili Ma
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Mengting Qiao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yating Zhou
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wenjia Sun
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yanyan Lv
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xu Zhou
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yi Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaoyu Wu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ruili Yu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Yao Y, Zhang S, Yu Q, Zhao X, Zhang X. The Financial Toxicity Experience of Patients with Colorectal Cancer During Chemotherapy: A Qualitative Study. Curr Oncol 2024; 32:23. [PMID: 39851939 PMCID: PMC11764152 DOI: 10.3390/curroncol32010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Revised: 12/24/2024] [Accepted: 12/27/2024] [Indexed: 01/26/2025] Open
Abstract
BACKGROUND This study aimed to explore the experience of financial toxicity in patients with colorectal cancer during chemotherapy and to inform the development of targeted interventions. METHODS A descriptive qualitative research method was used to conduct semi-structured interviews with a purposive sample of 15 patients with colorectal cancer undergoing chemotherapy who attended the Department of Medical Oncology of the First Affiliated Hospital of Anhui Medical University from March to June 2024, and the data were organized and analyzed using the Nvivo 11.0 qualitative data analysis software and the thematic analysis method. RESULTS Four themes were extracted: patients with chemotherapy-stage colorectal cancer bear direct and indirect multifaceted economic pressures, are affected by multidimensional risk factors, which cause multiple adverse outcomes, and cope with financial toxicity in various ways. CONCLUSIONS The experience of financial toxicity in colorectal cancer patients undergoing chemotherapy is presented in a multidimensional format, with multiple causes influencing their financial toxicity. In the future, healthcare professionals should identify patients at high risk for financial toxicity, provide financial toxicity interventions and support, and mitigate their exposure to financial toxicity.
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Affiliation(s)
- Yanli Yao
- School of Nursing, Anhui Medical University, Hefei 230032, China; (Y.Y.); (S.Z.); (Q.Y.); (X.Z.)
| | - Shijing Zhang
- School of Nursing, Anhui Medical University, Hefei 230032, China; (Y.Y.); (S.Z.); (Q.Y.); (X.Z.)
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Qun Yu
- School of Nursing, Anhui Medical University, Hefei 230032, China; (Y.Y.); (S.Z.); (Q.Y.); (X.Z.)
| | - Xia Zhao
- School of Nursing, Anhui Medical University, Hefei 230032, China; (Y.Y.); (S.Z.); (Q.Y.); (X.Z.)
| | - Xinqiong Zhang
- School of Nursing, Anhui Medical University, Hefei 230032, China; (Y.Y.); (S.Z.); (Q.Y.); (X.Z.)
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Mun G, Shim J. Stroke knowledge and health-promoting behaviors: Mediating effect of patient self-esteem. PATIENT EDUCATION AND COUNSELING 2024; 129:108398. [PMID: 39216147 DOI: 10.1016/j.pec.2024.108398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 07/14/2024] [Accepted: 08/08/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To investigate the levels of and associations between stroke knowledge, self-esteem, and health-promoting behavior (HPB) among stroke patients, and examine the mediating effect of self-esteem in the stroke knowledge-HPB relationship. METHODS This descriptive correlational study involved a total of 150 stroke patients. We collected data through questionnaires during outpatient visits at two Korean secondary hospitals, inquiring about general and disease-related characteristics, stroke knowledge, self-esteem, and HPB. Correlation and mediation analyses were performed. RESULTS Stroke knowledge significantly increased patients' self-esteem (β = .53, p = .001) and HPB (β = 1.64, p < .001). Self-esteem mediated the relationship between stroke knowledge and HPB, with the mediating effect coefficient determined to be 1.68 [95 % CI (0.56,-2.46)]. CONCLUSION Education and intervention programs that increase both self-esteem and stroke knowledge need to be developed and evaluated such that stroke patients are motivated to engage in HPB. PRACTICE IMPLICATIONS Stroke patients are often physically and mentally impaired, and low self-esteem can be a barrier to engaging in HPB after diagnosis, negatively affecting their health outcomes. Nursing interventions focused on enhancing self-esteem can empower these patients to effectively engage in HPB. Healthcare professionals should adequately communicate and impart disease-related knowledge to patients with poor disease-related knowledge or education.
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Affiliation(s)
- GyeongChae Mun
- College of Nursing, Dongguk University, 123 Dongdae-ro, Gyeongju 21936, South Korea.
| | - JaeLan Shim
- College of Nursing, Dongguk University, 123 Dongdae-ro, Gyeongju 21936, South Korea.
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Zhang Y, Shen B, Meng W, Gao B, Wang T, Geng Y. Correlation of internalized stigma with self-esteem, social support and coping styles in patients with rheumatoid arthritis: A cross-sectional study. Jpn J Nurs Sci 2024; 21:e12616. [PMID: 39136343 DOI: 10.1111/jjns.12616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/23/2024] [Accepted: 07/25/2024] [Indexed: 10/03/2024]
Abstract
AIM To understand the status of internalized stigma in patients with rheumatoid arthritis (RA) and explore its relationship with self-esteem, social support, and coping style. METHODS This cross-sectional study selected patients with RA who visited the Rheumatology and Immunology Department of a tertiary hospital from May 2022 to May 2023. The Chinese versions of the Internalized Stigma of Mental Illness Scale-Rheumatoid Arthritis (ISMI-RA), Social Support Rating Scale, Rosenberg Self-Esteem Scale, and Medical Coping Style Questionnaire were administered to assess the internalized stigma, social support, self-esteem, and coping styles, respectively. The Pearson correlation test or Spearman rank correlation was then used to analyze the correlation between these measures. RESULTS Overall, 69.5% participants reported high level of internalized stigma. The average age of the 174 participants was 52.67 ± 12.24 years, with 87.36 per cent female patients. The mean ISMI-RA score was 54.49 ± 9.62, and the ISMI-RA subscale with the highest average score was alienation. The Pearson's correlations show that internalized stigma was positively associated with the coping styles of avoidance (r = .212, p < .01) and acceptance (r = .560, p < .01), and that internalized stigma was negatively associated with the coping styles of confrontation (r = -.479, p < .01), social support (r = -.570, p < .01), and self-esteem(r = -.512, p < .05). CONCLUSION The high level of internalized stigma in RA patients suggests that we should develop interventions to improve patients' self-esteem, encourage them to adopt positive coping styles, and gain more social support for them, so as to alleviate their internalized stigma.
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Affiliation(s)
- Yi Zhang
- Department of Rheumatology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
- Department of Nursing, Nanjing Medical University, Nanjing, China
| | - Biyu Shen
- Department of Nursing, Shanghai Children's Medical Center affiliated to Shanghai Jiao Tong University School of Medcine, Shanghai, China
| | - Weifen Meng
- Department of Rheumatology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Bo Gao
- Department of Rheumatology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Tiantian Wang
- Department of Pain Rehabilitation, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Yaqin Geng
- Department of Rheumatology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
- Department of Nursing, Nanjing Medical University, Nanjing, China
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Xu L, Dong Q, Jin A, Zeng S, Wang K, Yang X, Zhu X. Experience of financial toxicity and coping strategies in young and middle-aged patients with stroke: a qualitative study. BMC Health Serv Res 2024; 24:94. [PMID: 38233772 PMCID: PMC10795406 DOI: 10.1186/s12913-023-10457-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/08/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND While financial toxicity (FT) is prevalent in patients with cancer, young and middle-aged patients with stroke are also affected by FT, which can exacerbate their physical and psychological challenges. Understanding the patient's experience and response measures can further understand the impact of FT on patients with stroke, to help alleviate FT. However, little is known concerning the experience of patients with stroke with FT or their coping strategies. Therefore, this study aimed to describe the experiences of FT in young and middle-aged patients with stroke and their coping strategies. METHODS A phenomenological method was utilized. Semi-structured interviews were conducted with 21 young and middle-aged stroke patients (aged 18-59) between October 2022 and March 2023. The participants were recruited from a tertiary hospital in Shanghai, China. The research team used NVivo 12.0 software. Giorgi's phenomenological analysis method was used to analyse the interview data. RESULTS The interview results were divided into two categories in terms of patients' experiences of FT and their coping strategies. Nine subthemes were constructed. The experience category included four subthemes: (1) taking on multifaceted economic pressure, (2) dual choice of treatment, (3) decline in material living standards, and (4) suffering from negative emotions such as anxiety and depression. The coping strategy category included five subthemes: (1) reducing expenses, (2) improving living habits, (3) proactive participation in medical decision-making, (4) making a job position choice, and (5) seeking social support. CONCLUSIONS FT in young and middle-aged patients with stroke, which affected their physical and mental health, led them to implement strategies for dealing with FT. The Chinese government needs to broaden the reach of health insurance coverage and advance the fairness of healthcare policies. Healthcare professionals must pay active attention to FT in such patients in terms of strengthening their health education and considering their needs and preferences. Patients need to improve their sense of self-efficacy, actively reintegrate into society, and adhere to rehabilitation and treatment. Individuals at a high risk of stroke are recommended to purchase health insurance. Multifaceted efforts are needed to reduce the impact of FT in young and middle-aged patients with stroke.
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Affiliation(s)
- Ling Xu
- Department of Nursing, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- School of Nursing, Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Qiong Dong
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Aiping Jin
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Sining Zeng
- Department of Nursing, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kai Wang
- Department of Nursing, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaopei Yang
- Department of Nursing, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaoping Zhu
- Department of Nursing, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
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