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Cited by 3Health and Wellbeing ResearchStroke Rehabilitation and RecoveryNursing care and research

The Relationship Between Knowledge, Psychological Flexibility, Anxiety and Healthy Behaviour in Stroke Patients: A Chain Mediation Model.

Open access
Ma, Ruili, Qiao, Mengting, Zhou, Yating, Sun, Wenjia, Lv, Yanyan, Zhou, Xu, Wang, Yi, Wu, Xiaoyu +1 more·2026·Journal of Clinical Nursing
DOI 10.1111/jocn.17820
Open this paper in CoChat — free accountOpen PDF

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.

Integrity signals

Registry

Crossref · 10.1111/jocn.17820

Cites

30 of 30 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

11 of 38 cited sources checked · 4 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Only 36.5% of stroke patients had knowledge of stroke-related warning signs and symptoms.

    “It was found that only 36.5% of stroke patients had knowledge of stroke-related warning signs and symptoms, and 59.6% did not know the risk factors associated with stroke (Liang et al. 2023).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Liang et al. 2023 source
  • Premisecitation

    59.6% of stroke patients did not know the risk factors associated with stroke.

    “It was found that only 36.5% of stroke patients had knowledge of stroke-related warning signs and symptoms, and 59.6% did not know the risk factors associated with stroke (Liang et al. 2023).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Liang et al. 2023 source

      Table 3 (Results, Knowledge of stroke risk factors) classifies 59.6% of the 156 patients as having *poor* knowledge of stroke risk factors, not as knowing none of them; many identified individual risk factors. Table 2 (Results, Knowledge of stroke warning signs or symptoms) supports the sentence’s separate 36.5% figure for good knowledge of warning signs. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Premisecitation

    Stroke patients have poor self-management of health behaviour.

    “Stroke patients have poor self-management of health behaviour, and one study found that patients with stroke were less likely to eat one or more fruits and one or more vegetables per day, achieve weekly aerobic exercise and engage in two or three health behaviours compared to patients without stroke (Bailey et al. 2019).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Bailey et al. 2019 source
  • Premisecitation

    More than half of stroke patients had no urgency to change their health behaviour.

    “Although patients understood what a healthy lifestyle was, they were unable to adequately assess their health-related behaviour, and more than half of them had no urgency to change their health behaviour (Brouwer-Goossensen et al. 2021).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Brouwer-Goossensen et al. 2021 source
  • Premisecitation

    There is a substantial association between post-stroke anxiety and psychological flexibility in stroke patients.

    “There is a substantial association between post-stroke anxiety and psychological flexibility in stroke patients, which also affects their quality of life and mental quality (Lv et al. 2021;Stahl et al. 2024;Yuliana et al. 2023).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Lv et al. 2021

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Stahl et al. 2024 source

      The Results report significant associations between lack of psychological flexibility and anxiety scores in 70 stroke survivors (HADS r = 0.47; ISR r = 0.34). That supports the quoted association. The citing sentence also says this affects quality of life and mental quality, but the passages from this paper do not establish those effects; its Discussion describes the study as correlational. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites Yuliana et al. 2023 source
  • May combine two claims. 21
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 20

  • May combine two claims.

    Premisecitation

    Post-stroke anxiety and psychological flexibility affect quality of life and mental quality in stroke patients.

    “There is a substantial association between post-stroke anxiety and psychological flexibility in stroke patients, which also affects their quality of life and mental quality (Lv et al. 2021;Stahl et al. 2024;Yuliana et al. 2023).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Lv et al. 2021

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Stahl et al. 2024 source

      The Results (Table 2; page unavailable) report a significant association between lack of psychological flexibility and anxiety-disorder symptoms in stroke survivors. The Methods > Outcomes section lists measures of psychopathology and flexibility, but not quality of life or “mental quality”; the Discussion > Limitations also cautions that the correlational design cannot establish causality. Thus the source supports the association, not the claimed effects on quality of life or mental quality. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites Yuliana et al. 2023 source

  • May combine two claims.

    Premisecitation

    Patients with stroke were less likely to eat one or more fruits and one or more vegetables per day, achieve weekly aerobic exercise and engage in two or three health behaviours compared to patients without stroke.

    “Stroke patients have poor self-management of health behaviour, and one study found that patients with stroke were less likely to eat one or more fruits and one or more vegetables per day, achieve weekly aerobic exercise and engage in two or three health behaviours compared to patients without stroke (Bailey et al. 2019).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Bailey et al. 2019 source

  • May combine two claims.

    Premisecitation

    Patients with high psychological flexibility can effectively regulate their emotional responses while coping with the disease and experience fewer negative emotions, which leads to more positive self-health management.

    “In addition, patients with high psychological flexibility can effectively regulate their emotional responses while coping with the disease and experience fewer negative emotions (Morimoto 2024;Deng et al. 2023), which leads to more positive self-health management.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites Morimoto 2024 source

      The Introduction defines psychological flexibility partly in terms of allowing painful emotions, and Results §3.3 finds lower depression and anxiety in dementia family caregivers with high psychological flexibility. The cited finding concerns caregivers, not patients coping with their own disease; it does not establish that they effectively regulate emotional responses. The subsequent claim about self-health management is outside the citation’s immediate scope and is not addressed by this study. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites Deng et al. 2023 source

      The Results (Correlations Between Profile and Mental Health Outcomes; page unavailable) report lower negative affect in the active psychological-flexibility group, and the Discussion describes its acceptance and harnessing of distress. The study concerns Chinese college students during COVID-19, not patients coping with a disease, and it does not establish that flexibility enables emotional regulation. The self-health-management clause follows the citation and appears to be the citing authors’ inference; this paper does not test it. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    Younger and female stroke patients were more likely to be anxious.

    “In this study, it was found that the overall level of anxiety in stroke patients was mild and that younger, female patients were more likely to be anxious (Zhang et al. 2023;Solgajová et al. 2017), which requires urgent attention from healthcare professionals.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Zhang et al. 2023 source

      The Discussion identifies female sex as a risk factor for post-stroke anxiety in the study’s rural ischaemic stroke survivors. It does not support the younger-age part: the Results subgroup analysis reports no significant difference in anxiety profiles by age (p = 0.541). (LLM, conf=0.90)

      Experimental — accuracy not yet measured
    • cites Solgajová et al. 2017

  • May combine two claims.

    Findingown data

    The indirect effect of stroke knowledge on health behaviour was 0.194, accounting for 39.84% of the overall effect.

    “The overall effect of stroke knowledge on health behaviour was 0.487 (95% CI: 0.279, 0.465), and the direct and indirect effects of stroke knowledge on health behaviours were 0.293 and 0.194, which accounted for the overall effects of 60.16% and 39.84%, respectively.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Psychological flexibility and anxiety mediated the effect of stroke knowledge on health behaviour, with an effect value of 0.018 (95% CI: 0.004, 0.037).

    “There was a significant chain-mediated effect of psychological flexibility and anxiety in the relationship between stroke knowledge and health behaviour.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The direct effect of stroke knowledge on health behaviour was 0.293, accounting for 60.16% of the overall effect.

    “The overall effect of stroke knowledge on health behaviour was 0.487 (95% CI: 0.279, 0.465), and the direct and indirect effects of stroke knowledge on health behaviours were 0.293 and 0.194, which accounted for the overall effects of 60.16% and 39.84%, respectively.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Anxiety is negatively correlated with health behaviour in stroke patients; anxious patients had poorer health behaviour.

    “This study also found a negative correlation between anxiety and health behaviour, i.e., anxious patients had poorer health behaviour.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    A total of 219 valid questionnaires were collected.

    “A total of 219 valid questionnaires were collected.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In this study, the Cronbach's alpha for the Health Behaviour Scale for Stroke Patients was 0.71.

    “In this study, the Cronbach's alpha was 0.71.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Patients with higher psychological flexibility had higher levels of healthy lifestyle promotion and better quality of life.

    “Previous studies had shown that patients with higher psychological flexibility had higher levels of healthy lifestyle promotion and better quality of life (Li et al. 2024;Lv et al. 2021).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Li et al. 2024

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Lv et al. 2021

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    35% of patients have post-stroke anxiety.

    “Anxiety is a common complication in post-stroke patients, and some studies have shown that 35% of patients have poststroke anxiety (Ruthmann et al. 2025).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Ruthmann et al. 2025 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In this study, the Cronbach's alpha for the Stroke Knowledge Questionnaire was 0.79.

    “In this study, the Cronbach's alpha was 0.79.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In this study, the Cronbach's alpha for the General Anxiety Scale was 0.81.

    “In this study Cronbach's alpha was 0.81.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Stroke knowledge directly affects health behaviour and indirectly affects health behaviour through the chain mediation of psychological flexibility and anxiety.

    “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.”
    • Also stated in: § 5 | Discussion · plain
      “Consistent with our previous hypothesis, stroke knowledge not only directly affects health behaviour, but also indirectly through psychological flexibility and anxiety.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Disease perception, anxiety and depression negatively influenced self-management in stroke patients.

    “Some studies had found that patient self-efficacy and social support positively influenced self-management in stroke patients, and disease perception, anxiety and depression negatively influenced selfmanagement in stroke patients (Zhang et al. 2024)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Zhang et al. 2024

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Interpretationcitation

    Different patients will have different beliefs, opinions and thus different behaviour after being subjected to the stimulating event of stroke.

    “That is, different patients will have different beliefs, opinions and thus different behaviour after being subjected to the stimulating event of stroke.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductcitation

    The Stroke Knowledge Questionnaire had a content validity of 0.95 and Cronbach's alpha of 0.86.

    “The questionnaire had a content validity of 0.95 and Cronbach's alpha of 0.86 (Yao 2016).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Yao 2016

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Study design and conductcitation

    The final valid questionnaires of this study were 219 cases, which satisfied the minimum requirement of the sample size of 200 people for structural equation modelling.

    “The final valid questionnaires of this study were 219 cases, which satisfied the minimum requirement of the sample size of 200 people for structural equation modelling (McDonald and Ho 2002).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites McDonald and Ho 2002 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Good health behaviour only accounted for 19.9% of stroke patients.

    “Chinese scholars classified the health behaviour of stroke patients into unstable health behaviour, good health behaviour and low health behaviour, of which good health behaviour only accounted for 19.9% (Guo et al. 2023).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Guo et al. 2023

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Patient self-efficacy and social support positively influenced self-management in stroke patients.

    “Some studies had found that patient self-efficacy and social support positively influenced self-management in stroke patients, and disease perception, anxiety and depression negatively influenced selfmanagement in stroke patients (Zhang et al. 2024)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Zhang et al. 2024

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Premisecitation

    Ellis's ABC theoretical model indicates that when confronted with the same activating event, different individuals hold different beliefs about the event, which can lead to different consequences.

    “Ellis's ABC theoretical model (Ellis 1991) indicates that when confronted with the same activating event (Activating Event, A), different individuals hold different beliefs (Belief, B) about the event, which can lead to different consequences (Consequence, C).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Ellis 1991 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In this study, the Cronbach's alpha for the Comprehensive Assessment of Acceptance and Commitment Therapy Processes was 0.73.

    “In this study, the Cronbach's alpha was 0.73.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The Health Behaviour Scale for Stroke Patients had a Cronbach's alpha of 0.88 and a content validity of 0.85.

    “The original scale had a Cronbach's alpha of 0.88 and a content validity of 0.85 (Wan et al. 2017).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Wan et al. 2017

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The Chinese version of the General Anxiety Scale had a Cronbach's alpha of 0.90.

    “The Chinese version of Cronbach's alpha was 0.90 (He et al. 2010), and in this study Cronbach's alpha was 0.81.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites He et al. 2010

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The cross-sectional design can only show correlation between variables and does not indicate causality.

    “In addition, this was a crosssectional study, which can only show the correlation between the variables and does not indicate causality.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    This study was approved by the ethics committee of the first author's institution (No. 2022-KY-1168-001).

    “This study was approved by the ethics committee of the first author's institution (No. 2022-KY-1168-001).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Stroke knowledge can reduce patients' anxiety by improving their psychological flexibility, which ultimately improves their health behaviour.

    “That is, stroke knowledge can reduce patients' anxiety by improving their psychological flexibility, which ultimately improves their health behaviour.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    This study was reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies.

    “This study was reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites STROBE

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    All participants gave informed consent before data collection and could withdraw at any time.

    “All participants gave informed consent before data collection and could withdraw at any time.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Lack of knowledge of stroke might lead to a decrease in patients' psychological flexibility and anxiety, and ultimately had a negative impact on patients' health behaviour.

    “This study showed that the lack of knowledge of stroke might lead to a decrease in patients' psychological flexibility and anxiety, and ultimately had a negative impact on patients' health behaviour.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The more psychological flexibility patients have, the better their health behaviour and the more positive changes in response to poor lifestyle habits.

    “The more psychological flexibility the patients have will lead to better health behaviour (Hooker et al. 2020) and more positive changes in response to poor lifestyle habits.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Hooker et al. 2020 source

  • May combine two claims.

    Interpretationreasoning

    The health behaviour of patients can be improved by increasing patients' psychological flexibility and reducing their anxiety.

    “These results suggest that the health behaviour of patients can be improved by increasing patients' psychological flexibility and reducing their anxiety.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    There is a relationship between anxiety and cardiovascular health.

    “some scholars have shown that anxiety affected patients' health behaviour, and there was a relationship between it and cardiovascular health (He et al. 2022)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites He et al. 2022

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The Comprehensive Assessment of Acceptance and Commitment Therapy Processes had a Cronbach's alpha of 0.87.

    “The Cronbach's alpha of the scale was 0.87 (Wang et al. 2018).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Wang et al. 2018

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Patients with a high level of stroke disease knowledge were better able to understand and solve health-related issues and disease coping skills, which led to the use of correct information to manage the disease and improve their health behaviour.

    “In addition, it has been stated that patients with a high level of stroke disease knowledge were better able to understand and solve health-related issues and disease coping skills (Liu et al. 2024), which led to the use of correct information to manage the disease and improve their health behaviour.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Liu et al. 2024 source
36 of 36

  • The paper relies on this without support.

    It is unclear how knowledge, psychological flexibility, anxiety and health behaviour simultaneously influence health behaviour in stroke patients.

    “However, it is unclear how these factors simultaneously influence health behaviour.”

  • The paper relies on this without support.

    Less is known about psychological flexibility and anxiety as chain mediators between knowledge and health behaviour.

    “In addition, less is known about psychological flexibility and anxiety as chain mediators between knowledge and health behaviour.”

  • The paper relies on this without support.

    This is the first study to provide evidence for a chain-mediated role of psychological flexibility and anxiety between knowledge and health behaviour in stroke patients.

    “This is the first study to provide evidence for a chain-mediated role of psychological flexibility and anxiety between knowledge and health behaviour in stroke patients.”

  • The paper relies on this without support.

    Lack of stroke knowledge leads to maintenance of poor health behaviour and increased chance of recurrence in stroke patients.

    “The lack of stroke knowledge may not only lead to delays in seeking medical treatment (Dong et al. 2024), which affects the prognosis of the patients, but also lead to the maintenance of poor health behaviour in the patients, which can increase the chance of recurrence in stroke patients.”

  • The paper relies on this without support.

    There is an urgent need to improve patients' stroke knowledge to enhance their health behaviour.

    “Therefore, there is an urgent need to improve patients' stroke knowledge to enhance their health behaviour.”

  • The paper relies on this without support.

    A better understanding of the psychological factors that influence the relationship between knowledge and health behaviour among stroke patients will be beneficial.

    “In addition, a better understanding of the psychological factors that influence the relationship between knowledge and health behaviour among stroke patients will be beneficial.”

  • The paper relies on this without support.

    The mechanism of the relationship between anxiety and adverse clinical outcomes is not clear.

    “At present, the mechanism of the relationship between anxiety and adverse clinical outcomes is not clear”

  • The paper relies on this without support.

    Stroke patients have fewer ways of acquiring knowledge about the disease.

    “and this population had fewer ways of acquiring knowledge about the disease.”
8 of 8

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Flexibility-behaviour relationship changes direction

    Major

    The abstract describes a negative correlation between health behaviour and psychological flexibility, whereas the discussion says greater flexibility leads to better health behaviour. A negative correlation with the reverse-scored Comp ACT measure would support the latter claim, not the abstract's wording.

  • Total-effect estimate falls outside its confidence interval

    Minor

    The reported total effect is 0.487, but its stated 95% confidence interval ends at 0.465. The point estimate cannot lie above the upper bound of its own confidence interval.

  • Low knowledge is said both to lower anxiety and to increase it

    Minor

    The clinical implications say that lacking stroke knowledge may decrease anxiety. The discussion instead says patients with less knowledge are more likely to be anxious.

  • Knowledge-flexibility relationship is described in opposite directions

    Minor

    The results call the association between stroke knowledge and psychological flexibility negative, while the discussion says greater knowledge accompanies greater flexibility. The scale is reverse-scored, which may explain the mix-up, but the statements about flexibility itself conflict.

4 of 4

Cites

Flagged first, then by citations

1 of the 31 references couldn’t be matched to a known paper.

Research works printed but not linked: 10

  1. Guo X. R., 2023, Analysis of Latent Categories and Influencing Factors of Health Behaviors in Stroke Patients, Chinese Journal of Social Medicine, 40, 182
  2. He X., 2010, Reliability and Validity of the Generalized Anxiety Scale in a General Hospital, Shanghai Archives of Psychiatry, 22, 200
  3. Li P., 2024, Correlation Analysis Between Psychological Flexibility and Health‐Promoting Lifestyle in Stroke Patients, Psychological Monthly, 19, 16
  4. Report on Stroke Prevention and Treatment in China Writing Group, 2020, Summary of ‘China Stroke Prevention and Treatment Report 2019’, Chinese Journal of Cerebrovascular Disease, 17, 272
  5. Report on Stroke Prevention and Treatment in China Writing Group, 2023, Summary of ‘China Stroke Prevention and Treatment Report 2021’, Chinese Journal of Cerebrovascular Diseases, 20, 783
  6. Sun T., 2024, Effect of Recurrence Risk Perception on Health Behavior in Patients With First Ischemic Stroke, Chinese Journal of Practical Nervous Diseases, 27, 499
  7. Tian L., 2024, Analysis of the Current Status and Influencing Factors of Psychological Flexibility in Stroke Patients During Rehabilitation Period, Journal of Nursing Science, 39, 18
  8. Wan L., 2017, Development and Reliability and Validity Test of Health Behavior Scale for Stroke Patients, Journal of Nursing Science, 32, 25
  9. Wang M., 2018, Reliability and Validity Analysis of the Chinese Version of the Comprehensive Questionnaire on Psychological Flexibility Among Financial Institution Staff, Chinese Journal of Behavioral Medicine and Brain Science, 27, 72
  10. Yao Q., 2016, Effect of Self‐Management Intervention on Knowledge, Belief, Behavior and Subjective Well‐Being of Stroke Recovery Patients

Cited by

Sorted by citations

Related

Authors
Ma, R., Qiao, M., Zhou, Y., Sun, W., Lv, Y., Zhou, X., Wang, Y., Wu, X., & Yu, R.
Affiliations
  • Department of Neurology The First Affiliated Hospital of Zhengzhou University Zhengzhou Henan China
  • First Affiliated Hospital of Zhengzhou University (CN)
ORCID
Venue
Journal of Clinical Nursing
Publisher
Wiley
Published
2025-05-06
Volume
35
Issue
1
Pages
219-228
ISSN
  • 0962-1067 (ISSN-L)
  • 1365-2702
DOI
10.1111/jocn.17820
OpenAlex
W4410178379
Semantic Scholar
e52deb24c151901749a465cee3c81324f4dbfaea
Cited by
3
References
31
Citations by year
2026: 2 · 2025: 1
FWCI
3.76
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Journal of Clinical Nursing (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Health and Wellbeing Research
  • Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
  • Health Sciences › Health Professions › Pharmacy › Nursing care and research
Keywords
stroke, stroke knowledge, psychological flexibility, anxiety, health behavior, serial mediation, stroke patients, patient education, caregiver interventions
MeSH terms
Adult, Aged, Anxiety, China, Cross-Sectional Studies, Female, Humans, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Surveys and Questionnaires, Health Behavior, Stroke

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