Association Between Stroke-Related Knowledge and Self-Management Behaviours in Patients With Ischemic Stroke: Serial Mediation by Health Beliefs and Depression.

OBJECTIVE: To examine the association between stroke-related knowledge and self-management behaviours among patients with ischemic stroke and to assess the potential mediating roles of health beliefs and depression. METHODS: A total of 382 patients with ischemic stroke were enrolled from a tertiary hospital in Henan Province between June 2024 and March 2025. Data were collected using a general information questionnaire, the Stroke Knowledge Questionnaire, the Health Belief Scale, the Self-Rating Depression Scale and the Self-Management Behaviour Scale. Spearman correlation analysis was performed to examine the associations among the variables. Serial mediation was examined using structural equation modelling with robust maximum likelihood estimation in the lavaan package (version 0.7-2). RESULTS: Stroke-related knowledge was positively associated with self-management behaviours (total effect: B = 2.448, 95% CI [1.925, 3.015]). After accounting for health beliefs and depressive symptoms, the direct effect of stroke-related knowledge on self-management behaviours remained statistically significant (B = 1.124, 95% CI [0.552, 1.696]) and the total indirect effect through health beliefs and depressive symptoms was also statistically significant (B = 1.324, 95% CI [0.966, 1.752]), accounting for 54.08% of the total effect. Specifically, the indirect effect through health beliefs (B = 0.594, 95% CI [0.238, 0.970]), the indirect effect through depressive symptoms (B = 0.419, 95% CI [0.236, 0.683]) and the serial indirect effect involving health beliefs and depressive symptoms (B = 0.311, 95% CI [0.176, 0.510]) were all statistically significant. CONCLUSIONS: Among patients with ischemic stroke, stroke-related knowledge was significantly associated with self-management behaviours, with health beliefs and depressive symptoms serving not only as separate mediators but also as a significant serial mediation pathway. IMPLICATIONS FOR NURSING PRACTICE: Nurses should provide individualized stroke education, assess patients' health beliefs and depressive symptoms and offer psychological support when needed. Integrating educational and psychological assessment into rehabilitation nursing may provide more comprehensive support for self-management. REPORTING METHOD: This study is reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. PATIENT/PUBLIC CONTRIBUTION: Patients with ischemic stroke were surveyed to collect relevant data.