Factors influencing the health behaviors of patients with ischemic stroke from a social-ecological perspective: a cross-sectional study
Abstract Background Although numerous studies have investigated factors associated with health behaviors in patients with first-onset ischemic stroke, the variables examined have varied substantially. Moreover, most analyses have employed ordinary linear regression models that treat variables across...
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2025-08-01
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| Online Access: | https://doi.org/10.1186/s12889-025-24167-0 |
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| author | Min-Xiu Wang Gui-Zhen Weng Jin-Hua Liao Xin-Yan Chen Yan-Juan Lin |
| author_facet | Min-Xiu Wang Gui-Zhen Weng Jin-Hua Liao Xin-Yan Chen Yan-Juan Lin |
| author_sort | Min-Xiu Wang |
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| description | Abstract Background Although numerous studies have investigated factors associated with health behaviors in patients with first-onset ischemic stroke, the variables examined have varied substantially. Moreover, most analyses have employed ordinary linear regression models that treat variables across different levels as equivalent, thereby overlooking the nested structure of influencing factors. To address this methodological limitation, the present study adopts the Social-Ecological Model as a theoretical framework and employs hierarchical linear modeling (HLM) as a statistical approach. This framework enables systematic stratification of factors across individual, interpersonal, community, and societal levels, and facilitates the identification of key level-specific factors associated with health behaviors in this patient population. Methods This cross-sectional study included 350 patients with first-onset ischemic stroke who were assessed via structured telephone interviews three months after hospital discharge. Univariate analysis, correlation analysis, stratified multivariate analysis, and hierarchical linear modeling (HLM) were conducted to identify key factors associated with patients’ health behaviors. Results Stratified multivariate analysis identified educational level, physical functioning, stroke-related knowledge, and health beliefs as individual-level factors; per capita monthly household income and perceived social support as interpersonal-level factors; and community health environment, distance to the hospital, and place of residence as community- and societal-level factors associated with patients’ health behaviors. Further analysis using hierarchical linear modeling (HLM) revealed stroke-related knowledge, health beliefs, and perceived social support as the most salient associated factors across levels. Conclusions Health behaviors among patients with ischemic stroke were shaped by a hierarchically structured set of factors spanning the individual, interpersonal, community, and societal levels. The present study offers a theoretical foundation for informing the development of targeted, multilevel strategies aimed at promoting health behavior improvement in this population. |
| format | Article |
| id | doaj-art-fd13c07cdaeb4b89a984b1d1e7881cc9 |
| institution | Kabale University |
| issn | 1471-2458 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
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| series | BMC Public Health |
| spelling | doaj-art-fd13c07cdaeb4b89a984b1d1e7881cc92025-08-24T11:56:13ZengBMCBMC Public Health1471-24582025-08-0125111210.1186/s12889-025-24167-0Factors influencing the health behaviors of patients with ischemic stroke from a social-ecological perspective: a cross-sectional studyMin-Xiu Wang0Gui-Zhen Weng1Jin-Hua Liao2Xin-Yan Chen3Yan-Juan Lin4Department of Neurology Nursing, Fujian Medical University Union HospitalDepartment of Oncology Nursing, Fujian Medical University Union HospitalSchool of Nursing, Fujian Medical UniversityDepartment of Neurology Nursing, Fujian Medical University Union HospitalDepartment of Nursing, Fujian Medical University Union HospitalAbstract Background Although numerous studies have investigated factors associated with health behaviors in patients with first-onset ischemic stroke, the variables examined have varied substantially. Moreover, most analyses have employed ordinary linear regression models that treat variables across different levels as equivalent, thereby overlooking the nested structure of influencing factors. To address this methodological limitation, the present study adopts the Social-Ecological Model as a theoretical framework and employs hierarchical linear modeling (HLM) as a statistical approach. This framework enables systematic stratification of factors across individual, interpersonal, community, and societal levels, and facilitates the identification of key level-specific factors associated with health behaviors in this patient population. Methods This cross-sectional study included 350 patients with first-onset ischemic stroke who were assessed via structured telephone interviews three months after hospital discharge. Univariate analysis, correlation analysis, stratified multivariate analysis, and hierarchical linear modeling (HLM) were conducted to identify key factors associated with patients’ health behaviors. Results Stratified multivariate analysis identified educational level, physical functioning, stroke-related knowledge, and health beliefs as individual-level factors; per capita monthly household income and perceived social support as interpersonal-level factors; and community health environment, distance to the hospital, and place of residence as community- and societal-level factors associated with patients’ health behaviors. Further analysis using hierarchical linear modeling (HLM) revealed stroke-related knowledge, health beliefs, and perceived social support as the most salient associated factors across levels. Conclusions Health behaviors among patients with ischemic stroke were shaped by a hierarchically structured set of factors spanning the individual, interpersonal, community, and societal levels. The present study offers a theoretical foundation for informing the development of targeted, multilevel strategies aimed at promoting health behavior improvement in this population.https://doi.org/10.1186/s12889-025-24167-0Ischemic strokeSocio-ecological modelHierarchical linear modelSecondary preventionHealth behaviorInfluencing factor |
| spellingShingle | Min-Xiu Wang Gui-Zhen Weng Jin-Hua Liao Xin-Yan Chen Yan-Juan Lin Factors influencing the health behaviors of patients with ischemic stroke from a social-ecological perspective: a cross-sectional study BMC Public Health Ischemic stroke Socio-ecological model Hierarchical linear model Secondary prevention Health behavior Influencing factor |
| title | Factors influencing the health behaviors of patients with ischemic stroke from a social-ecological perspective: a cross-sectional study |
| title_full | Factors influencing the health behaviors of patients with ischemic stroke from a social-ecological perspective: a cross-sectional study |
| title_fullStr | Factors influencing the health behaviors of patients with ischemic stroke from a social-ecological perspective: a cross-sectional study |
| title_full_unstemmed | Factors influencing the health behaviors of patients with ischemic stroke from a social-ecological perspective: a cross-sectional study |
| title_short | Factors influencing the health behaviors of patients with ischemic stroke from a social-ecological perspective: a cross-sectional study |
| title_sort | factors influencing the health behaviors of patients with ischemic stroke from a social ecological perspective a cross sectional study |
| topic | Ischemic stroke Socio-ecological model Hierarchical linear model Secondary prevention Health behavior Influencing factor |
| url | https://doi.org/10.1186/s12889-025-24167-0 |
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