Mediation Role of Behavioral Decision-Making Between Self-Efficacy and Self-Management Among Elderly Stroke Survivors in China: Cross-Sectional Study

<b>Background:</b> Identifying the factors that impact self-management is crucial, as elderly stroke survivors frequently face challenges in self-management. Self-efficacy and behavioral decision-making are reported as influencing factors of self-management, but their relationship within the elderly population remains unconfirmed. This study aimed to explore whether self-efficacy impacts self-management through the mediating role of behavioral decision-making among elderly stroke survivors. <b>Methods:</b> A cross-sectional design and convenience sampling method were used in this study. A total of 291 elderly stroke survivors were recruited from a tertiary hospital in Henan Province, China, between March and July of 2024. Questionnaires were distributed to collect sociodemographic, self-efficacy, behavioral decision-making, and self-management data. A path analysis and correlation analysis were used to analyze the data. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. <b>Results:</b> Elderly stroke survivors reported having a moderate level of self-management. There was a positive correlation between self-efficacy, behavioral decision-making, and self-management (all <i>p</i> < 0.01). The mediation model indicated that behavioral decision-making mediated the association of self-efficacy and self-management in the regression model (95% <i>CI</i> 0.03 to 0.14), and the effect value was 0.08. It was also confirmed that behavioral decision-making mediated the impact of self-efficacy and self-management, accounting for 25.81% of the total effect. <b>Conclusion:</b> Self-efficacy is not solely a key factor influencing self-management in elderly stroke survivors, but it also improves their self-management behaviors by facilitating behavioral decision-making. As a result, healthcare professionals should consider self-efficacy and behavioral decision-making as crucial elements for assessing elderly stroke survivors during discharge and follow-up.