Self-efficacy mediates the effect of hope on health promotion intention in Chinese stroke patients

Stroke remains a leading global threat to life and health, with secondary prevention of recurrence and restoration of physical/neurological function representing critical challenges in post-stroke care. While surgical and pharmacologic treatments for stroke are well-studied, fewer studies have explored strategies to improve health promotion intention in stroke patients, which could enhance long-term prognosis. This study aimed to explore the relationship between health promotion intention, hope, and self-efficacy. From June 2023 to November 2023, a questionnaire survey was conducted among 521 stroke patients in the affiliated hospitals of Hunan University of Chinese Medicine using cluster sampling. The survey instruments included a general demographics questionnaire, Health-Promoting Lifestyle Scale-II R, General Self Efficacy Scale, and Herth Hope Index. Multiple regression analysis was used to explore the influencing factors of health promotion intention, and structural equation modeling was constructed to test the mediating role of self-efficacy between hope and health promotion intention. A total of 499 valid questionnaires were included. There was a significant positive correlation between health promotion intention, hope, and self-efficacy (p < 0.01). Hope (β = 0.160, p < 0.01), self-efficacy (β = 0.390, p < 0.001), and disease knowledge (β = 0.167, p < 0.001) significantly and positively influenced health promotion intention. Self-efficacy partially mediated the relationship between hope and health promotion intention [β = 0.258, 95%CI (0.126, 0.401)], with the indirect effect accounting for 41.55%. This study demonstrated that hope directly enhances health promotion intention in stroke patients, with self-efficacy partially mediating this relationship. Future interventions should target both hope and self-efficacy to optimize outcomes, while accounting for additional unexamined variables that may influence this pathway. Further research is needed to identify other potential mediators and refine evidence-based behavioral intervention programs.