Effectiveness of Self-Management Education on Behavior Improvement Among Stroke Survivors in Indonesia: A Randomized Controlled Trial

Background: This study aimed to investigate the impact of stroke self-management education (SSME) on improving self-management behaviors among stroke survivors. Methods: An individual randomized controlled trial was conducted from June to August 2024 in an educational hospital in Surabaya, Indonesia. Participants were selected based on the inclusion and exclusion criteria and then randomly assigned via computer-generated randomization to the intervention and control groups. After 3 weeks of intervention, the self-management behavior of stroke survivors was evaluated using the Stroke Self-Management Behavior Questionnaire (SSMBQ). A per-protocol analysis was used to compare the intervention groups, which included only those patients who completed the treatment allocated initially to them. The data was analyzed using descriptive tests, t-tests, and Cohen's d. Results: Of the 36 participants, 34 completed both baseline and post-intervention assessments (intervention group: 18; control group: 16). All variables were normally distributed and met the assumptions for t-test analysis. The intervention group demonstrated significant improvements in self-integration, self-regulation, interaction with healthcare workers, self-monitoring, and medication adherence (p < 0.001). In contrast, the control group showed a significant change only in self-regulation (p = 0.037). Independent t-tests indicated significant between-group differences across all five indicators (p < 0.001), with large effect sizes (Cohen’s d > 0.65). Conclusion: The implementation of SSME for 3 weeks effectively improved self-management behaviours. By enhancing knowledge of self-management, stroke survivors will be more motivated to improve their behavior during continued care at home. Keywords: Non-communicable disease, Patient discharge, Self-management, Social support, Stroke, Indonesia