Factors Influencing Adherence to Home-Based Exercise Rehabilitation in Stroke Patients from a Temporal Perspective: An Explanatory Sequential Mixed-Methods Study

Jianing Shao,1,2,* Sunling Cong,3,* Yuxin Han,1,2 Wenjin Xu,1 Qing Wang,4 Jiachen Zhang,3 Xiaoxiao Wei,1,2 Rui Ren1,2 1Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, People’s Republic of China; 2School of Nursing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, People’s Republic of China; 3School of Medicine, Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China; 4Department of Nursing, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Qing Wang, Department of Nursing, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, People’s Republic of China, Email [email protected]: This study aimed to examine the factors influencing the adherence of stroke patients to home-based exercise rehabilitation and to elucidate the potential driving mechanisms of temporal perspective on rehabilitation adherence.Patients and Methods: This study employed a sequential, explanatory, and mixed-methods design. In the quantitative phase, a questionnaire survey was conducted among 289 stroke patients from January 2025 to May 2025 using convenience sampling. In the qualitative phase, 16 stroke patients were selected from the quantitative sample through purposive and maximum variation sampling to explain and supplement the quantitative findings using semi-structured interviews.Results: Quantitative analysis demonstrated a significant positive correlation between temporal perspective and rehabilitation adherence, with rehabilitation intention partially mediating this relationship. Behavioral advantage exerted a negative moderating effect on the intention–adherence pathway, whereas the moderating effect of self-regulation ability did not reach statistical significance. Qualitative analysis identified four main themes: consistency belief, time-bound potency, behavioral advantage, and self-regulation ability.Conclusion: Temporal perspective is an important driver of adherence to home-based rehabilitation among stroke patients. As rehabilitation habits develop, behavioral patterns gradually shift from being “intention-driven” to becoming “automatic habits”, thereby weakening the direct driving effect of intention. Given the potential presence of latent executive dysfunction in stroke patients, targeted assessment tools and intervention strategies should be developed to bridge the gap between intention and behavior.Keywords: temporal perspective, intention, behavioral advantage, self-regulation ability, quantitative study, qualitative study