Abstract:

Objective To explore the dilemma of self-management behavior maintenance in ischemic stroke patients，and to provide references for continuous self-management intervention design for ischemic stroke patients. Methods The descriptive qualitative research method was used to select samples by the purpose sampling method. From November to December 2023，18 patients hospitalised with stroke from the neurology ward of a tertiary general hospital in Luoyang City，Henan Province were selected for semi-structured interviews. Based on the Capability，Opportunity，Motivation-Behavior（COM-B） model，the data were analyzed by directed content analysis. Results A total of 3 themes and 12 sub-themes were identified，namely capability factors（poor level of health literacy，lack of self-control），opportunity factors（lack of medical resources impeding the maintenance of behaviors，social customs inducing the return of undesirable behaviors，difficult to satisfy the need for multiple emotional support，behavior being improved briefly after follow-up），and motivation factors（impulsive thinking，role conflict leading to forgetfulness，difficult to change previous bad habits，acceptance of the aging，weak self-management effect，symptoms inducing behavioral changes）. Conclusion The maintenance of self-management behavior in ischemic stroke patients is affected by 3 aspects of obstacles，including capability，opportunity and motivation. On the premise of fully evaluating the specific characteristics of ischemic stroke patients，medical staff should meet the multidimensional needs of patients to promote the maintenance of self-management behaviors to improve their health outcomes.

Key words: Ischemic Stroke, Self-Management, Qualitative Research, Nursing Care

摘要：

目的 深入探讨缺血性脑卒中患者自我管理行为维持困境，为缺血性脑卒中患者持续性自我管理干预设计提供参考。方法 采用描述性质性研究方法，使用目的抽样法选取样本，于2023年11月—12月选取河南省洛阳市某三级甲等综合医院神经内科病区住院治疗的18例缺血性脑卒中患者进行半结构式访谈，基于能力、机会、动机-行为模型，采用定向内容分析法进行资料分析。结果 共提炼出能力因素（健康素养水平不佳、自我控制能力缺如）、机会因素（医疗资源匮乏阻碍行为维持、社会习俗诱发不良行为回归、多元情感支持需求难以满足、接受随访后行为短暂改善）和动机因素（冲动思维持续存在、角色冲突导致遗忘服药、既往习惯难以改变、服老心态削弱动机、自觉管理成效甚微、症状诱发行为变化）3个主题及12个亚主题。结论 缺血性脑卒中患者自我管理行为维持过程中受到能力、机会、动机3个方面障碍因素影响，医护人员应在充分评估缺血性脑卒中患者特异性的前提下，满足患者多维度需求以促使其维持自我管理行为，改善其健康结局。

关键词: 缺血性脑卒中, 自我管理, 定性研究, 护理