Association of Nursing Competence and Family Participation with Self-Management Behaviors in Post-Stroke Patients: A Cross-Sectional Study

Abstract

Background: Despite the importance of self-management in preventing post-stroke complications, the combined association of nursing care competence and family collaborative care with self-management behaviors has not been fully investigated. Objectives: This study aimed to examine the associations between nursing competence and family participation and self-management behaviors among patients after stroke. Methods: This descriptive, correlational, cross-sectional study was conducted from April 2025 to April 2026 at Alavi Educational and Medical Center in Ardabil, Iran. The study included 71 nurses recruited using census sampling and 306 discharged stroke patients and their primary family caregivers selected using random sampling. Data were collected using the Stroke Care Competence Questionnaire, Family Collaborative Care Questionnaire, and Stroke Self-Management Behaviors Questionnaire. Independent-samples t tests, analysis of variance, Pearson correlation, and linear regression analyses were performed using SPSS version 27.0. Results: Most nurses (83.1%) reported a moderate level of nursing competence, and most caregivers (63.1%) reported a moderate level of family collaborative care. Family collaborative care was positively correlated with patient self-management (r = 0.22, P = 0.001). In the adjusted multiple linear regression model, family collaborative care was the strongest positive predictor of self-management (β = 0.630, P < 0.001), and nursing competence was also independently and positively associated with self-management (β = 0.222, P = 0.027). The model explained 63.3% of the variance in self-management (R2 = 0.633). In the family-participation dimension model, monitoring health status was the strongest predictor (β = 0.25, P = 0.001). Nursing competence scores were significantly higher among nurses with a master’s degree and those working in intensive care units (P = 0.001). Conclusions: Family collaborative care and nursing competence were both positively associated with post-stroke self-management, with family collaborative care demonstrating the stronger association. Family-centered transitional care strategies that strengthen caregiver involvement while supporting nurses’ competencies in patient and caregiver education may help improve self-management after discharge.