Self-advocacy in stroke patients in China: A mixed-methods analysis

Objective Self-advocacy is associated with positive health outcomes, which is a central issue in chronic disease management. This study attempted to define self-advocacy operationally and conduct a mixed-methods analysis of self-advocacy among stroke patients in China. Design Schwartz-Barcott and Kim's method was used to clarify the concept of self-advocacy. Setting Two hospitals in Zhengzhou and Luoyang City, Henan Province, China. Participants A total of 12 stroke patients were recruited and interviewed face to face from October 2023 to December 2023. Outcomes A three-phase method (theoretical phase, fieldwork phase and final analysis phase) was employed to conduct the mixed concept analysis. In the theoretical phase, a literature search was conducted using PubMed, Web of Science, EBSCO, Embase, PsycINFO, CNKI, Wanfang database, VIP database and CBMdisc. 38 articles in databases were evaluated without time limits up to August 2023. In the fieldwork phase, semistructured interviews were used to interview the 12 participants who were chosen using purposive sampling. In the final analysis phase, the results from both the initial and second phases were integrated. Results The review of literature in the theoretical phase determined the attributes of the concept, including 'self-cognition', 'self-decision making', 'effective communication', 'social connection'. In the field study phase, attributes such as 'self-awareness', 'self-care knowledge and abilities' and 'seeking support' were added. In the final analysis phase, self-advocacy was finally defined as five attributes: 'self-awareness', 'self-care level', 'self-decision-making', 'effective communication' and 'seeking support'. Conclusions Self-advocacy was defined as the capacity of stroke patients to comprehend and articulate their personal needs and care preferences, make proactive and meaningful decisions, engage in effective communication with healthcare providers and derive strength by seeking support from others.