Association Between Fear of Progression and Dyadic Self-Care in Patients With Stroke and Their Spouses: A Moderated Network Analysis

Vollständiger Abstract

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Background: Self-care, while a vital factor affecting health outcomes in patients with stroke, remains unsatisfactory in this patient population. The dyadic self-care concept offers new research directions. Although fear of disease progression is known to affect self-care significantly, the focus of prior research has been primarily on macro-level variables, and micro-level perspectives have been inadequately explored. Purpose: This study was designed to explore the relationship between fear of disease progression and dyadic self-care in patients with stroke and their spouses and the moderating role of sex on this relationship. Methods: From August 2024 to March 2025, 384 stroke patient-spouse dyads completed surveys, including the Fear of Progression Questionnaire Short Form, the Fear of Progression Questionnaire Short Form/Partner, the Self-Care of Chronic Illness Inventory, and the Caregiver Contribution to Self-Care Chronic Illness Inventory. Moderated network analysis was used to explore the bidirectional relationships between fear of disease progression dimensions and dyadic self-care and the moderating role of sex. Results: The relationships between the patient’s and spouse’s disease progression dimensions and those between the patients’ self-care dimensions and spouses’ contribution to self-care dimensions were shown to be bidirectionally positively correlated. Fear of disease progression dimensions were shown to be bidirectionally negatively correlated with the dyadic self-care dimensions. Fear of disease progression dimensions in male patients were shown to influence their spouses’ fear of disease progression dimensions negatively, while the impact was positive in female patients. Fear of disease progression in female spouses was found to have a stronger negative impact on their contribution to self-care than in male spouses. Conclusions/Implications for Practice: Fear of disease progression and dyadic self-care are dyadic phenomena in patients with stroke and their spouses. Fear of disease progression is bidirectionally and negatively associated with dyadic self-care, moderated by sex. For male patients, the couple’s emotional regulation is “complementary,” whereas for female patients, this regulation is “covariant.” For male patient–female spouse families, the male patient should be helped to redefine strength and proactively inquire about his spouse’s concerns to provide her with dedicated psychological support to express her emotions. For female patient–male spouse families, open communication should be affirmed while cautioning against excessive emotional contagion, and couple emotion regulation skills should be taught. As excessive fear in female spouses has a stronger negative impact on their contribution to self-care than male spouses, future interventions should assist female spouses to identify and manage invisible emotional labor, to establish “emotional breaks,” and to share emotional support and caregiving tasks with other family members or support systems. Support groups should be created that provide safe spaces for emotional expression and experience sharing. Finally, remote monitoring technologies may be employed to assist patients in improving their self-management efficacy.