Pathways related to the degeneration of health behavior in stroke patients: a qualitative comparative analysis

Stroke is characterized by a high recurrence rate, which can cause significant physical and psychological harm to patients. The implementation of specific health behaviors represents an effective measure to reduce the recurrence rate; however, the current status of specific health behavior implementation in stroke patients is not optimal. The evolution of certain health behaviors is a complex process. However, previous studies have predominantly focused on isolated variables and, as a direct consequence, cannot fully explain the underlying mechanisms involved, thus hindering the development of effective interventions. To solve this problem, we adopted the crisp-set qualitative comparative analysis (csQCA) method from a configurational perspective to analyze the health behavior cases of 210 stroke patients. We investigated the complex influences between these variables and the outcome variable by performing univariate necessity analysis and path configuration analysis. The analysis revealed no single necessary condition. We identified seven sufficient pathways, categorized as endogenous (dominated by self-control and self-regulation deficits) or exogenous (driven by external misinformation). Robustness tests confirmed a stable core configuration (low self-control × insufficient motivation × self-control weakening) within the endogenous pathways. This underscores that degradation stems from specific combinations of conditions, not isolated factors. Our findings suggest that we should focus on identifying and addressing multiple conditional variables from a holistic perspective, with particular attention to a patient's self-control ability and the accuracy of external information sources. Future intervention programs may be developed by considering the specific combination of variables identified in each pathway. Our findings advocate for a shift from single-factor to configurational, multi-level interventions. These should simultaneously target the stable psychological core and mitigate diverse contextual risks. This study provides a hierarchical framework for understanding health behavior degradation, offering a basis for personalized intervention strategies.