Financial toxicity and exercise adherence in stroke patients: a parallel mediation model of perceived social support...

To analyze the relationship between financial toxicity and exercise adherence among stroke patients and to test the parallel mediating effects of perceived social support and self-efficacy.

Using convenience sampling, 362 stroke patients were surveyed from September 2024 to July 2025. The survey instruments included Basic Information Questionnaire, Comprehensive Scores for Financial Toxicity Based on the Patient-Reported Outcome Measures, Stroke Self-Efficacy Questionnaire, Perceived Social Support Scale, and Questionnaire of Exercise Adherence. Pearson correlation analysis, structural equation modeling, and Bootstrap methods were applied to examine the connections among stroke patients' financial toxicity, self-efficacy, perceived social support, and exercise adherence.

The correlations between financial toxicity, self-efficacy, perceived social support, and exercise adherence were statistically significant (p < 0.01). The structural equation model fit well, and the main paths were statistically significant (p < 0.05). Bootstrap results showed that the direct effect of financial toxicity on exercise adherence was 0.279 (95% CI [0.199, 0.359]), the indirect effect of self-efficacy was 0.152 (95% CI [0.103, 0.208]), and the indirect effect of perceived social support was 0.063 (95% CI [0.035, 0.094]).

Financial toxicity is significantly associated with exercise adherence among stroke patients. An indirect association was also observed between financial toxicity and exercise adherence via self-efficacy and perceived social support. This suggests that in clinical practice, in addition to addressing financial toxicity, it is also important to enhance patients' self-efficacy and strengthen social support to promote exercise adherence.