Assessment-need mismatch in discharge readiness among young and middle-aged stroke survivors: A mixed-methods study

Young and middle-aged stroke survivors face distinct challenges when transitioning from hospital to home, particularly regarding disruptions to occupational roles, family responsibilities, and social participation. Examining discharge readiness profiles alongside patients' accounts may help clarify the specific support needs of this younger cohort.

This study aimed to identify distinct discharge readiness profiles among young and middle-aged stroke survivors, examine associated factors and explore their anticipated transition needs, and examine how quantitative readiness scores correspond with patients' accounts of preparation for home.

A rolling explanatory sequential mixed-methods design.

Five neurology wards within a tertiary grade-A hospital in northwestern China.

The quantitative phase enrolled 732 stroke survivors, from whom 11 individuals were purposively selected for the qualitative phase.

In the quantitative stage, participants aged 18-59 years completed, 24-48 h before scheduled discharge, the Readiness for Hospital Discharge Scale (RHDS), the Brief Illness Perception Questionnaire (BIPQ), and the Social Support Rating Scale (SSRS). Latent profile analysis (LPA) of the three RHDS dimension item means was used to identify distinct patterns of discharge readiness, with multinomial logistic regression analysis examining associated factors. In the qualitative stage, semi-structured interviews were conducted before discharge with 11 purposively selected participants. These narrative data underwent inductive content analysis; Meleis' transition theory guided the interview topics and interpretation. Quantitative and qualitative strands were integrated through a joint display to evaluate how the identified profiles mapped onto reported preparation for home and anticipated care needs.

Latent profile analysis yielded four distinct discharge readiness configurations: comprehensive vulnerability (9.84 %), high adaptability-low support (16.39 %), support advantage (20.49 %), and balanced preparation (53.28 %). Survivors in the high adaptability-low support subgroup reported high personal status and adaptation ability but low expected support. Multinomial regression indicated that age, education level, per capita monthly family income, SSRS, and BIPQ were associated with profile membership; the gender test was not significant. Qualitative analysis revealed seven care needs organized into four themes: changes in role identity and psychological support needs, practical self-management support needs, continuing support needs, and socioeconomic needs. Data integration linked readiness profiles to concerns about rehabilitation at home, continuity of care, returning to work, and family responsibilities.

Discharge readiness in young and middle-aged stroke survivors is highly heterogeneous. Pairing RHDS dimension profiles with targeted, patient-centered inquiry can clarify life-stage-related concerns and support priorities, informing individualized discharge planning and continuity of care.