Impact of Illness Perceptions on Poststroke Activity Engagement and the Moderating Role of Gender

Abstract

Importance: Beyond existing knowledge of demographic and performance skill factors, establishing relationships between poststroke activity engagement and illness perceptions sets the stage for the development of more effective intervention strategies.

Objective: To describe the illness perceptions of community-dwelling people with stroke in the first 2 yr poststroke; specifically, to examine whether illness perceptions are associated with activity engagement and to explore the moderating role of gender in these relationships.

Design: Cross-sectional study.

Setting: Participants were recruited from eight rehabilitation settings in Beijing, China.

Participants: 202 community dwellers with stroke.

Outcomes and Measures: Activity engagement and illness perceptions were measured with the Mandarin version of the Assessment of Life Habits and the Chinese version of the Stroke-Specific Illness Perceptions Questionnaire–Revised, respectively. Participants’ demographic information, cognitive status, and motor function were also collected.

Results: Stronger perceptions of consequences and controllability were related to better performance in activity engagement at the personal level, and stronger perceptions of illness coherence were related to better performance in activity engagement at the societal level. In addition, gender differences in the relationship between illness perceptions and activity engagement were described.

Conclusions and Relevance: How people with stroke perceived their conditions dictated their levels of activity engagement in their community of residence. The findings suggest that understanding clients’ illness perceptions may assist practitioners in developing comprehensive, targeted interventions to improve activity engagement and maximize recovery after stroke. Future studies are needed to explore the gender effect of illness perceptions on activity engagement in people with stroke.

What This Article Adds: This study identified the relationships between illness perceptions and level of activity engagement in real-life environments in people with stroke. In addition to motor and cognitive interventions, providing opportunities for clients to gain a better understanding of stroke would facilitate their activity engagement in their real-life environment.

How people perceived their condition following a stroke dictated their levels of activity engagement in their community of residence. The findings suggest that understanding clients’ illness perceptions may assist occupational therapy practitioners in developing comprehensive, targeted interventions to improve activity engagement and maximize recovery.

Because approximately 65% of community-dwelling people with stroke experience limitations while engaging in daily routine activities, assisting and supporting people with stroke to improve their activity engagement has been a major intervention focus in health fields (Singam et al., 2015; Yang et al., 2016). Identifying the factors associated with poststroke activity engagement is a crucial step toward developing and implementing effective interventions. Factors such as older age (Norlander et al., 2016; Yang et al., 2016), female gender (Chau et al., 2009), lower education level (Yang et al., 2016), lower neurological baseline (Alexander et al., 2012; Yang et al., 2016) or motor functions (Norlander et al., 2016), cognitive deficits (Adamit et al., 2015; Yang et al., 2016), and depression (Zhang et al., 2017) have been reported to be associated with more challenges in poststroke activity engagement. However, these factors do not provide a comprehensive picture of poststroke activity engagement, because they only focus on demographic characteristics or a person’s performance skills.

We propose in this article that poststroke activity engagement is affected by illness perceptions in addition to the aforementioned factors. Leventhal et al.’s (2016) common-sense model suggested that illness recovery depends on how people view the nature, impact, and causes of their illness (Leventhal et al., 2016). Specifically, people react to a health threat or illness by forming cognitive and emotional perceptions of the illness (Leventhal et al., 2001). The illness perceptions guide the selection, performance, and evaluation of illness-related management strategies and thus affect health behavioral outcomes (Leventhal et al., 2001).

Illness perceptions refer to organized beliefs surrounding the symptoms, consequences, time course, controllability, cause of an illness, emotional representations, and illness coherence (Leventhal et al., 2001; Moss-Morris et al., 2002). Previous studies have shown that positive illness perceptions are related to better activity engagement in people with various chronic diseases such as diabetes, cancer, rheumatologic disorders, and muscular diseases (Graham et al., 2014; Hampson et al., 2000; Mickevičienė et al., 2013; van Erp et al., 2017). Despite the findings for people with the aforementioned chronic diseases, there has been limited research on perceptions of stroke and poststroke activity engagement. Johnston et al., for example, conducted a series of studies and found that people who believed that they could control the symptoms of their stroke had higher levels of independence and social interaction (Johnston et al., 2004), whereas Harris found that those who failed to return to work after stroke perceived their stroke as significantly more threatening than did those who returned to work (Harris, 2014). However, these studies examined only the controllability component of illness perceptions or focused only on work-related activities. Therefore, further exploration and research are warranted to examine associations between different components of illness perceptions and activity engagement in various life situations at both the personal and societal levels.

The purpose of this study was to examine the influence of each illness perceptions component on activity engagement in community dwellers with stroke after controlling for age, gender, education, cognitive status, and motor function. On the basis of Leventhal et al.’s (2016) common-sense model, we hypothesized that people would face more challenges and require more assistance when engaging in daily activities if they attribute more symptoms to stroke, perceive more severe effects of their stroke, and believe that their stroke will last for a longer time. On the other hand, people with stroke who perceive more responsiveness to self-treatment and expert intervention, have positive emotional responses to illness, and perceive that they have a better understanding of their illness would have better accomplishment in their daily activities. We further hypothesized that gender differences exist in the relationships between illness perceptions and activity engagement, because previous studies have reported that the consequences and impacts of stroke differed by gender (Wang et al., 2013).

Method

Design

This study used a descriptive, cross-sectional research design, exploring the relationships between poststroke activity engagement and illness perceptions components. It is part of a larger project focusing on the factors related to poststroke activity engagement in community dwellers in Beijing, China. Between June and December 2019, people with stroke were recruited from various rehabilitation settings in Beijing, including four hospital-based rehabilitation outpatient clinics, two rehabilitation centers, and two community rehabilitation health stations. Flyers, social media, admission databases of participating institutions, and direct recruitment from participating institutions were used to recruit participants. Questionnaires and functional outcome measures were used for data collection. The institutional review board of the New York University and all participating rehabilitation settings approved the study. Participants were fully informed about the study protocol and gave their consent.

Participants

Inclusion criteria included ages 50 yr or older, a diagnosis of stroke 6 mo to 2 yr before study entry, the ability to understand and respond to verbal or written instructions, and residence in a Beijing community for at least 30 days. People were excluded if they had a history of recurrent stroke, aphasia, depression with scores of 10 or higher on the Chinese version of the Patient Health Questionnaire–9 (PHQ–9; Yeung et al., 2008), or dementia with scores less than 18 for people with more than 6 yr of education on the Montreal Cognitive Assessment–Beijing Version (MoCA–BJ; Xu et al., 2014) or scores less than 14 for people with 6 yr of education or less (Mellor et al., 2016).

Measures

Activity Engagement

We used the Mandarin version of the Assessment of Life Habits (LIFE–H) to measure activity engagement (Fougeyrollas & Noreau, 2002). It assesses participants on 77 life habits from daily activities to social participation across 12 domains. The Daily Activities subscale (37 items) includes nutrition, fitness, personal care, communication, housing, and mobility. The Social Roles subscale (40 items) includes responsibilities, interpersonal relationships, community life, education, employment, and leisure. Scores on the Mandarin version of the LIFE–H are based on one’s perception of difficulty and assistance required (assistive devices, human assistance, adaptation) in daily activities and social roles. For each item, the scores range from 0 (not accomplished) to 9 (accomplished without difficulty or assistance), with higher scores reflecting higher engagement. In this study, a weighted score for each subscale of the LIFE–H was used to represent activity engagement at the personal level and at the societal level, respectively. The Mandarin version of the LIFE–H is reported to have good internal consistency for the stroke population (Zeng et al., 2013). In the present sample, the Cronbach’s αs for the Daily Activities subscale and the Social Roles subscale of the LIFE–H were .91 and .89, respectively.

Illness Perceptions

The Chinese version of the Stroke-Specific Illness Perception Questionnaire–Revised (S-S IPQ–R), modified from the Chinese version of the IPQ–R (https://www.uib.no/ipq/), was used to measure participants’ perceptions of stroke. Stroke-specific symptoms and causes were added to the questionnaire on the basis of Aujla et al.’s (2020) and Twiddy et al.’s (2012) studies. We conducted an expert panel review to ensure the translation equivalence and content validity of the modified questionnaires before data collection (Beaton et al., 2000). The 21 experts in health care professionals—including 14 occupational therapists, 1 physical therapist, 1 speech pathologist, 1 nurse, 3 physicians, and 1 dentist—reviewed translated and modified questionnaires. These professionals were fluent in both Mandarin Chinese and English and had educational or working experiences in English-speaking countries. The majority of the panel members (95%) have experience in working with people with stroke. The panel experts reached 100% consensus on all items of the content equivalence. For the translation equivalence, items were revised if the agreement among experts was lower than 90%. When items needed revision, the suggested translations with the highest agreement among the experts were chosen for the final version. The final version of the questionnaire, with optimal experts’ agreements in content and translation equivalence, was used for the data collection.

The Chinese version of the S-S IPQ–R consists of 100 items organized into nine subscales: Identity (33 items), Consequences (six items), Timeline Acute/Chronic (six items), Timeline Cyclical (four items), Personal Control (six items), Treatment Control (five items), Illness Coherence (five items), Emotional Representations (six items), and Cause (29 items). We used all of the subscales except the Cause subscale, to explore the relationships between activity engagement and stroke-specific illness perceptions. A higher subscale score indicates more symptoms, greater perceived effects of the illness on one’s life, a chronic and cyclic nature of the stroke, high expectations of personal control and treatment control, better illness coherence, or more negative emotional representations, respectively. In the present sample, the Cronbach’s αs ranged from .65 to .93 for the subscales of the Chinese version of the S-S IPQ–R (Table 1).

Table 1.

Participant Characteristics

Characteristic	M (SD)	Cronbach’s α
Age, yr	61.3 (8.3)
Male, n (%)	155 (76.7)
Education, yr	12.8 (3.7)
Cognitive status a	23.8 (3.6)
Upper extremity motor function b	33.6 (21.6)
Lower extremity motor function, n (%) c
0 = Nonfunctional ambulatory	7 (3.5)
1 = Dependent for assistance II	14 (6.9)
2 = Dependent for assistance I	20 (9.9)
3 = Dependent for supervision	33 (16.3)
4 = Independent on level surfaces	38 (18.8)
5 = Independent	90 (44.6)
Wheelchair user, n (%)	105 (52)
Days since stroke onset	314.3 (170.5)
Stroke type, ischemic, n (%)	170 (84.2)
Right side affected, n (%)	81 (40.1)
Depressive symptoms d	2.63 (2.41)
Activity engagement e
Personal level	7.61 (1.42)	.91
Societal level	6.21 (2.21)	.89
Illness perceptions f
Identity	12.7 (3.7)	—
Consequences g	20.4 (3.3)	.66
Timeline Acute/Chronic g	19.0 (4.0)	.86
Timeline Cyclical g	9.0 (1.9)	.65
Personal Control g	21.3 (4.3)	.93
Treatment Control g	18.2 (2.5)	.74
Emotional Representations g	16.3 (4.0)	.80
Coherence g	17.0 (4.0)	.93

Note. N = 202. Dash indicates that Cronbach’s α does not apply to this subscale.

Measured using the Montreal Cognitive Assessment–Beijing Version.

Measured using the Fugl-Meyer Assessment Upper Extremity subscale.

Measured using the Functional Ambulation Category.

Measured using the Chinese version of the Patient Health Questionnaire–9.

Measured using the Mandarin version of the Assessment of Life Habits.

Mearued using the Chinese version of the Stroke-Specific Illness Perception Questionnaire–Revised.

Scores were obtained using a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree).

Demographic Information and Motor Functions

We collected basic demographic characteristics and stroke-related information, including age, gender, years of education, stroke type, days since stroke onset, and wheelchair use. We measured motor functions, including upper extremity and lower extremity functions, with the Fugl-Meyer Assessment Upper Extremity subscale (FMA–UE; Fugl-Meyer et al., 1975) and the Functional Ambulation Categories (FAC; Holden et al., 1986), respectively. The reliability and validity of the FMA–UE and FAC have been previously established in the stroke population (Hsieh et al., 2009 ; Mehrholz et al., 2007). In this study, for FMA–UE, Cronbach’s α = .87.

Statistical Analysis

Descriptive statistics were calculated for all variables in the study. We used Pearson’s correlation to measure the bivariate associations between continuous variables and conducted a series of hierarchical multiple regressions to assess the relationships between illness perceptions and activity engagement at the personal and societal levels. We conducted hierarchical multiple regression models to demonstrate whether illness perceptions show a significant additional influence on activity engagement after accounting for all other variables. In the first block of each analysis, we controlled for the contributions of the following covariates: age, gender, education level, cognitive status, and upper extremity and lower extremity functions. The second block for each model included each illness perception component. The interaction terms of gender and illness perceptions component were added in the third block to test the moderation effect of gender. On the basis of the preliminary descriptive data analysis, we added status of wheelchair use as a covariate in regressions, estimating the relationships between societal level activity engagement and associated factors because of its significant correlation to activity engagement at the societal level (r = −.56). We performed analyses using R Version 4.2.1 (R Core Team, 2021). To ensure that the proposed analysis methods were appropriate for hypothesis tests, we conducted the relevant assumption tests, including multicollinearity, linearity, normality, homoscedasticity, and influential points using tolerance, residual versus fitted plots, residual normal Q-Q plots, scale-location plots, and Cook’s D. As the results of assumption tests, all regression assumptions were met, and no influential points were identified. We conducted an a priori power analysis using G-Power, Version 3.1 (Faul et al., 2009) for sample size estimation. Results indicated that a sample size of 187 would achieve a power of .80 to detect an effect size of .05 with a significance criterion α of .05. Thus, the sample size of 202 participants in the study is adequate to test all hypotheses in this study.

Results

Table 1 shows the characteristics of the participants. A total of 202 community-dwelling people with stroke—155 (76.7%) men and 47 (23.3%) women—participated in the study. Participants’ mean age was 61.3 yr (SD = 8.3), and their average education level was 12.8 yr (SD = 3.7). On average, these participants had experienced a stroke 314.3 days (SD = 170.5) before study entry. The majority of participants (84.2%) were diagnosed with ischemic stroke, and 85.1% of the participants had intact cognition as measured by the MoCA–BJ. The mean score on the FMA–UE was 33.6 (SD = 3.6), indicating moderate upper extremity impairment (Woytowicz et al., 2017). Regarding lower extremity motor function, 33.1% of participants required supervision or physical assistance while walking, 3.5% were unable to perform functional ambulation, and 52% used wheelchairs on a daily basis for indoor and/or outdoor mobility. Participants’ scores on the Mandarin version of the LIFE–H and the Chinese version of the S-S IPQ–R are also presented in Table 1.

We used Pearson’s correlation to examine the strength of the linear association between activity engagement and the illness perceptions components (Table 2). The results showed that the participants experienced more challenges in poststroke activities at both the personal and societal levels if they perceived a greater impact of stroke on their lives (Consequences; r = −.31, p < .001, and r = −.21, p = .003, respectively); believed that stroke was less likely to be controlled by health care services (Treatment Control; r = .22, p = .002, and r = .16, p = .025, respectively); had a limited understanding of stroke (Illness Coherence; r = .16, p = .020, and r = .20, p = .004, respectively); and generated negative emotional responses to stroke (Emotional Representations; r = −.16, p = .024, and r = −.15, p = .029, respectively). In addition, those who attributed more symptoms to stroke (Identity; r = −.16, p = .021) and believed that stroke was less likely to be controlled by self-management (Personal Control; r = .23, p = .001) had more difficulties in personal-level activities but not in societal-level activities.

Table 2.

Pearson Correlations Between Activity Engagement and Illness Perceptions

Variable	1	2	3	4	5	6	7	8	9	10
1. AE personal	—	.75***	−.16*	−.31***	.10	−.05	.23**	.22**	−.16*	.16*
2. AE societal		—	−.14	−.21**	.09	−.10	.11	.16*	−.15*	.20**
3. Identity			—	.35***	.20**	.04	−.18*	−.04	.18*	−.14
4. Consequences				—	.25***	.07	−.18*	−.10	.27***	−.05
5. Timeline Acute/Chronic					—	.11	−.06	−.07	.08	.12
6. Timeline Cyclical						—	.08	−.02	.10	−.13
7. Personal Control							—	.26***	−.11	.15*
8. Treatment Control								—	−.07	.13
9. Emotional Representations									—	−.20**
10. Coherence										—

Note. N = 202. AE personal = activity engagement at the personal level; AE societal = activity engagement at the societal level.

*p < .05. **p < 0.01. ***p < 0.001.

Table 3 presents the results of hierarchical regression models for personal and societal levels of activity engagement with illness perceptions components. Consequences and controllability significantly explained an additional 1.7% and 1.2%, respectively, of the variance in activity engagement at the personal level. The results indicate that those who perceived little impact of stroke on their lives and who believed that stroke can be controlled by self-management and health care services performed better in activities at the personal level. As for activity engagement at the societal level, only the illness coherence component significantly explained an additional 1.5% of the variance, indicating that participants with a solid understanding of stroke performed better in activities at the societal level.

Table 3.

Hierarchical Regressions Estimating the Associations of Illness Perceptions and Activity Engagement at the Personal and Societal Levels

Variable	Identity	Consequences	Timeline	Controllability	Emotional Representations	Coherence
Illness Perceptions and Activity Engagement at the Personal Level
Step 1: Covariates
Age	.02	.00	.02	.02	.02	.03
Gender	.00	.00	.00	.00	.00	.00
Education	.02	.00	.01	.02	.01	.01
Cognitive status	.16***	.17***	.17***	.16***	.17***	.17***
Upper extremity motor function	.27***	.26***	.27***	.29***	.28***	.27***
Lower extremity motor function	.54***	.52***	.55***	.51***	.53***	.54***
Step 2: Illness perception components
Identity	−.08
Consequences		−.14***
Timeline Acute/Chronic			−.05
Timeline Cyclical			.03
Personal Control				.11*
Treatment Control				0.02
Emotional Representations					−.05
Coherence						.07
R ²	.644***	.654***	.640***	.649***	.640***	.642***
ΔR ²	.007	.017**	.003	.012*	.003	.005
F for ΔR ²	3.45	9.39	0.76	3.21	1.50	2.44
dfs	1, 194	1, 194	2, 193	2, 193	1, 194	1, 194
Illness Perceptions and Activity Engagement at the Societal Level
Step 1: Covariates
Age	−.05	−.07	−.06	−.05	−.06	−.04
Gender	.07	.07	.07	.08	.07	.07
Education	−.05	−.06	−.04	−.05	−.05	−.07
Cognitive status	.15*	.15**	.15**	.15*	.15*	.15**
Upper extremity motor function	.24***	.23***	.25***	.25***	.25***	.24***
Lower extremity motor function	.20**	.18*	.19*	.18*	.19*	.19*
Wheelchair use	−.24***	−.24***	−.24***	−.24***	−.23***	−.24***
Step 2: Illness perception components
Identity	−.07
Consequences		−.07
Timeline Acute/Chronic			−.02
Timeline Cyclical			−.04
Personal Control				.02
Treatment Control				.03
Emotional Representations					−.07
Coherence						.13*
R ²	.448***	.449***	.446***	.445***	.449***	.459***
ΔR ²	.004	.005	.002	.001	.005	.015*
F for ΔR ²	1.44	1.77	0.37	0.25	1.81	5.45
dfs	1, 193	1, 193	2, 192	2, 192	1, 193	1, 193

Note. N = 202. At each step, standardized coefficients are reported for variables entered into the regression at that step.

*p < .05. **p < .01. ***p < .001.

Regarding the moderation effect of gender (Figure 1), crossover interactions between gender and illness perceptions components were identified. That is, the effects of illness perceptions components on activity engagement were reversed between men and women. Specifically, there were significant crossover interactions between gender and identity on activity engagement at the personal level: R ² _{change_Gender × Identity} = .008, F(1, 193) = 4.50, p = .035. That is, women with stroke who attributed more symptoms to stroke performed better in activities at the personal level. On the other hand, men with stroke who attributed more symptoms to stroke experienced more challenges. There were also significant crossover interactions between gender and consequences on activity engagement at the societal level: R ² _{change_Gender × Consequences} = .011, F(1, 192) = 4.10, p = .044. That is, women with stroke who perceived more severe impacts of stroke on their lives performed better in activities at the societal level. In contrast, men with stroke who held the same perceptions experienced more challenges.

Figure 1.

Interaction effects of gender and illness perceptions components on activity engagement.

Discussion

This study examined the relationships between activity engagement and illness perception components among community dwellers with stroke in Beijing, China. It is one of the first studies to examine the effects of illness perceptions on health-related outcomes in the stroke population. Results show that people with stroke who perceived stroke as having only a limited impact on their lives (consequences), and who believed stroke can be managed by their own behaviors as well as professional interventions (controllability) functioned better in activity engagement at the personal level.

The significant relationship between controllability and activity engagement at the personal level was aligned with the findings of Johnston et al.’s series of studies on the relationships between locus of control and activity engagement at the personal level in people with stroke (Johnston et al., 1999, 2004; Partridge & Johnston, 1989). The significant relationship between consequences and personal activity engagement echoed previous studies that reported on other chronic illnesses (Bijsterbosch et al., 2009; Graham et al., 2014; Mickevičienė et al., 2013), with the exception of two studies (Spain et al., 2007; Tiemensma et al., 2011). The small sample size in Tiemensma et al.’s (2011) study might not provide sufficient statistical power to detect the effect of consequences on activity engagement (Algina & Olejnik, 2003), whereas the nonsignificant results between consequences and activity engagement in Spain et al.’s (2007) study might be specifically related to the nature of the studied medical condition, multiple sclerosis.

As for activity engagement at the societal level, we found that people who demonstrated stronger belief in their understanding of their illness (coherence) performed better in societal-level activities. To our knowledge, this is the first study to demonstrate positive relationships between illness coherence and activity engagement at the societal level. This finding was not reported by the previous studies on chronic illness (Graham et al., 2014; Mickevičienė et al., 2013; van Erp et al., 2017). The difference in results could be due to the fact that data were collected at various stages of disease progression in the studied samples. Participants in the previous studies were at a relatively chronic stage of their disease, with an average duration of 4 to 16 yr, whereas the participants in the present study were within the first 2 yr after stroke. According to the common-sense model, participants update their illness perceptions over time as their illness status and treatment procedures change (Leventhal et al., 2001). Specifically, as reported in Bijsterbosch et al.’s (2009) study, participants’ beliefs regarding their understanding of their disease (illness coherence) increased in relation to time. Therefore, collecting data at different stages of disease may give some insight into why the results of the present study were disparate. Future research is needed that uses a longitudinal design to understand the interplay of different components of illness perceptions on activity engagement at different phases of poststroke.

Gender differences were identified between illness perception components and activity engagement in this study. Specifically, the present study indicates that beliefs about the symptoms and impact of stroke (identity and consequences) may serve as facilitators or barriers to activity engagement, depending on the person’s gender. That is, among men with stroke, those who attributed more symptoms to stroke and perceived more severe impact of stroke faced more challenges in activity engagement, whereas women with stroke who attributed more symptoms and severe impact to stroke performed better.

The different coping strategies used by men and women for health-related stressors may shed some light on these findings. Previous studies have indicated that coping styles mediate the relationships between illness perceptions and health-related outcomes (Bassi et al., 2021) and coping styles affect health outcomes differently for women and men (Gemmell et al., 2016). Women and men use different coping mechanisms for health-related stressors such as chronic kidney disease, health failure, and cardiovascular risk (Gemmell et al., 2016). Researchers have also reported that women use a greater range of coping strategies and become more active in the management of illness when faced with more challenging conditions (Heo et al., 2008), whereas men tend to avoid stressful situations (Martin et al., 2013). However, because of the limited number of women in the present sample, no definitive conclusion can be drawn. Future research using a larger sample size of various gender identities and expressions to investigate gender differences in the association between illness perceptions and activity engagement is recommended.

Several limitations were identified. The cross-sectional design makes it difficult to determine the direction of the relationships between activity engagement and illness perceptions. It should also be noted that we only recruited participants from rehabilitation settings in one urban city in China, so the generalizability of our findings is limited. In addition, a self-report questionnaire was used to measure activity engagement. Although using the self-report questionnaire allows us to better understand participants’ experience, and although this questionnaire is easier to administer than physical testing (Rallon & Chen, 2008), it may have several more inherited limitations than performance-based assessments have (Kempen et al., 1996). Future studies should consider including both self-report and performance-based tests when assessing participants’ challenges and needs for assistance in activity engagement.

Implications for Occupational Therapy Practice

The results of this study have the following implications for occupational therapy practice:

▪ Activity engagement in people with stroke is related to how they perceive their health condition. Occupational therapy practitioners may include information related to people’s perceptions of stroke when developing interventions to improve poststroke performance in real-life environments.

▪ Occupational therapy practitioners should provide people with stroke with opportunities to better comprehend their stroke condition and develop a positive outlook on their future. This information includes, but is not limited to, the relevant sequelae, the development of stroke, treatment and rehabilitation protocols, the prognosis, and the potential impact on daily living.

▪ Different genders in stroke may require different approaches to facilitate community-dwelling activity engagement. Future research is needed to determine the effect of illness perceptions on poststroke activity engagement among people of different genders.

Conclusion

In conclusion, this study demonstrated that illness perceptions are significantly related to the activity engagement of people with stroke. Specifically, people with stroke who perceived a smaller impact of the stroke on their lives, who felt in control, and who had confidence regarding their knowledge of stroke performed better in their daily activities. The findings suggest that interventions that encourage positive beliefs about stroke may improve their activity engagement poststroke.

Footnotes

Acknowledgments

We thank the participants for sharing their experiences and the institutes that assisted with recruitment.

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