The relationship between social frailty and self-care ability in elderly stroke patients: the mediating role of self-efficacy

Introduction After stroke onset, patients commonly experience varying degrees of impairment in self-care ability, and psychosocial factors may play an important role in this capacity. This study aimed to examine the association between social frailty and self-care ability in elderly stroke patients and to explore the mediating role of self-efficacy in this relationship. Methods A cross-sectional study was conducted in China between May 2024 and September 2025. A total of 436 elderly stroke patients were recruited. Data were collected on demographic characteristics, self-care ability as assessed by the Barthel Index, social frailty as measured by the Social Frailty Assessment Scale for the Elderly (SFASE), and self-efficacy as measured by the General Self-Efficacy Scale (GSES). Linear regression analyses were performed to examine the associations among social frailty, self-care ability, and self-efficacy. The mediating effect of self-efficacy was tested using the PROCESS macro in SPSS. Results After controlling for demographic characteristics, social frailty was significantly and negatively associated with self-care ability (β = −0.211, p < 0.001), indicating that greater social frailty was associated with poorer self-care ability. Mediation analysis revealed a significant indirect effect of self-efficacy, with an effect value of −0.121. Self-efficacy partially mediated the relationship between social frailty and self-care ability, indicating that lower self-efficacy was associated with poorer self-care ability. Bootstrap mediation analysis showed that the direct effect (−0.090, 95% CI: −0.163 to −0.018) and the indirect effect (−0.121, 95% CI: −0.179 to −0.074) accounted for 42.76% and 57.24% of the total effect (−0.211, 95% CI: −0.285 to −0.137), respectively. Discussion This study demonstrated that there is a significant negative correlation between social frailty and self-care ability in elderly stroke patients, and that self-efficacy partially mediates this relationship. The findings suggest that reducing social frailty and improving self-efficacy may be important targets in rehabilitation management, and provide a scientific basis for developing more individualized clinical intervention strategies.