The relationship between fear of recurrence and quality of life in stroke patients: the chain mediating role of self-efficacy and health behaviors

Stroke recurrence is a significant concern that profoundly affects patients’ psychological well-being and quality of life. Fear of recurrence (FoR) is prevalent among stroke survivors, yet the mechanisms through which it influences quality of life remain insufficiently explored. This study aimed to investigate the relationship between fear of recurrence and quality of life in stroke patients and to examine the chain mediating effects of self-efficacy and health behaviors in this relationship. A cross-sectional survey was conducted among 120 stroke patients recruited from the Department of Neurosurgery and Neurology at a tertiary hospital in China between March 2024 and March 2025. Data were collected using the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), the Stroke-Specific Quality of Life Scale (SS-QOL), the General Self-Efficacy Scale (GSES), and the Health-Promoting Lifestyle Profile II Revised (HPLP-IIR). Pearson correlation analysis and the PROCESS macro for SPSS (Model 6) with bootstrap methods were employed to test the hypothesized chain mediation model. Fear of recurrence was negatively correlated with quality of life ( r = -0.487, p < 0.01), self-efficacy ( r = -0.396, p < 0.01), and health behaviors ( r = -0.312, p < 0.01). Self-efficacy was positively correlated with health behaviors ( r = 0.524, p < 0.01) and quality of life ( r = 0.461, p < 0.01). Health behaviors were positively correlated with quality of life ( r = 0.438, p < 0.01). The chain mediation model demonstrated that fear of recurrence was associated with quality of life through three indirect pathways: (1) through self-efficacy alone (indirect effect = -0.098, 95% CI [-0.179, -0.031]), (2) through health behaviors alone (indirect effect = -0.052, 95% CI [-0.114, -0.008]), and (3) through the sequential chain of self-efficacy and health behaviors (indirect effect = -0.037, 95% CI [-0.076, -0.011]). The total indirect effect was − 0.187, accounting for 38.4% of the total effect. Self-efficacy and health behaviors show significant chain mediating roles in the relationship between fear of recurrence and quality of life among stroke patients. Interventions aimed at enhancing self-efficacy and promoting health behaviors may buffer the negative association of fear of recurrence on quality of life.