Stroke is a chronic non-communicable disease (NCD) that causes premature mortality and results in the loss of life on a global scale. The World Stroke Organization (1) estimated that 13.7 million new cases of stroke occur each year, 5.5 million deaths per year and 80 million people worldwide are still living after a stroke worldwide. In Thailand, stroke is an important public health problem. According to the latest statistics in 2019, it was found that stroke is the second leading cause of death in Thailand after cancer. According to the Information in 2018, there were 30,837 patients, representing a mortality rate of 47.15 per 100,000 population, and in 2019, there were 34,728 patients, representing a mortality rate of 53.0 per 100,000 population (2). A stroke is caused by a blockage or rupture of a blood vessel supplying the brain to the brain resulting in damage or destruction of brain cells, which has different effects depending on where it occurs in the brain. The patient's body, movement, speech, thoughts, and feelings are all affected (3). Stroke has a chance of recurrence. Therefore, it is essential to effectively control the risk factors by educating patients about stroke, and making the right changes in health behaviors and lifestyles to optimize disease prophylaxis and minimize recurrence (4-6).
Therefore, it is crucial for patients to pay attention to changing stroke patients' behaviors to healthcare behavior (HB) in order to control their disease and prevent a recurrence. Changing lifestyles to be appropriate and encompassing physical, mental, and social dimensions is therefore a sustainable solution. Currently, there have been studies of the healthcare behavior of patients in terms of physical, mental, and emotional lifestyle including diet, smoking cessation, unhealthy alcohol use, medication use, exercise, rehabilitation, physical activities, rest, illness prevention, and treatment, mental health and stress management, ongoing treatment and prevention of complications, spiritual development and interpersonal relationships (5-8). Thus, the HB of stroke patients in this research consisted of Diet, Exercise, Medication, and Stress management. When patients have the ability to take good care of themselves physically and mentally, they will be able to adapt to society and have good relationships with others.
Stroke patients are a group of people who need to change their self-care habits in a sustainable way because it is one of the factors that contribute to disease recurrence. Studies have shown that individuals are more likely to maintain this behavior if they are physically and mentally prepared (9). There were studies on the program implemented in the NCD group. Studies of positive psychology programs among patients with NCDs, most of the research found that mindfulness and self-regulation had a high influence on the outcomes of patients which stroke patients are also classified as NCDs (10). A review of literature and research suggests that positive psychology is applied in the care of NCDs, which has been shown to improve outcomes in psychology, and health and lower mortality rates. Patient well-being results in lower mortality in patients with chronic diseases (11,12). At present, mindfulness practice, which is a concept of positive psychology, has been applied to reduce stress and benefit the health of Stroke patients. It is found that patients have a better quality of life in all aspects. Mindfulness practice for mental and physical well-being helps patients learn to deal with diseases and manage stress, as observed with lower blood pressure levels after mindfulness practice (13,14). There is an application of mindfulness practice in conjunction with healthcare in stroke patients. Mindfulness has been found to improve early mindfulness skills, reduce physical and mental tension, and increase attention and determination. Mindfulness practice is a long-term treatment for mental fatigue after a stroke and has been shown to reduce muscle spasms in patients with chronic stroke (15-17). According to the concept of Kabat-Zinn (18), Mindfulness is awareness, which consists of two components: attention to the present and an attitude of openness and acceptance in the present moment. For the change in health behavior, mindfulness can help develop self-awareness and awareness of one's own thought processes. It facilitates openness and acceptance of ideas with calmness. Which is a process of mindfulness to the lack of self-awareness to behavior and change behavior (19,20).
Self-regulation is a process in that persons make a plan and direct their own behaviors with the purpose to change their behaviors to target behaviors. It is a process that rerequires practicing and development to achieve behavioral change. Self-regulation consists of 3 processes self-observation through goal setting and self-monitoring, self-judgments, and self-reaction (21). According to the study on the effectiveness of telephone follow-up to set a goal of HB among stroke patients, the program used in the experimental group was a goal-setting program, a procedure for self-regulation. The study results showed that the telephone follow-up had effectiveness to increase consistency in medicine taking among stroke patients (7). Besides, there was a study through systematic review about the use of self-management among stroke patients. Most of the programs used emphasized the most common components, such as information giving, goal setting, planning, and problem-solving. All of the programs gave importance to the psychosocial aspect in addition to physical factors. The study results found that after receiving the self-management program, patients gained more knowledge and self-efficacy including self-management behaviors, HB adjustment about physical rehabilitation and daily life activities, social activities, quality of life, and perceived emotions of participants, with the reduction of undesirable outcomes like dependence and death (22,23).
Social support is one of the factors influencing health behaviors. Family support is an environmental factor that plays an important role in the recovery from illness. When patients receive support from family members in various ways, it gives them encouragement. Understand the problem and fight it. It also affects the good quality of life. From the literature review, family involvement is the action taken by family members to gain comfort by taking care of family members during hospital admission. Families are involved in care in many ways, such as helping with meals and brushing teeth. Other activities for comfort and assist in patient posture or joint movement or exercise (24). The study found that to improve the patient's quality of life, health personnel and family members, in addition to providing physical assistance, should also provide emotional support. Social support is important for social activity participation, rest, and return to work in stroke patients (25,26).
Consequently, the researcher was interested in studying the effect of mindfulness and self-regulation programs (MSRP) affecting HB among stroke patients since only one concept cannot be used to change self-care behaviors, which are complicated, in every aspect. It is believed that when patients have mindfulness, awareness, acceptance, and attention to the present, they shall be able to express those behaviors through self-regulation, leading to the HB adjustment in terms of physical, mental, and social aspects in a sustainable manner.

It is widely known that HB is necessary for stroke patients. According to the findings HB outcomes of stroke patients are used to design the MSRP consisting of behavioral changes. The study results showed that the HB of stroke patients is at a high level, leading to a guideline for relevant agencies or hospitals caring for stroke patients to bring the program to strengthen HB accordingly.
Besides, the study results found the questionnaire about HB and FSSs has quality. It can be used to screen and evaluate a training program given to inpatients. Furthermore, the MSRP with 5 activities for 5 weeks is practical and can improve the HB of stroke patients. Relevant agencies or hospitals caring for patients with stroke can apply the study results to serve other benefits; for example, organizing learning activities that allow family members to participate in caring for stroke patients, organizing activities to practice self-care skills to patients, allowing patients to set a goal and make a plan by themselves while undergoing treatments, and organizing daily mindfulness practice in which the context is appropriately adjusted to meet stroke patients, etc.