As one of the multiple types of cerebrovascular diseases, stroke has remained highly prevalent in the clinic in recent years, becoming a serious disease burden in society and threatening people’s life and health [1] . Swallowing disorders are the most common complications caused by stroke; are closely related to complications such as aspiration pneumonia, malnutrition, and aspiration; and increase the risk of illness and death in stroke patients. For stroke patients with swallowing disorders, in addition to conventional treatment, corresponding swallowing training and nutritional management are needed, which is the key to reducing complications and promoting recovery [2] . Conventional single-subject interventions are limited in many aspects, and the overall improvement effect on swallowing disorders needs to be improved. The Health Action Process Approach (HAPA) model conceptualizes health behavior change as a three-phase continuum: the pre-intentional phase, intentional phase, and action phase, which facilitates behavioral transformation by mobilizing individual self-efficacy [3] . The integration of the HAPA with a multidisciplinary collaborative model establishes a comprehensive nutrition management system that synergizes the expertise of diverse healthcare professionals, thereby providing a scientific and efficient intervention pathway for managing post-stroke dysphagia [4] . There are few clinical reports on the combined application of the HAPA model and multidisciplinary collaboration. To this end, this study included stroke patients with swallowing disorders to construct a multidisciplinary collaborative nutritional management system based on the HAPA model and explored its effect, which is reported below.

During the recovery phase, stroke patients are more prone to developing dysphagia, and without prompt therapeutic and rehabilitation interventions, their feeding difficulties may worsen, potentially leading to psychological disorders, social isolation, and various complications [6] . While traditional single-discipline interventions, such as nutritional support or swallowing therapy alone, have shown some effectiveness in improving swallowing function [7] . However, not all patients benefit equally due to inherent limitations. For instance, nutrition specialists often overlook how swallowing training affects dietary safety, while rehabilitation teams frequently fail to monitor nutritional indicators during therapy, often resulting in adverse events like aspiration and malnutrition—underscoring the urgent need for more scientific and efficient management systems [8] .

Our results revealed that, after intervention, the GUSS and GSES scores of the observation group increased compared with those of the control group; moreover, the Hb and Alb levels in the observation group increased compared with those in the control group after intervention. The results suggest that the application of the HAPA model-based multidisciplinary collaborative nutritional management system for stroke patients with dysphagia can improve swallowing function, self-efficacy, and nutritional status. Analysis of specific reasons: The multidisciplinary collaborative nutrition management system based on the HAPA model divides the intervention process into three steps, among which the pre-intention stage helps patients gain an in-depth understanding of the mechanism, risk factors, common complications, and harmfulness of dysphagia with the help of multidisciplinary education such as nutrition, neurorehabilitation, and speech rehabilitation, so as to improve patients’ risk awareness, enhance health beliefs, and secondary self-efficacy [9] . At the same time, in the intention stage, the nutritionist formulated the individualized diet plan, the rehabilitation department developed the individualized swallowing training plan, and the nurses provided professional psychological counseling to improve the patient’s physical and mental state and promote the development of a correct diet and training behavior [10] . In addition, in the action stage, the implementation of the patient’s dietary behavior is supervised by the nurse, the dietician dynamically adjusts the dietary plan, and the rehabilitation physician regularly adjusts the training intensity, which can continuously strengthen and consolidate the patient’s healthy behavior [11] . Through the abovementioned dynamic intervention and the integration of multidisciplinary resources, the correct eating behavior of patients and scientific swallowing training will help to accelerate the recovery of swallowing function and improve nutritional status. The HAPA model is particularly suitable for dysphagia management as its three-phase intervention (pre-intention-intention-action) specifically addresses patients’ behavioral challenges: enhancing risk perception in the pre-intention phase, establishing individualized plans in the intention phase, and reinforcing behavior maintenance in the action phase. This progressive approach effectively overcomes common issues in dysphagia patients including insufficient cognition, lack of motivation, and poor adherence. This study compared complications during hospitalization, and the total incidence in the observation group was lower than that in the control group. The multidisciplinary collaborative nutritional management system based on the HAPA model helps reduce the risk of complications in stroke patients with swallowing disorders. This model promotes the recovery of swallowing function, reduces the degree of swallowing dysfunction, improves the ability to eat, and improves the nutritional status of stroke patients with dysphagia through closed-loop management, thereby reducing the risk of malnutrition and aspiration [12] . The findings suggest that implementing this HAPA-based multidisciplinary nutrition management system requires establishing specialized teams (nutritionists, rehabilitation physicians, nurses), standardized cross-departmental protocols, and regular staff training to ensure intervention fidelity.

In summary, for stroke patients with dysphagia, the use of the HAPA model-based multidisciplinary collaborative nutritional management system can improve swallowing function, self-efficacy, nutritional status, and the incidence of complications. However, this study has some limitations. First, the quasi-experimental design based on admission time may introduce selection bias. Second, potential confounding factors such as patients’ baseline nutritional status and severity of complications were not fully controlled. Future studies will address these limitations through improved study design.

This study was supported by the Scientific Research Fund Project of Yunnan Provincial Department of Education (Grant No.: 2025J16771); Yunnan Provincial Clinical Medical Center for Rehabilitation (Grant No.: ZX2019-04-02); Provincial Key Clinical Specialty Construction Project of Yunnan Province during the “14^th Five-Year Plan” Period [Document No.: Yun Wei Ban Yi Fa (2023) No. 10].

*Corresponding author.

^#These authors contributed equally to this study.