<p>Post-stroke self-management presents a challenge due to the multifaceted care needs and complex disabling consequences, hindering survivor engagement. This study aims to investigate the effects of a Trans-theoretical model-based Empowerment education on self-management behaviors, self-efficacy, and activities of daily living in young and middle-aged stroke survivors. A single-blind randomized controlled trial was conducted, dividing participants into a control group receiving conventional health education and an intervention group receiving a Trans-theoretical model-based Empowerment education. Outcome data were collected at baseline, 1 month, 3 months, and 6 months. Repeated measures ANOVA was used to assess changes in self-management behaviors, self-efficacy, and activities of daily living. A total of 101 young and middle-aged stroke survivors participated in the study. No significant differences were found between the intervention methods of the two groups in improving self-management behaviors (<i>F</i> = 0.608, <i>P</i> = 0.438). However, significant differences were observed in self-management behavior scores at different intervention time points (<i>F</i> = 77.048, <i>P</i> &lt; 0.001), with an interaction effect between the intervention method and time factors (<i>F</i> = 19.714, <i>P</i> &lt; 0.001). Simple effects analysis indicated that the intervention group scored significantly better in self-management behaviors at all time points compared to baseline (<i>P</i> &lt; 0.05). Significant between-group differences in self-efficacy were observed between pre- and post-intervention periods (<i>F</i> = 3.993, <i>P</i> = 0.05). Additionally, within-group differences in self-efficacy scores across intervention time points demonstrated statistically significant variations (<i>F</i> = 5.900, <i>P</i> &lt; 0.001). Significant differences in Barthel Index scores were observed between pre- and post-intervention periods (<i>F</i> = 7.893, <i>P</i> &lt; 0.006). Additionally, The Barthel Index scores at different time points within the two groups showed statistically significant variations (<i>F</i> = 14.977, <i>P</i> &lt; 0.001). The Trans-theoretical model-based Empowerment education improved self-management behaviors, enhanced self-efficacy, and increased daily activity living in young and middle-aged stroke survivors. These findings provide valuable insights for developing personalized intervention strategies and improving stroke survivor care protocols.</p>