Objective To explore activation among patients with first stroke and its influencing factors, and to provide reference for developing targeted intervention. Methods A total of 228 first stroke patients were investigated using the general information questionnaire, Patient Activation Measure, Stroke Knowledge Questionnaire and Stroke Self-efficacy Questionnaire. Results The activation score of the first stroke patients was (49.44±12.75).Multiple linear regression analysis showed that, self-efficacy, educational background, self-care level, monthly family personal income and health knowledge were the main influencing factors of patient activation, which explained 40.4% of the total variance. Conclusion The activation among first stroke patients is at a low level, especially those patients with a low educational background and monthly family personal income, poor self-care ability and health knowledge, and low self-efficacy, so targeted intervention should be provided to improve their activation.