Objective To systematically evaluate factors influencing health behaviors in stroke patients using the Active Health framework and the Capability Opportunity Motivation-Behavior (COM-B) model. Methods A mixed-methods systematic review was conducted. Databases including PubMed, Web of Science, Cochrane Library, SinoMed, China National Knowledge Infrastructure (CNKI), WanFang Data, and VIP, were systematically searched for studies on health behaviors in stroke patients published until February 2025. A convergent integrated approach was utilized to synthesize quantitative and qualitative data. Results A total of 18 studies were included. The integrated results identified influencing factors across COM-B dimensions:capability (stroke-related knowledge and skills, cognitive function, physical functioning, and self-management ability), opportunity (social support and resources, environmental and cultural contexts, healthcare infrastructure and economic resources, work and occupation), and motivation (self-efficacy, health beliefs and attitudes, risk awareness and action planning, mental state). Conclusion Active health behaviors in stroke patients emerge from complex interactions between self-management capacity and external support systems, and are affected by multifaced factors.Healthcare providers should enhance patients′ capacity through disease-specific education and functional rehabilitation training, optimize opportunity by cultivating supportive environments, and strengthen motivation by adjusting mental state and enhancing health beliefs, thus to promote their active health behaviors.