An exploration of lifestyle beliefs and lifestyle behaviour following stroke: findings from a focus group study of patients and family members

Abstract

BackgroundStroke is a major cause of disability and family disruption and carries a high risk of recurrence. Lifestyle factors that increase the risk of recurrence include smoking, unhealthy diet, excessive alcohol consumption and physical inactivity. Guidelines recommend that secondary prevention interventions, which include the active provision of lifestyle information, should be initiated in hospital, and continued by community-based healthcare professionals (HCPs) following discharge. However, stroke patients report receiving little/no lifestyle information.There is a limited evidence-base to guide the development and delivery of effective secondary prevention lifestyle interventions in the stroke field. This study, which was underpinned by the Theory of Planned Behaviour, sought to explore the beliefs and perceptions of patients and family members regarding the provision of lifestyle information following stroke. We also explored the influence of beliefs and attitudes on behaviour. We believe that an understanding of these issues is required to inform the content and delivery of effective secondary prevention lifestyle interventions.MethodsWe used purposive sampling to recruit participants through voluntary sector organizations (29 patients, including 7 with aphasia; 20 family members). Using focus group methods, data were collected in four regions of Scotland (8 group discussions) and were analysed thematically.ResultsAlthough many participants initially reported receiving no lifestyle information, further exploration revealed that most had received written information. However, it was often provided when people were not receptive, there was no verbal reinforcement, and family members were rarely involved, even when the patient had aphasia. Participants believed that information and advice regarding healthy lifestyle behaviour was often confusing and contradictory and that this influenced their behavioural intentions. Family members and peers exerted both positive and negative influences on behavioural patterns. The influence of HCPs was rarely mentioned. Participants' sense of control over lifestyle issues was influenced by the effects of stroke (e.g. depression, reduced mobility) and access to appropriate resources.ConclusionsFor secondary prevention interventions to be effective, HCPs must understand psychological processes and influences, and use appropriate behaviour change theories to inform their content and delivery. Primary care professionals have a key role to play in the delivery of lifestyle interventions.

Barriers to healthy-lifestyle participation in stroke

“…Timing of secondary prevention advice after stroke is important, with difficulties processing information in the acute phase (Allison et al, 2008;Lawrence et al, 2011;Sullivan and Katajamaki, 2009) and poor compliance identified (Skidmore et al, 2008). Participants in this study did not favour brochures/leaflets as an educational means.…”

“…Previous studies indicate that many stroke survivors and carers are ambivalent or dissatisfied with the information received (Wiles et al, 1998;Tooth and Hoffmann, 2004;Lawrence et al, 2011;Mckevitt et al, 2011). Timing of secondary prevention advice after stroke is important, with difficulties processing information in the acute phase (Allison et al, 2008;Lawrence et al, 2011;Sullivan and Katajamaki, 2009) and poor compliance identified (Skidmore et al, 2008).…”

Needs of Stroke Survivors as Perceived by Their Caregivers

“…Almost all studies reported the data collection process. Thirty studies provided the rationale for their research design, 9, 11, 23, 25–27, 29, 31–33, 35, 39, 41, 42, 44–50, 52–54, 58, 62, 65, 66, 70, 71 nine discussed the relationship between researcher and participants, 29, 42, 44, 46, 50, 54, 66, 70, 71 37 reported rigorous data analyses procedures, 4, 7, 9, 11, 24, 26–28, 30–37, 39, 41–46, 48–50, 52–54, 58, 60, 63, 65, 67–70 45 reported the ethical considerations, 4, 7, 9, 23–25, 27–29, 31, 32, 34, 36–50, 52–60, 62–66, 68–71 and 49 reported the recruitment strategy. 7, 9, 11, 23–25, 27–32, 34–63, 65–71 Of the 10 quantitative studies appraised using CEBMa, all clearly addressed the research question, methods, selection of participants, and had a sample representing the population.…”

Family Adaptation to Stroke: A Metasynthesis of Qualitative Research based on Double ABCX Model

“…Other parts of these resources included beliefs about stroke, healthy lifestyle, caregiver's own capacity and spirituality [12,37,41,45]. The internal resources of the family included the previous quality of the relationship between family caregiver and stroke survivor [48].…”