Evaluating Stroke Patients’ Awareness of Risk Factors and Readiness to Change Stroke Risk-Related Behaviors in a Randomized Controlled Trial

Abstract

Purpose:To identify the effects of a brief educational intervention on stroke patients' recall and recognition of risk factors and performance of and stage of change for stroke risk-related behaviors. Methods: Sixty-six patients with stroke participated in a multisite randomized controlled trial. The intervention group (n = 35) received a brief education intervention (tailored written stroke information, verbal reinforcement of information for 3 months after discharge, and provision of a telephone number). The control group (n = 31) received usual care. Unprompted recall (personal and general), prompted recognition of risk factors (0-13), and performance of (0-10) and stage of change for up to 7 stroke risk-related behaviors were assessed before and 3 months after discharge. Results: No signifi cant between-group differences were found. For all participants over time, there were signifi cant improvements for personal (mean difference [MD], 0.3; 95% CI, 0.004-0.69; P = .05) and general (MD, 0.6; 95% CI, 0.09-1.16; P = .02) risk factor recall; performance of stroke risk-related behaviors (MD, 0.8; 95% CI, 0.28-1.26; P < .01); and progression from a nonaction to an action stage of change for 4 of 7 behaviors over time. There was a signifi cant decline in total risk factor recognition scores (MD, -0.8; 95% CI, 0.39-1.13; P < .01). Conclusion: Stroke patients' unprompted recall of risk factors and performance of risk-related behaviors improved over time; readiness to change risk-related behaviors progressed for some behaviors. A brief educational intervention did not improve risk factor awareness or behavior change more than usual care. Key words: behavior, patient, randomized controlled trial, readiness to change, risk factor, stroke W ithin 5 years of their fi rst stroke, individuals are at high risk of stroke recurrence and death, with cumulative total risk estimates between 17% and 28% for stroke recurrence and between 32% and 65% for death. [1][2][3] Individuals can reduce their risk of secondary stroke by addressing the modifi able stroke risk factors through altering their lifestyle behaviors. 4,5 However, poststroke management of risk factors is typically suboptimal. [6][7][8][9] Information about secondary stroke prevention information is an important, but frequently neglected, part of the stroke information that should be routinely provided to patients and carers after stroke. [10][11][12] If patients are to undertake actions to modify their risk factors, they need to have an awareness of them. However, many individuals who have had a stroke have poor awareness of their risk factors. 13,14 For example, in one study, 52% of patients with stroke undergoing rehabilitation were unable to name any stroke risk factors.15 Even many individuals with adequate risk factor knowledge have diffi culty engaging in healthy behaviors to address stroke risk. [16][17][18][19][20] Exploration of associations between stroke knowledge and beliefs and subsequent riskrelated behavior change is in its early stages. Sullivan and Wa...

A Systematic Review of Tests Assessing Stroke Knowledge

“…34 Therefore, comprehensive SK concepts may need to include issues over one's entire life course 35 and encompass the epidemiology, risk factors, warning signs, emergency response, symptoms, and treatment/ rehabilitation of stroke, as well as concepts relevant to the long-term care, disability prevention, and health promotion. 36 Because SK covers multidimensional concepts across the continuum of stroke management, the framework proposed by the European Commission has the potential to be the basis for validating current SK tests and developing or refining additional tests. In addition, developing SK tests that appropriately consider different clinical situations relevant to different target populations is essential.…”

Reducing the psychosocial impact of aphasia on mood and quality of life in people with aphasia and the impact of caregiving in family members through the Aphasia Action Success Knowledge (Aphasia ASK) program: study protocol for a randomized controlled trial

“…The secondary outcome for people with aphasia will include a 10-item measure of self-reported stroke risk-related behaviors [ 19 ]. Both ideal (for example, taking medication as prescribed) and nonideal behaviors (for example, smoking cigarettes) will be measured with higher scores out of 10 indicating performance of more ideal behaviors.…”

“…In addition, people with aphasia who have completed the attention control intervention (SSPIP) are hypothesized to have a significantly better score on a stroke risk-related behavior measure [ 19 ] compared to those who receive the Aphasia ASK intervention.…”

Clinical Effect Size of an Educational Intervention in the Home and Compliance With Mobile Phone-Based Reminders for People Who Suffer From Stroke: Protocol

“…Some studies have shown the application of this type of intervention in people who have suffered a stroke as a means to reduce the risk of secondary stroke [ 26 ]. Educational intervention in this population remains unusual, however, despite being in great demand, due to the lack of information individuals often encounter in their rehabilitation process [ 26 , 27 ].…”

“…Some studies have shown the application of this type of intervention in people who have suffered a stroke as a means to reduce the risk of secondary stroke [ 26 ]. Educational intervention in this population remains unusual, however, despite being in great demand, due to the lack of information individuals often encounter in their rehabilitation process [ 26 , 27 ]. Therefore, in order to allow for continuity and applicability to the previous rehabilitation treatment received in the hospital, we propose an educational intervention at home for people who have suffered a stroke and who have been discharged to their homes in the 3 months prior to recruitment to the study.…”