<p>An Evaluation of the Video Narrative Technique on the Self-Efficacy of Medication Understanding and Use Among Post-Stroke Patients: A Randomized-Controlled Trial</p>

Abstract

Introduction: Self-efficacy is positively associated with medication understanding and use selfefficacy (MUSE) among post-stroke patients. It is also closely related to knowledge, belief, and perception, which vary among people from different socioeconomic backgrounds and cultures. As interventions using video and peer stories have emerged to be successful on behavior modification, this study aimed to explore the effectiveness of video narratives incorporated with Health Belief constructs on MUSE and its associated factors among patients with stroke at a local setting. Methods: A randomized controlled trial (RCT) for 12 months was carried out on patients diagnosed with stroke at Hospital Kuala Lumpur, Malaysia. The RCT recruited up to 216 eligible patients who were requested to return for two more follow-ups within six months. Consented patients were randomized to either standard care or intervention with video narratives. The control of potential confounding factors was ensured, as well as unbiased treatment review with prescribed medications, only obtained onsite. Results and Discussion: A repeated measure of MUSE mean score differences at T0 (baseline), T2 (6th month) and T4 (12th month) for antithrombotic, antihypertensive, and all medication categories indicated significant within and between groups differences in the intervention group (p<0.05). Moreover, this impact was reflected upon continuous blood pressure (BP) monitoring compared to the control group (F (1214) =5.23, p=0.023, ƞ2=0.024). Though BP measure differences were non-significant between the groups (p=0.552), repeated measure analysis displayed significant mean differences between intervention and control group on BP control over time (F (1.344, 287.55) =8.54, P<0.001, ƞ2=0.038). Similarly, the intervention's positive impact was also present with similar trends for knowledge, illness perception, and the belief about medicine. Though significant differences (p<0.05) of all outcome measures gradually decreased between T2 and T4 in the intervention group; nevertheless, these positive findings confirmed that personalized video narratives were able to motivate and influence MUSE and its associated factors among post-stroke patients. The significant improvement in medication-taking self-efficacy and the sustenance of BP monitoring habits among patients in the intervention group strengthened our conceptual framework's practicality.

An Integrative Review Considering the Impact of Storytelling and Sharing Interventions in Stroke

“…Fourteen studies were included in the integrated synthesis. This included six qualitative studies [ 29 , 30 , 31 , 32 , 33 , 34 ], two RCTs [ 35 , 36 ] and six mixed-method studies [ 37 , 38 , 39 , 40 , 41 , 42 ]. Figure 1 gives a full breakdown of the process of searching and identifying studies.…”

“…A total of 727 participants (657 stroke survivors) participated in the studies. The smallest study had a sample size of nine [ 31 ] and the largest had 216 [ 36 ]. Subjects ranged in age from 20 to 95 years.…”

“…Subjects ranged in age from 20 to 95 years. More than half of the studies recruited both males and females [ 32 , 33 , 34 , 35 , 36 , 37 , 39 ]. Three of these [ 33 , 35 , 39 ] had significantly more males than females.…”

“…Time since stroke onset ranged from two weeks post stroke to 174 months post stroke. Participants in the studies with the largest populations [ 32 , 35 , 36 , 38 , 40 ] had ischemic stroke. The type of stroke in the remaining studies [ 29 , 30 , 31 , 33 , 34 , 37 , 39 ] was unknown.…”

“…Kessler et al [ 32 ] included stroke survivors who had moderate dependence when performing basic activities of daily living. Appalasamy et al [ 36 , 40 ] included participants with several stroke risk factors and most had primary hypertension. The remaining studies did not provide information regarding their participants’ health or characteristics [ 30 , 37 , 38 , 39 ].…”