Exploring facilitators and barriers to long-term behavior change following health-wellness coaching for stroke prevention: A qualitative study conducted in Auckland, New Zealand

Integrating the Sufficiency Economy Royal Philosophy and Participatory Action Research Approach to Promote Self-Care for Stroke Prevention in Selected Communities of Southern Thailand

(1) Introduction: Effective control of stroke risk factors can reduce stroke incidence. Motivation for participatory action of community dwellers to practice self-care to modify stroke risk after providing them with knowledge of stroke risk factors is considered useful under a situation of limited healthcare resources. This study aimed to evaluate the outcomes of integrating the sufficiency economy philosophy (SEP), a royal economic philosophy in Thailand, and the participatory action research (PAR) approach on stroke risk factors control among selected communities. (2) Methods: Villagers who had medium to high stroke risk from two provinces with leading stroke incidences in southern Thailand were invited to participate in an eight-month SEP-PAR program conducted in 2019. Group meetings among the study participants, local healthcare providers, the researchers, and relevant stakeholders in the communities were held to co-design a health behaviors program targeting lower waist circumference (WC), body weight (BW), blood pressure (BP), fasting blood sugar, blood lipids, and smoking and alcohol consumption rates. Follow-up physical measurements and blood tests were compared with the baseline results for significant differences by descriptive statistics (p < 0.05) using the R program. (3) Results: Of 126 participants, 75.4% were female. Moderate and high stroke risk levels were found in 58.2% and 19.8%, respectively. Elevated baseline WC, BW, BP, and blood test results were found in 50-80% of the participants. The co-designed health behaviors in this study were dietary control, regular exercise, relieving psychological stress, and stopping smoking and alcohol consumption. Overall, the participants had significant adherence to the co-designed health behaviors. At the end of the program, the follow-up tests showed significant reductions in BW, BP, fasting blood sugar, and lipids, but not in WC. (4) Conclusions: A combined SEP and PAR approach was effective for stroke risk factors control among the community dwellers. Motivation for self-care is a significant strategic outcome expected of this approach. Longer follow-up studies in larger populations are needed.

Factors associated with health behaviours among stroke survivors: A mixed-methods study using COM-B model

AIMS

To identify factors associated with health behaviours among stroke survivors, through a multi-centre study.

DESIGN

A sequential mixed methods design.

METHODS

In the quantitative research phase, a total of 350 participants were recruited through multi-stage sampling from December 2022 to June 2023. General information questionnaires, The Stroke Prevention Knowledge Questionnaire (SPKQ), Short Form Health Belief Model Scale (SF-HBMS), Health Promoting Lifestyle Profile (HPLPII), and the WHOQOL-BREF (World Health Organization Quality of Life Questionnaire, Brief Version) were distributed across five tertiary hospitals in Henan province, China. For the qualitative research component, semi-structured interviews were conducted to explore the barriers and facilitators of health behaviour. This study adheres to the GRAMMS guidelines.

RESULTS

A total of 315 participants (90.0%) completed the survey. Identified barriers to health behaviour included residing in rural areas, higher scores on the Charlson Comorbidity Index (CCI) and mRS, as well as lower scores on SPKQ, SF-HBMS and WHOQOL-BREF. Twenty-four individuals participated in qualitative interviews. Twenty-eight themes were identified and categorised by frequency, covering areas such as knowledge, skills, intentions, social influences, social/professional role and identity, environmental context and resources, beliefs about capabilities, beliefs about consequences and behavioural regulation. Both quantitative and qualitative data suggested that health behaviour among stroke survivors is at a moderate level, and the identified barrier factors can be mapped into the COM-B model (Capability, Opportunity, Motivation and Behaviour).

CONCLUSION

The study indicates that key barriers to health behaviour among stroke survivors align with the COM-B model. These identified factors should be carefully considered in the planning of future systematic interventions aimed at improving health behaviours among stroke survivors.

PATIENT OR PUBLIC CONTRIBUTION

Patients were invited to completed questionnaires in the study and semi-structured interviews. The investigators provided explanation of this study' content, purpose and addressed issues during the data collection.

Mediation role of perceived social support between recurrence risk perception and health behaviour among patients with stroke in China: a cross-sectional study

OBJECTIVES

To examine whether patients who had a stroke with high recurrence risk perception would have healthier behaviour and to explore whether perceived social support would function as a mediator.

DESIGN

A cross-sectional study.

SETTING

The study was conducted in a public tertiary hospital in China.

PARTICIPANTS

A total of 254 patients with stroke were invited to participate, and 250 patients with stroke completed questionnaires validly.

PRIMARY AND SECONDARY OUTCOME MEASURES

Questionnaires were administered offline to collect data, consisting of four parts: general demographics and scales related to recurrence risk perception, perceived social support, and health behaviour. A path analysis and correlation analysis were used to analyse the data.

RESULTS

Out of 250 patients with stroke, 78.4% had moderately low health behaviour. The majority (70.8%) of these patients were elderly. High recurrence risk perception and high perceived social support were significantly associated with better health behaviour (all p<0.001). Perceived social support mediated the relationship between recurrence risk perception and health behaviour after controlling for age, gender, education and monthly income in the regression model (95% CI 0.263 to 0.460) and the effect value was 0.360. It was also confirmed that perceived social support had the highest mediation effect with a proportion of mediation up to 59.31%.

CONCLUSIONS

Recurrence risk perception and perceived social support were influential factors in promoting health behaviour. Moreover, the impact of recurrence risk perception on health behaviour was partially mediated by perceived social support. Therefore, to enhance the sustainability of health behaviour, it is crucial to inform patients with stroke about the risk of recurrence. Patients with more perception of recurrence risk can improve their recovery confidence and thus perceive more social support.