Developing a stroke intervention program: what do people at risk of stroke want?

Patients' perception in reducing risk factors for stroke

Stroke is the second leading cause of death and the third leading cause of disability worldwide. The purpose of this study is to identify and explore patients' experiences in reducing risk factors for stroke. This qualitative research is carried out by using phenomenology method. Seven participants were selected by purposive sampling at a health center (puskesmas) in Depok. The result of this study identifies three themes that describe the experiences of patients at high risk for stroke in seeking ways to reduce the risk factors. They are various perceptions of patients at risk for stroke toward the risk, behavior that trigger stroke, and information about reducing the risk factors. This study shows that health education program that could increase the knowledge, awareness, motivation, and ability to take care of patients at high risk for stroke is indispensable.

Opportunities and challenges in secondary stroke prevention: a mixed methods study

Purpose: To describe control of risk factors after stroke from the perspectives of the stroke survivor, the family, and healthcare professionals.Materials and methods: A mixed methods design was used, undertaken in two phases: i) qualitative study using focus group methodology to explore secondary stroke prevention and ii) survey of stroke survivors about use of technology and self-management of blood pressure (BP).Results: From the eight focus groups (n = 33), three themes were identified: i) stroke is a wake-up call to do the right things; ii) challenges to doing the right things; and iii) role of technology in helping you to do the right things. Among survey respondents (n = 82), most participants reported mobile phone ownership (93%), mostly smartphones (66%), and >80% identified a greater role for technology in supporting management of risk factors. Participants who reported monitoring BP at home were significantly more likely to know their target BP than those not monitoring at home (83 vs. 42%; p < 0.001) and more adherent with medications (78 vs. 52%; p = 0.016).Conclusions: These findings highlight the ongoing challenges with achieving risk factor control after stroke and the potential to utilise health information technology to engage stroke survivors in self-management of their risk factors.Implications for rehabilitationClinicians should be knowledgeable of the challenges that stroke survivors face in managing their risk factors after stroke and the role that they can play in providing tailored education.BP continues to be poorly controlled after stroke and there is opportunity for improvement.Stroke survivors and their families are receptive to using health information technology to support their risk factor control.Rehabilitation clinicians have an opportunity to incorporate different aspects of health information technology into their practice to support self-management of risk factors.

"A Lot of Things Passed Me by": Rural Stroke Survivors' and Caregivers' Experience of Receiving Education From Health Care Providers

PURPOSE

The purpose of this study is to examine rural Appalachian Kentucky stroke survivors' and caregivers' experiences of receiving education from health care providers with the long-term goal of optimizing educational interactions and interventions for an underserved population.

METHODS

An interprofessional research team, representing nursing, occupational therapy, physical therapy, and speech language pathology, conducted a qualitative descriptive study involving semistructured interviews with 13 stroke survivors and 12 caregivers. Qualitative content analysis included predetermined and emerging coding. This article presents an in-depth analysis of a subset of data from the coding scheme of a larger study that examined the overall experience of stroke for participants.

FINDINGS

Findings are presented within a developing model of patient and caregiver education constructs including providers and receivers of education and the content, timing, and delivery of information.

CONCLUSIONS

Understanding the experience of receiving education for survivors and caregivers will help practitioners provide the right education, to the right people, at the right time, and in the right way to better support underserved groups. Improving patient and caregiver education is paramount to supporting health behavior change to optimize life poststroke and prevent future strokes. Our results suggest the need for improved access to educational providers, proactive identification of informational needs by providers, greater inclusion of caregivers in education, enhanced communication with information provision, and education from multiple providers using multiple delivery methods at multiple time points.

Stroke education needs of African American women

OBJECTIVES

The purpose of this study was to explore the perceptions of African American women about stroke and examine their health information seeking practices outside of medical encounters.

DESIGN AND SAMPLE

An exploratory-descriptive qualitative study was conducted with 48 women of age 35 years and older recruited from four Black churches.

MEASURES

Data were collected during focus groups and analyzed with qualitative content analysis.

RESULTS

Most of what participants knew about stroke came from interaction with family members or acquaintances that had strokes rather than stroke campaigns or health providers. There was confusion about the multiple symptoms of stroke, and information about stroke symptoms may not provide meaningful symptom representations. Information about breast cancer was more readily available than information about stroke. The internet, other women, and television programs were main source of health information outside of medical encounters. There was uncertainty how to assess the trustworthiness of internet health sites.

CONCLUSIONS

The results suggest that culturally sensitive stroke education for African American women should include stories of women with stroke and provide experiential and visual depictions of stroke warning signs. Group forums, television, and web-based education may be acceptable ways to communicate stroke information to African American women.

Language, literacy, and characterization of stroke among patients taking warfarin for stroke prevention: Implications for health communication

OBJECTIVE

Warfarin is a medication commonly prescribed to prevent strokes associated with certain medical conditions such as atrial fibrillation; however, little is known about how people taking warfarin perceive the goal of therapy and how they describe strokes. We assessed the stroke-related health literacy of anticoagulated patients to inform ways in which to improve health communication among people taking warfarin.

METHODS

We conducted a mixed-methods study of an ethnically and linguistically diverse sample of people taking warfarin to prevent stroke (N=183) and measured literacy using the short-form Test of Functional Health Literacy in Adults. We asked participants to (1) describe their indication for warfarin, and (2) describe a stroke. Transcribed answers were coded as concordant or discordant with established indications for warfarin and definitions of stroke.

RESULTS

Forty-three percent of participants provided a discordant response when describing their indication for warfarin. Only 9.3% reported that the purpose of taking warfarin was to prevent stroke. Not speaking English [OR=2.4 (1.1-5.6)] and less than a college education [OR=3.3 (1.4-7.3)] were independently associated with discordant answers about warfarin. Nearly 40% of subjects had inaccurate perceptions of stroke, and only one-third of subjects described a symptom or sign of stroke. Among English and Spanish-speaking participants, inadequate literacy was strongly associated with discordant responses about stroke [OR=5.8 (2.1-15.6)].

CONCLUSION

Among high-risk people taking warfarin to prevent stroke, significant gaps in stroke-related health literacy exist. These gaps likely represent mismatches in the ways clinicians teach and patients learn.

PRACTICE IMPLICATIONS

Since stroke risk awareness and early recognition of the signs and symptoms of stroke are critical aspects of stroke prevention and treatment, clinicians should more strongly link warfarin therapy to stroke prevention and ensure that patients know the presenting symptoms and signs of stroke. Public health communication strategies regarding stroke prevention need to target individuals with limited literacy and limited English proficiency.

Stroke education: retention effects in those at low- and high-risk of stroke

OBJECTIVE

Relatively few studies have tracked retention effects of stroke education in low- and high-risk groups. Such information is important to improve the design of stroke prevention programs.

METHODS

The frequency of risk factors within the sample was defined as "high" if 30% or more of participants in that group had that risk. Only one stroke risk factor was present at this level in the low-risk group (n=29; all less than 50 years old). The high-risk group was 44 individuals aged 50 years or over, with four stroke risk factors present at this level. Stroke knowledge was tested on three occasions: baseline, post-education, and retention. Education consisted of reading a published stroke brochure.

RESULTS

Stroke knowledge improved over time, from baseline to post-education, but not from post-education to retention. The performance of both groups increased, but there was a differential learning effect: low-risk participants learned more than high-risk participants. Important information was learned and included details such when TIA symptoms dissipate. This particular issue was one about which both groups knew little at baseline (less than 15% of combined sample answered this item correctly), but post-education at least 75% of participants got this question correct.

CONCLUSION

Both low- and high-risk individuals can learn information about stroke and retain it over the short term. The "durable" effects in learning observed in this study are important because the benefit of brochure-only approaches to education have not yet been convincingly demonstrated.

PRACTICE IMPLICATIONS

Information about stroke from education brochures is retained by at-risk populations for at least 1 week.