Fellow: Dr M Lawrence
After a stroke, there is a risk of having another stroke. The risk gets less over time. Doctors don't always prescribe tablets that might help prevent another stroke. Doctors and other health professionals do not always give stroke survivors and their families enough information. Stroke survivors and their families do not always know that unhealthy lifestyle habits like smoking, a poor diet, lack of exercise and too much alcohol put them at risk of having a stroke. We know that making positive changes to unhealthy lifestyle habits is hard. It can be even more difficult after a stroke, especially if the stroke survivor is tired or depressed, or cannot move around as well as they could before their stroke.
Stroke survivors and their families want more information about how to prevent another stroke from happening, and they want help to make positive changes to unhealthy lifestyle habits. Also, stroke survivors and their families need more information about their tablets, so that they understand why it is important to keep taking them, even when they do not have symptoms.
This research project will run for three years. We will work with stroke survivors and their families. In year one, we will design a healthy living programme for stroke survivors and their families. The programme will provide information, education and support. It will help people to learn how to manage their own lifestyle risk factors.
In year two, we will test the healthy living programme. We will ask health professionals if the programme was easy to deliver. We will ask stroke survivors and their families if the programme was right for them and if they thought it was useful.
Long-term, we aim to provide a programme that helps stroke survivors and their families to live healthier and happier lives, for longer.
Research evidence demonstrates that stroke survivors and families fear stroke recurrence and that they want to address lifestyle risk factors for stroke (tobacco use, unhealthy diet, physical inactivity, alcohol consumption) but lack information and support. Recurrence rates are high. Guidelines recommend initiation of multimodal secondary prevention interventions (ie prescription of medication and education regarding lifestyle risk factors and medication adherence, using behaviour change techniques) soon after stroke.
However, secondary prevention is suboptimal. High rates of pharmacotherapy non-treatment are compounded by poor medication adherence, and evidence regarding the effectiveness of multimodal interventions is limited. Much behavioural research lacks theoretical underpinning. None is overtly family-centred, although families exert powerful influence on lifestyle behaviours.This project aims to develop and test a theoretically-informed intervention, delivered by the multi-disciplinary team, designed to reduce risk of recurrent stroke. It will be family-centred and adopt a self-management approach.
In Stage one, the intervention will be developed. In Stage two, mixed methods will be used to test acceptability and feasibility of intervention training/delivery.Projected outcomes are a multimodal family-centred secondary prevention intervention and associated training package for health professionals, and a funding proposal for a full-scale feasibility study. These outcomes represent the preparative groundwork necessary for a subsequent definitive randomised controlled trial.
1 January 2012