Patient perspectives on health‐related behavior change after transient ischemic attack or ischemic stroke

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Abstract

Objective

Unhealthy lifestyle is common among patients with ischemic stroke or TIA. Hence, health‐related behavior change may be an effective way to reduce stroke recurrence. However, this is often difficult to carry out successfully. We aimed to explore patients' perspectives on health‐related behavior change, support in this change, and sustain healthy behavior.

Methods

We conducted a descriptive qualitative study with in‐depth, semistructured interviews in eighteen patients with recent TIA or ischemic stroke. Interviews addressed barriers, facilitators, knowledge, and support of health‐related behavior change framed by the protection motivation theory. All interviews were transcribed and thematically analyzed.

Results

Patients seem unable to adequately appraise their own health‐related behavior. More than half of the patients were satisfied with their lifestyle and felt no urgency to change. Self‐efficacy as coping factor was the most important determinant (both barrier and facilitator). Fear as threat factor was named as facilitator for health‐related behavior change by half of the patients. Most of the patients did not need support or already received support in changing health behavior. Patients indicated knowledge, guidelines, and social support as most needed to support and preserve a healthy lifestyle.

Conclusion

This study suggests that patients with recent TIA or ischemic stroke often do not have a high intention to change health‐related behavior. The results fit well within the framework of the protection motivation theory. As many patients seem unable to adequately appraise their health behaviors, interventions should focus on increasing knowledge of healthy behavior and improving self‐efficacy and social support.

Abstract

TIA and stroke patients understand what constitutes a healthy lifestyle, but seem unable to adequately appraise their own health‐related behavior. More than half of the patients were satisfied with their lifestyle and felt no urgency to change. Self‐efficacy was the most important determinant for health‐related behavior change and mentioned both as barrier and as facilitator.

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Using the framework method for the analysis of qualitative data in multi-disciplinary health research

Nicola K Gale, Gemma Heath, Elaine Cameron … (2013)

Background The Framework Method is becoming an increasingly popular approach to the management and analysis of qualitative data in health research. However, there is confusion about its potential application and limitations. Discussion The article discusses when it is appropriate to adopt the Framework Method and explains the procedure for using it in multi-disciplinary health research teams, or those that involve clinicians, patients and lay people. The stages of the method are illustrated using examples from a published study. Summary Used effectively, with the leadership of an experienced qualitative researcher, the Framework Method is a systematic and flexible approach to analysing qualitative data and is appropriate for use in research teams even where not all members have previous experience of conducting qualitative research.

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Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.

Rafael Lozano, Mohsen Naghavi, Kyle Foreman … (2013)

Reliable and timely information on the leading causes of death in populations, and how these are changing, is a crucial input into health policy debates. In the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010), we aimed to estimate annual deaths for the world and 21 regions between 1980 and 2010 for 235 causes, with uncertainty intervals (UIs), separately by age and sex. We attempted to identify all available data on causes of death for 187 countries from 1980 to 2010 from vital registration, verbal autopsy, mortality surveillance, censuses, surveys, hospitals, police records, and mortuaries. We assessed data quality for completeness, diagnostic accuracy, missing data, stochastic variations, and probable causes of death. We applied six different modelling strategies to estimate cause-specific mortality trends depending on the strength of the data. For 133 causes and three special aggregates we used the Cause of Death Ensemble model (CODEm) approach, which uses four families of statistical models testing a large set of different models using different permutations of covariates. Model ensembles were developed from these component models. We assessed model performance with rigorous out-of-sample testing of prediction error and the validity of 95% UIs. For 13 causes with low observed numbers of deaths, we developed negative binomial models with plausible covariates. For 27 causes for which death is rare, we modelled the higher level cause in the cause hierarchy of the GBD 2010 and then allocated deaths across component causes proportionately, estimated from all available data in the database. For selected causes (African trypanosomiasis, congenital syphilis, whooping cough, measles, typhoid and parathyroid, leishmaniasis, acute hepatitis E, and HIV/AIDS), we used natural history models based on information on incidence, prevalence, and case-fatality. We separately estimated cause fractions by aetiology for diarrhoea, lower respiratory infections, and meningitis, as well as disaggregations by subcause for chronic kidney disease, maternal disorders, cirrhosis, and liver cancer. For deaths due to collective violence and natural disasters, we used mortality shock regressions. For every cause, we estimated 95% UIs that captured both parameter estimation uncertainty and uncertainty due to model specification where CODEm was used. We constrained cause-specific fractions within every age-sex group to sum to total mortality based on draws from the uncertainty distributions. In 2010, there were 52·8 million deaths globally. At the most aggregate level, communicable, maternal, neonatal, and nutritional causes were 24·9% of deaths worldwide in 2010, down from 15·9 million (34·1%) of 46·5 million in 1990. This decrease was largely due to decreases in mortality from diarrhoeal disease (from 2·5 to 1·4 million), lower respiratory infections (from 3·4 to 2·8 million), neonatal disorders (from 3·1 to 2·2 million), measles (from 0·63 to 0·13 million), and tetanus (from 0·27 to 0·06 million). Deaths from HIV/AIDS increased from 0·30 million in 1990 to 1·5 million in 2010, reaching a peak of 1·7 million in 2006. Malaria mortality also rose by an estimated 19·9% since 1990 to 1·17 million deaths in 2010. Tuberculosis killed 1·2 million people in 2010. Deaths from non-communicable diseases rose by just under 8 million between 1990 and 2010, accounting for two of every three deaths (34·5 million) worldwide by 2010. 8 million people died from cancer in 2010, 38% more than two decades ago; of these, 1·5 million (19%) were from trachea, bronchus, and lung cancer. Ischaemic heart disease and stroke collectively killed 12·9 million people in 2010, or one in four deaths worldwide, compared with one in five in 1990; 1·3 million deaths were due to diabetes, twice as many as in 1990. The fraction of global deaths due to injuries (5·1 million deaths) was marginally higher in 2010 (9·6%) compared with two decades earlier (8·8%). This was driven by a 46% rise in deaths worldwide due to road traffic accidents (1·3 million in 2010) and a rise in deaths from falls. Ischaemic heart disease, stroke, chronic obstructive pulmonary disease (COPD), lower respiratory infections, lung cancer, and HIV/AIDS were the leading causes of death in 2010. Ischaemic heart disease, lower respiratory infections, stroke, diarrhoeal disease, malaria, and HIV/AIDS were the leading causes of years of life lost due to premature mortality (YLLs) in 2010, similar to what was estimated for 1990, except for HIV/AIDS and preterm birth complications. YLLs from lower respiratory infections and diarrhoea decreased by 45-54% since 1990; ischaemic heart disease and stroke YLLs increased by 17-28%. Regional variations in leading causes of death were substantial. Communicable, maternal, neonatal, and nutritional causes still accounted for 76% of premature mortality in sub-Saharan Africa in 2010. Age standardised death rates from some key disorders rose (HIV/AIDS, Alzheimer's disease, diabetes mellitus, and chronic kidney disease in particular), but for most diseases, death rates fell in the past two decades; including major vascular diseases, COPD, most forms of cancer, liver cirrhosis, and maternal disorders. For other conditions, notably malaria, prostate cancer, and injuries, little change was noted. Population growth, increased average age of the world's population, and largely decreasing age-specific, sex-specific, and cause-specific death rates combine to drive a broad shift from communicable, maternal, neonatal, and nutritional causes towards non-communicable diseases. Nevertheless, communicable, maternal, neonatal, and nutritional causes remain the dominant causes of YLLs in sub-Saharan Africa. Overlaid on this general pattern of the epidemiological transition, marked regional variation exists in many causes, such as interpersonal violence, suicide, liver cancer, diabetes, cirrhosis, Chagas disease, African trypanosomiasis, melanoma, and others. Regional heterogeneity highlights the importance of sound epidemiological assessments of the causes of death on a regular basis. Bill & Melinda Gates Foundation. Copyright © 2012 Elsevier Ltd. All rights reserved.

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A Protection Motivation Theory of Fear Appeals and Attitude Change1

RONALD W. ROGERS (2010)

A protection motivation theory is proposed that postulates the three crucial components of a fear appeal to be (a) the magnitude of noxiousness of a depicted event; (b) the probability of that event's occurrence; and (c) the efficacy of a protective response. Each of these communication variables initiates corresponding cognitive appraisal processes that mediate attitude change. The proposed conceptualization is a special case of a more comprehensive theoretical schema: expectancy-value theories. Several suggestions are offered for reinterpreting existing data, designing new types of empirical research, and making future studies more comparable. Finally, the principal advantages of protection motivation theory over the rival formulations of Janis and Leventhal are discussed.

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Author and article information

Contributors

Dorien Brouwer‐Goossensen:

ORCID: https://orcid.org/0000-0003-4136-0419

d.goossensen@erasmusmc.nl

Journal

Journal ID (nlm-ta): Brain Behav

Journal ID (iso-abbrev): Brain Behav

Journal ID (doi): 10.1002/(ISSN)2157-9032

Journal ID (publisher-id): BRB3

Title: Brain and Behavior

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Electronic): 2162-3279

Publication date (Electronic): 04 March 2021

Publication date Collection: April 2021

Volume: 11

Issue: 4 ( doiID: 10.1002/brb3.v11.4 )

Electronic Location Identifier: e01993

Affiliations

[ ¹ ] Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands

[ ² ] Isala Hospital Zwolle The Netherlands

[ ³ ] University of Twente Twente The Netherlands

Author notes

[*] [* ] Correspondence

Dorien Brouwer‐Goossensen, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.

Email: d.goossensen@ 123456erasmusmc.nl

Author information

Dorien Brouwer‐Goossensen https://orcid.org/0000-0003-4136-0419

Article

Publisher ID: BRB31993

DOI: 10.1002/brb3.1993

PMC ID: 8035466

PubMed ID: 33662179

SO-VID: a0a60443-01f8-498a-8b67-0ca6beb7e73d

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

History

Date revision received : 18 November 2020

Date received : 24 June 2020

Date accepted : 20 November 2020

Page count

Figures: 2, Tables: 2, Pages: 10, Words: 7589

Custom metadata

source-schema-version-number 2.0

cover-date April 2021

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.1 mode:remove_FC converted:10.04.2021

ScienceOpen disciplines: Neurosciences

Keywords: health‐related behavior,patient perspectives,search terms: stroke,tia

Data availability:

ScienceOpen disciplines: Neurosciences

Keywords: health‐related behavior, patient perspectives, search terms: stroke, tia

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Patient perspectives on health‐related behavior change after transient ischemic attack or ischemic stroke

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Abstract

Objective

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Abstract

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The Dynamic Brain

Most cited references 52

Using the framework method for the analysis of qualitative data in multi-disciplinary health research

Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.

A Protection Motivation Theory of Fear Appeals and Attitude Change1

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Cited by 9

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