Stroke is a global issue and has been identified as a major cause of permanent disability. The progress of stroke awareness and numerous stroke prevention measures have not reduced the incidence of stroke.
A major concern after stroke is the risk of having a second one. If a stroke victim does not adapt well to his initial stroke, the risk of a secondary or recurrent stroke is very high. It is estimated that the risk of having a second stroke or any other vascular problem within five years of the initial brain attack is approximately 25%.
The outcome of the second stroke is no laughing matter. It may result in death if it occurs within 28 days of the first stroke. It may also lead to a higher risk of permanent disability and further dependence on other people.
Providing lifestyle information helps prevent stroke
Risk factors for a recurrent stroke are smoking, an unhealthy diet, too much alcohol intake and lack of exercise. We now understand that programs to prevent a recurrent stroke should not only focus on prescribing secondary prevention medication such as antihypertensives and statins (medicines which improve cholesterol levels by reducing LDL cholesterol levels) but should also include provision of lifestyle information and teachings on behavior modification.
Dispensing lifestyle information should be started as soon as a stroke victim is admitted to a hospital and should not be stopped even if the stroke survivor is ready for discharge. It should be reaffirmed by community-based health care professionals once the stroke victim is at home. It is crucial to bring a change in lifestyle from the stroke victim and family.
Lifestyle information as a part of secondary prevention also helps patients maintain a healthy lifestyle. Changes made by the stroke survivors and their immediate family members can save lives and reduce the outcome of permanent disability. Such changes also have an impact on family and can reduce disruption of familial relationships.
There is a need for more post-stroke education
Despite recent efforts, stroke victims state that they receive little or no lifestyle information. And there is only a fraction of available literature which provides effective secondary prevention lifestyle information.
Even if provision of lifestyle information is very important in stroke cases, a novel study showed that it is not done diligently. In the study, about 50% of stroke patients indicated that they were not given any dietary advice. About a third of stroke victims declared that they had not received any information about physical activity. Sadly, about 54% of stroke victims also stated that they did not receive any lifestyle information at all.
To address this need, a novel study was undertaken in Scotland to explore the beliefs and perceptions of stroke survivors and their family members about the teaching of lifestyle information after a stroke.
Patient experience of lifestyle information
The study team enlisted 49 volunteers. These volunteers included 29 stroke survivors and 20 family members. Of these stroke victims, 7 were identified to have aphasia. According to the US National Institutes of Health, “Aphasia is a disorder caused by damage to the parts of the brain that control language. It can make it hard for you to read, write and say what you mean to say”.
The study team performed focus group discussions with stroke victims (aged 18 years old and above) who were living at home with their family as well as family members who were living with an adult stroke survivor. Focus group discussions were carried out by the research team to promote interaction among the volunteers of the study. The idea was to emphasize agreements and disagreements among the volunteers. It also helped the study team observe and note non-verbal communication within members of the study group. The researchers elected to perform focus group discussions because this approach has been used successfully with stroke victims who have problems with communication.
Giving the right information, at the right time, the right way
Initially, almost all of the stroke volunteers including their family members said that they had received no health teachings about lifestyle associated with stroke. But when pressed further, the participants replied that they were given written lifestyle information.
1. The researchers found out that the information on lifestyle was given at the wrong time. This was during a time when the stroke victim was not receptive to the health education.
2. The study team also discovered that the health teachings were not verbally reinforced and that family members were rarely involved even when the stroke victim has aphasia.
Educating stroke victims and their families should start on the first day of admission in a medical center and should be reinforced by the healthcare team daily. Daily reinforcement ensures that lifestyle information given is absorbed by the recipient and it also gives time for stroke victims and their families to clarify any point.
3. The volunteers of the study also stated that the information provided by the healthcare team about healthy lifestyle behavior was often very confusing, sometimes even contradictory. In the end, they didn’t know who to listen to and admitted that family and peers both influenced their behavioral patterns after the stroke. On the contrary, the volunteers rarely discussed the influence made by the healthcare professionals – the very same people who should have made an impact on lifestyle information.
Changing post-stroke education
The study showed that dispensing lifestyle and health information are not sufficient in stimulating and enabling a change in behavior, even after a major life-threatening event. The provision of lifestyle information needs a correct timing and should be done when the stroke victims and their families are most receptive. It is also important to provide patients with appropriate resources, instead of standard information.
The research team also pointed out the influence of family members on patterns of lifestyle behavior. A stroke victim cannot succeed in maintaining a healthy lifestyle without the support of his family. The researchers concluded that healthcare professionals should take this into account, as relatives can help them change the way they perform their health education. This in turn will benefit stroke victims and their families, who will absorb lifestyle information better.
The study team also acknowledged that post-stroke depression and reduced mobility may affect stroke victims control over their lifestyle.