Hall Patricia, da Cruz Peniche Paula, Hickey Julianne, Lennon Olive
School of Public Health, Physiotherapy and Sports Science, Health Science Centre, University College Dublin, Dublin, Ireland.
iPASTAR (Improving Pathways for Acute Stroke and Rehabilitation) Collaborative Doctoral Award, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
BMC Neurol. 2025 Apr 2;25(1):135. doi: 10.1186/s12883-025-04144-1.
Lifestyle measures in addition to pharmacotherapy are recommended to optimise stroke secondary prevention. Adopting and sustaining good health behaviours after stroke necessitates ongoing motivation, influenced by complex social and cultural factors. This study analysed stroke survivors' experiences of addressing their lifestyle-related risks through a comprehensive theoretical lens addressing cognitive, affective, social, and environmental influences. Patient and public involvement (PPI) enhanced the research quality and transparency.
Eight focus group discussions (N = 35 stroke participants; N = 3 family members/informal carers) were facilitated using semi-structured questions co-developed with a PPI panel. Purposive sampling ensured adequate representation (e.g. urban/rural location and stroke-related disabilities). Data were first coded and categorised inductively and mapped to the Theoretical Domains Framework (TDF) deductively to identify relevant constructs and theories of behaviour-change.
Participants reported risk reducing lifestyle changes as largely self-directed activities they figured out themselves. Their experiences mapped to 10 of the 14 theoretical domains of the TDF. The most reported behaviour-change mediators discussed were in the domains of Knowledge and Social Influences, seen as encouraging change and supporting emotional reactions. Goals were discussed in a limited way indicating underutilisation. Reminders, reinforcements, and rules to observe for maintaining healthy behaviours, mapping to the Reinforcement and Behavioural Regulation domains, were valued constructs. Psychosocial challenges, emotional responses and cognitive difficulties (Memory, Attention & Decision Processes and Emotions domains) were strongly evident, resonating with the experiences of our PPI contributor and interfacing with behaviour change processes and knowledge uptake. Health-beliefs, self-identity and perceived ability to change behaviour were considered to assert both positive and negative influences on behaviours, mapping to Social/Professional Role & Identity, Beliefs about Consequences and Beliefs about Capabilities domains. 'Know how' was highlighted as largely lacking for behaviour change, with the associated theoretical domains Intentions, Skills, Environmental context & resources to encourage skills development and Optimism about change notably absent from discussions.
The TDF proved a valuable tool to link stroke survivors' secondary prevention experiences and unmet needs with recognised constructs for behaviour-change. Results have important theory-driven implications to guide future interventions designed to support individuals in risk reducing behaviours following stroke.
除药物治疗外，还建议采取生活方式干预措施以优化卒中二级预防。卒中后采用并维持良好的健康行为需要持续的动力，这受到复杂的社会和文化因素影响。本研究通过一个综合的理论视角，分析了卒中幸存者应对与生活方式相关风险的经历，该视角涵盖认知、情感、社会和环境影响。患者及公众参与（PPI）提高了研究质量和透明度。
使用与PPI小组共同制定的半结构化问题，组织了八次焦点小组讨论（35名卒中参与者；3名家庭成员/非正式照料者）。目的抽样确保了充分的代表性（如城乡地点和卒中相关残疾情况）。数据首先进行归纳编码和分类，然后演绎映射到理论领域框架（TDF），以识别行为改变的相关结构和理论。
参与者报告称，降低风险的生活方式改变主要是他们自己想出的自我导向活动。他们的经历映射到TDF的14个理论领域中的10个。讨论最多的行为改变中介因素出现在知识和社会影响领域，被视为鼓励改变和支持情感反应。对目标的讨论有限，表明其未得到充分利用。与强化和行为调节领域相关的提醒、强化措施以及维持健康行为的观察规则是有价值的结构。心理社会挑战、情感反应和认知困难（记忆、注意力与决策过程以及情感领域）非常明显，与我们的PPI参与者的经历相呼应，并与行为改变过程和知识获取相关。健康信念、自我认同和感知到的行为改变能力被认为对行为有积极和消极影响，映射到社会/职业角色与认同、对后果的信念以及对能力的信念领域。讨论中明显缺乏行为改变所需的“操作方法”，相关的理论领域意图、技能、鼓励技能发展的环境背景与资源以及对改变的乐观态度在讨论中明显缺失。
TDF被证明是一个有价值的工具，可将卒中幸存者的二级预防经历和未满足的需求与公认的行为改变结构联系起来。研究结果具有重要的理论驱动意义，可为未来旨在支持个体在卒中后采取降低风险行为的干预措施提供指导。
