Influences on health-related behaviours following first-ever stroke
Stroke is a health problem that causes high levels of mortality and morbidity. Healthy lifestyle choices to reduce stroke risk factors are an important component of reducing risk of secondary stroke, and include adherence to prescribed medications, smoking cessation, cessation of alcohol consumption, dietary control, and increased physical activity. Yet, uptake of health behaviours following stroke is low. Theories of health behaviour suggest various factors can influence health-related behaviours. While research has focused on different clinical populations, little is known about factors that might influence health-related behaviours in stroke populations.
A literature review explored the factors that might influence health-related behaviour following a stroke. Qualitative and quantitative studies suggested that health-related behaviour following a stroke is a complex process. Health-related behaviours have been found to be influenced by a variety of factors, including physical factors, behavioural factors, and psychosocial factors. Two psychological factors identified in the literature as potentially influencing health behaviours, but where little definitive evidence was identified, were illness perceptions and satisfaction with stroke care.
A mixed methods approach explored the factors that influence health-related behaviour following first-ever stroke in New Zealand. A quantitative study investigated whether an individual’s illness perceptions, or satisfaction with their stroke care, influenced their health-related behaviours following first-ever stroke. 386 participants completed questionnaire assessments at 28-days, six-months, and twelve-months post-stroke. In this group of participants, illness perceptions (measured using the Brief Illness Perception Questionnaire) were found to have two dimensions (emotional and practical). Emotional and practical illness perceptions were found to be independent predictors of health behaviours; however, the links were not consistent over time or across health behaviours. Age was the only sociodemographic factor that was significantly related to health behaviour. Satisfaction with stroke care was not significantly related to health behaviour at any time-point.
The qualitative study used an interpretive descriptive approach to explore what influenced stroke survivor health-related behaviours following first-ever stroke. Nine stroke survivors, six significant others, and six motivational interviewers participated in this study. Stroke survivors and significant others struggled to describe how and why health behaviour change was relevant to them but acknowledged the importance of the broader concept of recovery post-stroke. Four inter-related sub-themes were identified in the data including Past and present experiences; Individuality, beliefs and choice; What the stroke means for me; and Access, knowledge, and availability of resources.
The key combined findings from this research were that the emotional aspects of illness are challenging and have a greater influence on health-related behaviour than is currently recognised. Second, health-related behaviour may not be a priority for people following stroke and the practicalities of implementing change into everyday life are challenging. Third, health behaviour advice (from health professionals) may have more relevance for stroke survivors within the community rather than hospital setting. Finally, the results highlighted that individual needs should be addressed by health professionals rather than an ‘one-size fits all’ approach.