Stroke is the second leading cause of death and disability in the world, and one of the most devastating chronic diseases. It is rapidly increasing on a global scale, particularly in the countries that have low-income levels although incidence rates have declined in high-income countries. The incidence of stroke is higher in men compared with women and impacts the individuals’ life, families, society and employment and education opportunities. The physical, psychological and social consequences of stroke are very high in New Zealand especially among Māori and Pacific Islanders compared with European New Zealanders. Stroke has modifiable risk factors including hypertension, diabetes, alcohol, smoking, and obesity which are preventable. There are also non-modifiable risk factors such as age, sex, and race. Stroke prevention can be achievable when individuals make positive changes in their health behaviours through the help of intervention health programmes or independently by adapting to a new lifestyle including healthy diet and being physically active. People who participate in a health behaviour change intervention such as Health and Wellness Coaching (HWC) gain many benefits from positive coaching, through direct motivation and other elements that lead to health improvement. But this study aimed to explore the factors that may influence behaviour in the Control Group of a trial to prevent stroke This was conducted using thematic analysis of qualitative interviews of Control Group participants in the Health and Wellness Coaching study. The current study recruited participants (n=12) from the Control Group of participants in an existing randomised controlled trial (RCT) to test the effectiveness of HWC for prevention of stroke. A qualitative descriptive analysis approach was utilized. Thematic analysis was used to analyse the data and generate seven overarching themes arising from the study: 1) Internal positive factors impacting health behaviour; 2) External positive factors impacting health behaviour; 3) The direct impact of being in the study/study elements impacting health behaviour; 4) The impact of learning, knowledge and health information in changing health behaviour; 5) Making practical changes in lifestyle; 6) Personality readiness; and 7) Negative factors impacting health behaviour. The findings suggest that there are some important factors that have direct and indirect impact on health and wellness behaviour in the Control group of a trial to prevent stroke. Most of the ii

factors were found to demonstrate positive impact in the health and wellness behaviour. Selfawareness and awareness of health were the empowering factors that influenced health behaviour changes that participants’ experienced. Both internal (personal) factors and external factors had a strong role in impacting health behaviour. The findings suggest that most of the participants used similar strategies to prevent stroke such as changing diet and increasing physical activities. The findings acknowledge some barriers that affect health behaviour negatively but the study found that those barriers could be preventable, to some degree, so as not to become a threat to health in general and for stroke specifically.
The current study is unique in highlighting the factors in a control group in relation to health behaviour change that leads to stroke prevention. It also illustrates the importance of selfawareness, the awareness of health risks and consequences, being positive toward health and life in general including family and the importance of having a good quality of life.