Perceptions of recurrence risk and behavioural changes among first-ever and recurrent stroke survivors: A qualitative analysis

Global Burden and Risk Factors of Stroke in Young Adults, 1990 to 2021: A Systematic Analysis of the Global Burden of Disease Study 2021

BACKGROUND

This study aimed to estimate the disease burden of ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and overall stroke among young adults (aged 15-49 years) in 204 countries and territories from 1990 to 2021, along with the associated risk factors.

METHODS

GBD (Global Burden of Disease Study) 2021 data were used to assess the burden and trends via age-standardized rates and their estimated annual percentage changes.

RESULTS

Although age-standardized rates generally declined from 1990 to 2021, the number of incident and prevalent stroke cases among young adults increased by 36% (95% uncertainty interval, 31%-41%) and 41% (95% uncertainty interval, 38%-43%), respectively. Notably, from 2015 to 2021, the age-standardized incidence of ischemic stroke and subarachnoid hemorrhage among young adults increased, with estimated annual percentage changes of 0.65 (95% CI, 0.39-0.92) and 0.58 (95% CI, 0.47-0.69), respectively. High systolic blood pressure was the primary risk factor for stroke-related disability-adjusted life-years among young adults. However, other risk factors varied by region, with higher proportions of smoking, high low-density lipoprotein cholesterol, and high body mass index in high sociodemographic index regions, and higher proportions of household air pollution from solid fuels and diet low in vegetable in low sociodemographic index regions. From 1990 to 2021, the total number of stroke-related disability-adjusted life-years among young adults due to risk factors increased by 12% (95% uncertainty interval, 2%-22%), driven principally by high systolic blood pressure, ambient particulate matter pollution, high body mass index, high low-density lipoprotein cholesterol, and high fasting blood glucose.

CONCLUSIONS

Since 2015, there has been a concerning rebound in the age-standardized incidence rates of ischemic stroke and subarachnoid hemorrhage among young adults globally. Given regional and sociodemographic index variations in risk factors, targeted and cost-effective policies and interventions are urgently needed to reduce stroke burden in this demographic.

Current Status of Information and Communication Technologies Utilization, Education Needs, Mobile Health Literacy, and Self-Care Education Needs of a Population of Stroke Patients

BACKGROUND/OBJECTIVES

With the rising prevalence of chronic diseases and an aging population, the incidence of stroke is continuously increasing, which leads to higher medical costs. Stroke carries a high risk of recurrence, necessitating ongoing self-care and lifestyle changes, for which education is crucial. The aim of this study is to identify the ICT utilization education needs, mobile health literacy, and self-care education needs of stroke patients and confirm the differences in mobile health literacy and self-care education needs according to ICT utilization to establish a basis for self-care intervention.

METHODS

The study included 100 stroke patients diagnosed at three general hospitals or higher in City C, hospitalized or visiting neurology and neurosurgery outpatient clinics. A survey was conducted from 7 July 2023 to 30 May 2024. The survey cites computers, the Internet, live broadcasting technology, recorded broadcasting technology, and telephony as examples of ICTs. The gathered data were analyzed using descriptive statistics, independent t-tests, one-way ANOVA, and the Pearson correlation coefficient.

RESULTS

The final analysis included 100 people, with 64 participants being men and an average age of 57.75 ± 12.30 years. Self-care education needs showed no significant differences based on general or disease-related characteristics. Many patients could use smart devices but experienced difficulties in searching for information. The main reasons for using smart devices included acquiring disease-related information and accessing resources without time limitations. The use of ICT services that provide disease-related information was low, 70% of participants were willing to use them in the future. Additionally, they preferred doctor-led education sessions once a month, lasting no longer than 30 min each. Mobile health literacy was significantly higher among those willing to use ICT services.

CONCLUSIONS

Mobile health literacy was significantly higher in the group willing to use ICT services than in the group unwilling. Self-care education needs were both highly important and necessary in the group willing to utilize ICT, but no statistically significant difference was found.

Two-stage DRG grouping of cerebral infarction based on comorbidity and complications classification

Background

Since 2017, cerebral infarction (CI) has become a leading cause of mortality in China, with rising treatment costs posing significant challenges to the healthcare system. The Diagnosis-Related Groups (DRG) payment system has been recognized as a potential solution to curb rising healthcare expenditures. However, in its implementation, China faces considerable hurdles due to its vast geographical size, regional economic disparities, and heterogeneous disease spectrum.

Objective

This study proposes a novel two-stage grouping strategy with a two-stage method tailored to address the local context of western China. The method adaptively accommodates regional variations in disease burden and healthcare resource distribution.

Methods

Using hospitalization data from 111,025 CI patients collected by the Healthcare Security Administration of a western Chinese city between 2016 and 2018 (during the pre-DRG implementation period), we developed a two-stage DRG method. In the first stage, regression analysis identified and prioritized comorbidities and complications that influence medical costs. In the second stage, a decision tree algorithm established standardized classification protocols for DRG grouping, ensuring regional adaptability.

Results

The average hospitalization cost for CI patients was USD$ 1,565, with total expenditures reaching USD$ 1.71 million in the target city. By employing this localized two-stage grouping model, the proportion of inter-group variations, as measured by the coefficient of variation (CV), is below 1, reaching 100%, satisfying the technical criteria for DRG categorization. This optimization reduced the number of DRG from 18 to 4. It increased the proportion of groups with CV to <0.8 from 67 to 100%, signifying a substantial enhancement in group heterogeneity compared to the existing grouping method, China Healthcare Security Diagnosis-Related Groups (CHS-DRG).

Conclusion

This study demonstrates the effectiveness of our proposed two-stage method using real data. Implementation of this localized method in the target city could result in potential savings of USD$ 8.59 million, surpassing the existing CHS-DRG method. These findings suggest that this adaptive method may be a scalable strategy for resource-limited regions undergoing healthcare system reforms.

How perceived risk of recurrence strengthens health management awareness in stroke patients: the chain mediating role of risk fear and health literacy

Background

Prior research has found that perceived risk in stroke patients motivates health behaviors in visitors. However, the role that perceived risk of recurrence in stroke patients plays in reinforcing health management awareness during the motivation phase is unclear.

Objective

This study explores this issue by examining the effects of risk fear and health literacy on health management awareness due to perceived risk of recurrence in stroke patients.

Methods

We validated the effect of perceived risk of recurrence on health management awareness and its internal mechanism by constructing a structural equation model and including 763 stroke patients, extending the relevant literature and application of the Healthy Behavior Procedural Approach (HAPA) model.

Result

The results suggest that perceived risk of recurrence in stroke patients can effectively reinforce and improve health management awareness, with risk fear and health literacy having a chain-mediated role in this group relationship.

Conclusion

This study reveals the differential effects of perceived risk of recurrence, risk fear, and health literacy in stroke patients on health management awareness at the individual level, providing valuable guidance for healthcare practitioners and families to improve patients' health outcomes and health well-being.

Neurological Nurses' Perspectives on Communication of Stroke Recurrence Risks: A Mixed-Method Study

AIM

To gain a comprehensive understanding of the practices, attitudes, and thoughts of neurological nurses regarding communication about the risk of stroke recurrence.

DESIGN

This is a mixed-method study with a sequential explanatory design.

METHODS

An electronic survey was conducted amongst 280 neurological nurses from 30 hospitals to explore their clinical practice and attitudes towards stroke recurrence risk communication (RC). Furthermore, 10 nurses' from three tertiary hospitals were interviewed using a convenience sampling approach, and data were analysed with Colaizzi's methods.

RESULTS

Most neurological nurses view recurrence RC essential and beneficial. Quantitative results indicated that nurses frequently discuss warning symptoms, risk factors, the likelihood, and severity of stroke recurrence with patients. However, qualitative analysis indicated that these communications are often non-standardised, with cautious language, use of informal language, non-fixed timing, and limited focus on structured communication strategies. Factors influencing communication practices span three levels: the nurse, the patient, and the organisation. Influencing factors fall into three categories: nurse-related (age, education, experience, confidence, and knowledge), patient-related (trust and preferences), and organisational (lack of standardised models for communication).

CONCLUSIONS

Although neurological nurses recognise the significance of recurrence RC, their skills in this area could benefit from further development. Developing training and supporting nurses in delivering effective stroke recurrence risk education independently or in collaboration with physicians is crucial.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The findings highlight the necessity of standardising stroke recurrence RC, including the development of assessment tools, training programs, and communication strategies. These are essential for optimising risk education in stroke secondary prevention and promoting effective cardiovascular RC in clinical practice.

REPORTING METHOD

This study adhered to the GRAMMS checklist.

PATIENT OR PUBLIC CONTRIBUTION

Not applicable.

TRAIL REGISTRATION

CTR2000034244.

Perception of recurrence risk in patients with IgG4-related disease: a descriptive phenomenological study

Objective

About 40% of IgG4-related disease (IgG4-RD) patients face recurrence, severely impacting their quality of life. We aimed to explore the characteristics of the perception of recurrence risk in patients with IgG4-RD.

Methods

A qualitative study design with a descriptive phenomenological approach was used. Fourteen patients with IgG4-RD were recruited via purposive sampling, including six patients with first onset and eight patients experiencing recurrence. Semi-structured interviews were conducted to collect data, and transcripts were analysed by two independent researchers using Colaizzi's descriptive analysis framework. The COREQ checklist was followed.

Results

Data analysis identified nine subthemes falling into four themes: (a) perception of differential susceptibility to recurrence; (b) perception of crucial recurrence risk factors; (c) perception of recurrence warning signs and medical behaviours; (d) perception of multiple recurrence outcomes. We found that susceptibility perception formed the basis of recurrence risk perception. For patients with first onset, the main manifestations were misconception or evasion of the risk of recurrence, whereas patients experienced recurrence demonstrated a clear perception of recurrence risk and feelings of fear. Based on this, other themes emerged.

Conclusions

Since the absence of accurate knowledge related to recurrence, the perception of recurrence risk in patients with IgG4-RD primarily manifested as misconception, evasion or feeling fear. Ultimately, they couldn't take appropriate actions to prevent recurrence. Healthcare professionals should develop comprehensive interventions for patients with IgG4-RD, integrating health education, disease consultation and psychological support, with the aim of enhancing awareness of recurrence risk and empowering them to manage their conditions in the long term.

Stroke patient and stakeholder engagement (SPSE): concepts, definitions, models, implementation strategies, indicators, and frameworks-a systematic scoping review

BACKGROUND

Involving stroke patients in clinical research through patient engagement aims to ensure that studies are patient-centered, and may help ensure they are feasible, ethical, and credible, ultimately leading to enhanced trust and communication between researchers and the patient community. In this study, we have conducted a scoping review to identify existing evidence and gaps in SPSE.

METHODS

The five-step approach outlined by Arksey and O'Malley, in conjunction with the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) guidelines, provided the structure for this review. To find relevant articles, we searched PubMed, Web of Science, and Embase databases up to February 2024. Additionally, the review team conducted a hand search using Google Scholar, key journals, and references of highly relevant articles. Reviewers screened articles, selecting eligible English-language ones with available full texts, and extracted data from them into a pre-designed table tested by the research team.

RESULT

Of the 1002 articles initially identified, 21 proved eligible. Stakeholder engagement primarily occurred during the design phase of studies and within the studies using qualitative methodologies. Although the engagement of stakeholders in the research process is increasing, practice regarding terminology and principles of implementation remains variable. Researchers have recognized the benefits of stakeholder engagement, but have also faced numerous challenges that often arise during the research process.

CONCLUSION

The current study identifies stakeholder groups and the benefits and challenges researchers face in implementing their engagement. Given existing challenges and limited specific models or frameworks, it is suggested to explore applied recommendations for stakeholder engagement in future studies, that may enhance stakeholder engagement, overcome obstacles, and unify researchers' understanding of engagement and implementation.

Recurrence Risk Perception, Fear of Progression, and Health Behaviors Among Patients With Ischemic Stroke

BACKGROUND

The relationship between recurrence risk perception, fear of progression, and health behaviors in patients with ischemic stroke is unclear.

OBJECTIVE

To explore the effect of accuracy and level of recurrence risk perception on health behaviors and the mediating role of fear of progression.

METHODS

We conducted a 2-wave survey. Patients with ischemic stroke (N = 261) were recruited from 2 hospitals in Guangzhou, China. Before discharge, demographic information, objective recurrence risk, perceived recurrence risk, fear of progression, and health behaviors were investigated. After 1 month, the patient's health behaviors were followed up.

RESULTS

The median (quartiles 1-3) scores for recurrence risk perception and fear of progression were 43.0 (39.0-46.0) and 22.0 (18.0-28.0), respectively. Only 22.2% of the patients correctly perceived the risk of recurrence, 23.0% underestimated the risk, and 30.7% overestimated the risk. Patients who overestimated the risk of recurrence (β = 0.421, P = .002) or had a higher perceived level of recurrence risk (β = 0.446, P < .001) had a higher fear of progression, which contributed to better health behaviors at 1 month (β = 0.197, P = .001). Fear of progression played a partial and full mediating role, respectively. Patients who underestimated the recurrence risk had worse health behaviors than those who accurately perceived it (β = -0.296, P = .033).

CONCLUSION

Both accuracy and level of recurrence risk perception were independent predictors of future health behaviors, and fear of progression was mediating. Health care professionals should develop individualized risk education programs to help stroke patients properly understand and cope with the risk of recurrence.

Developing a Chain Mediation Model of Recurrence Risk Perception and Health Behavior Among Patients With Stroke: A Cross-sectional Study

PURPOSE

To understand the recurrence risk perception of stroke patients and develop a chain mediation model of recurrence risk perception and health behavior.

METHODS

A cross-sectional study and convenience sampling were used. Stroke survivors were recruited from the neurology departments of three tertiary hospitals. Their recurrence risk perception, behavioral decision-making, social support, self-efficacy, recurrence worry, and health behavior were measured by relevant tools. Data was analyzed through one-way analysis and regression analysis, and the AMOS 21.0 software was used to explore the mediating relationships between variables.

RESULTS

Of the 419 participants, 74.7% were aware of stroke recurrence risk. However, only 28.2% could accurately estimate their own recurrence risk. Recurrence risk perception was significantly correlated with behavioral decision-making, social support, self-efficacy, and health behavior (r = .19 ∼ .50, p < .05). Social support and recurrence risk perception could affect health behavior indirectly through self-efficacy, behavioral decision-making, and worry. Behavioral decision-making acted as a main mediator between recurrence risk perception and health behavior, while the path coefficient was .47 and .37, respectively. The chain mediation effect between recurrence risk perception and health behavior was established with a total effect value of .19 (p < .01).

CONCLUSION

Most stroke survivors could be aware of recurrence risk but failed to accurately estimate their individual risk. In the mediation model of recurrence risk perception and health behavior, social support seemed to be an important external factor, while self-efficacy, behavioral decision-making, and worry seemed to act as key internal factors.

REGISTRATION

The research project was registered on 29 June 2020 (CTR2000034244).

Perception of recurrent risk versus objective measured risk of ischemic stroke in first-ever stroke patients from a rural area in China: A cross-sectional study

OBJECTIVE

Risk perception is critical to the formation of individual health prevention behaviors. A long-term accurate perception of stroke recurrent risks is imperative for stroke secondary prevention. This study aims to explore the level of recurrence risk perceptions and the influential factors of inaccuracy between perceived and objective risk in first-ever ischemic stroke patients from a rural area.

METHODS

From May to November 2020, 284 first-ever ischemic stroke patients were conveniently recruited in a rural area of Henan Province, China. Perceived risk was measured based on self-reported using a numerical rating scale, whereas the objective risk was measured by the Essen Stroke Risk Score. Patients' perceived risk was compared with their objective risk and categorized as "Accurate," "Underestimated," and "Overestimated." The influencing factors of inaccuracy were further evaluated using multivariate regression analyses.

RESULTS

46% of the participants underestimated their stroke risk, while 15.9% overestimated their risks. Patients who were younger (≤65 years), didn't worry about recurrent stroke, and had a low actual recurrent risk were more likely to underestimate their recurrent risk. Patients who were employed, had lower independence, and had greater anxiety were more likely to overestimate their recurrent risk.

CONCLUSIONS

The majority of participants were unable to accurately perceive their own risk of stroke recurrence. Patients' age, working status, worry about recurrent stroke, actual recurrent risk, level of dependence, and anxiety played a role in perception inaccuracy.

PRACTICE IMPLICATIONS

The findings could help healthcare providers gain a better understanding of the level and accuracy of recurrence risk perceptions among first-ever stroke patients in the rural area. Future counseling on the perceived risk of stroke recurrence and individual objective risk assessment could be conducted to help patients better understand their risk of recurrence. Individualized risk communication and multidisciplinary teamwork can be developed to improve the accuracy of recurrence risk perceptions and health behaviors.