- Title
- Post-stroke health risk factors: support options and opportunities
- Creator
- Clancy, Brigid Maeve
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2024
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background: There have been significant improvements in the identification and treatment of stroke in recent decades contributing to more people surviving stroke. Modifiable health risk factors such as diet, physical activity, smoking, alcohol use, mental health, and blood pressure are being increasingly recognised for their role in stroke risk and secondary prevention. However, models for post-stroke care have not kept up with the complex support needs people experience after stroke and many stroke survivors do not receive appropriate secondary prevention information or support. Aims and objectives: The overall aim of this thesis is to explore current knowledge gaps related to provision of post-stroke support, especially in relation to modifiable stroke risk factors. In this thesis, post-stroke support refers to the wide range of interventions, services and resources that can be delivered by, or referred to by, healthcare providers to address the needs of people who have experienced stroke. To achieve the overall aim, this thesis has the following broad objectives: 1. To analyse health risk factor profiles of Australians who have experienced stroke; 2. To map the available evidence relating to alcohol consumption in people who have experienced stroke; 3. To explore healthcare provider perceptions of support provision to people who have experienced stroke; 4. To describe the access to and use of the internet and related facilities among Australians who have experienced stroke; and 5. To explore online health information seeking behaviours, barriers, and preferences among people who have experienced stroke. Methods: Multiple methodologies were employed across five studies (reported in Chapters 2-6) to address the research objectives. Chapter 2 presents a latent class analysis conducted to identify clustering of health risk factors (diet quality, physical activity, blood pressure medication, alcohol intake, smoking status, anxiety, and depression) among 399 Australians who have experienced stroke, and associations between these clusters and participant characteristics. In Chapter 3, a scoping review was utilised to identify and map existing literature reporting on alcohol consumption in people who have experienced stroke in relation to prevalence and patterns of use, effect of alcohol on recovery, mortality and morbidity after stroke, and interventions to reduce alcohol consumption. A qualitative descriptive study was employed in Chapter 4 to examine the perspectives of 14 rural and metropolitan healthcare providers, from across the stroke care continuum, on providing supports to people who have experienced stroke in Australia. Chapters 5 and 6 examined internet use in everyday life among people who have experienced stroke. Chapter 5 explores access to, and use of, internet and related technologies through cross-sectional analysis (N=354). Chapter 6 presents a combined inductive-deductive qualitative analysis of online health-seeking behaviours in a convenience sample of 15 Australian stroke survivors. Key findings: The latent class analysis in Chapter 2 identified two distinct groups of stroke survivors based on health risk factors, with one group more likely to have poor physical activity, diet quality, anxiety, and depression, and the other more likely to meet diet and exercise guidelines but have a higher probability of risky drinking. This study also identified unexpectedly high levels of risky drinking (48%) across the entire sample. The results in the Chapter 3 scoping review highlighted the paucity of research related to alcohol use after stroke, and the lack of rigour with which the existing research has been conducted, including widespread issues related to inadequate reporting of measures and instruments and failure to use standardised and validated instruments. Across Chapters 4 and 6, both healthcare providers and people who had experienced stroke identified issues of inadequate follow-up and long-term support after stroke. Chapter 5 found Australian stroke survivors with low levels of disability frequently use the internet, including for health information, and the presence of health risk factors does not correlate with seeking health information online. In Chapter 6, people who have experienced stroke repeatedly reported that post-stroke supports (both digital and traditional) do not adequately reflect the diversity of stroke experiences, which can lead to disconnection and lack of engagement with these supports. Conclusions: Research is required to address gaps in the provision of effective post-stroke support, especially in relation to secondary prevention through stroke risk behaviour modification. There is a lack of a reliable foundational evidence base for post-stroke alcohol use and a comprehensive, coordinated research plan is required to understand the prevalence, patterns, and impacts of alcohol consumption after stroke to develop evidence-based secondary prevention guidelines and inform the development of targeted interventions. Evidence-based, co-designed, and tailored post-stroke supports that reflect diverse post-stroke experiences should be developed and evaluated to enhance the likelihood that available supports are appealing and engaging to all people with stroke. The most significant recommendation to emerge from this thesis is for the development of a secondary prevention initiative, modelled after the Stroke Recovery and Rehabilitation Roundtable initiative, to improve the consistency, quality, and rigour of secondary prevention research and ultimately improve the support provided to people who have experienced stroke.
- Subject
- stroke; secondary prevention; eHealth; risk factors; alcohol; support; post-stroke; recurrent stroke
- Identifier
- http://hdl.handle.net/1959.13/1512966
- Identifier
- uon:56686
- Rights
- Copyright 2024 Brigid Maeve Clancy
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 8 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 330 KB | Adobe Acrobat PDF | View Details Download |