Stop Stroke: development of an innovative intervention to improve risk factor management after stroke.
OBJECTIVE
Stroke survivors are at high risk of stroke recurrence yet current strategies to reduce recurrence risk are sub-optimal. The UK Medical Research Council (MRC) have proposed a framework for developing and evaluating complex interventions, such as community management of stroke secondary prevention. The Framework outlines a five-phased approach from theory through to implementation of effective interventions. This paper reports Phases I-III of the development of a novel intervention to improve risk factor management after stroke.


METHODS
The pre-clinical/theoretical phase entailed reviewing the literature and undertaking quantitative and qualitative studies to identify current practices and barriers to secondary prevention. In Phase I (modelling), findings were used to design an intervention with the potential to overcome barriers to effective stroke secondary prevention management. The feasibility of delivering the intervention and its acceptability were tested in the Phase II exploratory trial involving 25 stroke survivors and their general practitioners.


RESULTS
This led to the development of the definitive risk factor management intervention. This comprises multiple components and involves using an on-going population stroke register to target patients, carers and health care professionals with tailored secondary prevention advice. Clinical, socio-demographic and service use data collected by the stroke register are transformed to provide an individualised secondary prevention package for patients, carers and health care professionals at three time points: within 10 weeks, 3 and 6 months post-stroke.


CONCLUSIONS
The intervention is currently being evaluated in a randomised controlled trial. Further research is needed to test generalisability to other aspects of stroke management and for other chronic diseases.


CONCLUSIONS
The MRC Framework for complex interventions provides a structured approach to guide the development of novel interventions in public health. Implications for practice in stroke secondary prevention will emerge when the results of our randomised controlled trial are published.
Redfern
Judith
J
King's College London UK, Division of Health & Social Care Research, London, UK. Judith.m.redfern@kcl.ac.uk
Rudd
Anthony D
AD
Wolfe
Charles D A
CD
McKevitt
Christopher
C
D000359:Aftercare / Q000458:organization & administration; D005240:Feasibility Studies; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D020380:Needs Assessment / Q000458:organization & administration*; D010342:Patient Acceptance of Health Care / Q000523:psychology; D010353:Patient Education as Topic; D010865:Pilot Projects; D011320:Primary Health Care; D016730:Program Development; D015397:Program Evaluation; D036301:Qualitative Research; D012008:Recurrence; D012042:Registries; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D017741:Survivors / Q000523:psychology; D013997:Time Factors; D017749:Total Quality Management / Q000458:organization & administration; D006113:United Kingdom