Reducing risk behaviours after stroke: An overview of reviews interrogating primary study data using the Theoretical...

Area of Science:

• Neuroscience
• Behavioral Science
• Public Health

Background:

• Secondary stroke prevention relies on lifestyle changes and medication.
• Behavior-change interventions show promise but lack theoretical understanding of mediators.
• Limited research exists on theory-driven mediators influencing post-stroke behavior change.

Purpose of the Study:

• To systematically review and synthesize evidence on theoretically-grounded behavior-change interventions for stroke secondary prevention.
• To identify mediators of behavior change post-stroke and their impact on risk-reducing behaviors.

Main Methods:

• Systematic search of electronic databases (MEDLINE, Embase, etc.) for systematic reviews up to March 2023.
• Interrogation of primary studies from identified reviews for theoretically-grounded interventions and mediators.
• Meta-analyses of behavior-change domains from the Theoretical Domains Framework (TDF) and secondary prevention outcomes.

Main Results:

• 19 trials (N=2530) used theoretically-grounded interventions, mapping to 5 TDF domains.
• Interventions targeting 'Knowledge' improved medication adherence, physical activity, and smoking cessation (low certainty evidence).
• Targeting 'Knowledge' and 'Beliefs about Consequences' improved medication adherence (very low certainty evidence); 'Beliefs about Capabilities' and 'Emotions' modulated low mood (low certainty evidence).

Conclusions:

• Stroke secondary prevention trials have limited theory-based research and mediator utilization.
• Knowledge, Beliefs about Consequences, and Emotions are key domains influencing risk-reducing behaviors post-stroke.
• Future interventions should incorporate these constructs, and trials must focus on cardiovascular outcomes with adequate follow-up.