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"Everyone's Responsibility and No-One's Responsibility": A Thematic Analysis of a Roundtable on the Complex Problem
Seamus Barker1, Dominique Cadilhac2,3, Jan Cameron2
1Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
Insights
Improving secondary stroke prevention in Australia requires a comprehensive model of care. Addressing complex, interconnected factors and shared priorities is crucial for reducing recurrent stroke risk.
Area of Science:
- Public Health
- Neurology
- Health Services Research
Background:
- Recurrent stroke affects approximately 25% of individuals post-stroke.
- Suboptimal risk factor control persists despite available secondary prevention strategies.
- A national model of care for stroke secondary prevention is lacking in Australia.
Purpose of the Study:
- To identify implementation and research priorities for enhancing stroke secondary prevention in Australia.
- To understand barriers and enablers from diverse stakeholder perspectives.
Main Methods:
- Online roundtable and small group discussions involving people with lived experience, researchers, health professionals, and government representatives.
- Thematic analysis of transcribed discussions following Braun and Clarke's methodology.
- Incorporation of patient and caregiver lived experience throughout the research process.
Main Results:
- Key priorities centered on developing integrated 'models of care' for stroke secondary prevention.
- Identified barriers included challenges in 'coordination', 'resourcing', and the 'research translation pipeline'.
- Priorities were diverse, with both shared and conflicting perspectives among participants.
Conclusions:
- Stroke secondary prevention is a complex issue requiring a systems-level approach.
- A nationally recognized model of care is needed to address the multifaceted nature of secondary stroke prevention.
- Integrating diverse perspectives and shared priorities is essential for effective implementation.
Background:
Around one in four people with stroke will have a recurrent stroke. The risk can be reduced through medication and lifestyle changes, but many have poor risk factor control post-stroke. There is no nationally recognised model of care for stroke secondary prevention, and inadequate secondary prevention may be a complex problem that cannot be effectively dealt with by addressing various contributing factors independently. We sought to understand implementation and research priorities to address gaps in stroke secondary prevention in Australia.
Methods:
An online roundtable and four follow-up small group discussions were conducted between March and April 2023. Participants were people with lived experience of stroke, researchers, health professionals and representatives from stroke advocacy organisations and the Australian federal government. Participants were given pre-discussion questions on stroke secondary prevention priorities, barriers and enablers. Moderated discussion invited reflection on system-level connections between priorities and shared understanding of diverse perspectives, rather than consensus-building. Discussions were recorded, transcribed and analysed following Braun and Clarke's thematic analysis methodology.
Results:
In the roundtable and small-group discussions, 25 people participated (68% women). Most priorities related to the inductive theme, 'models of care', including programmes, interventions and health system settings. Perceived barriers and enablers related to the following inductive themes: 'coordination', 'resourcing', and the 'research translation pipeline'. Identified priorities were heterogeneous and extensive. Tensions existed between some priorities, but others were shared by participants.
Conclusion:
Our roundtable identified a range of priorities for stroke secondary prevention, coming from diverse perspectives. Stroke secondary prevention is a complex problem with interacting system elements that make improvement challenging. A model of care for stroke secondary prevention in Australia is needed that accounts for this complexity while building upon shared priorities.
Patient Or Public Contribution:
This project embedded people with lived experience of stroke. This included three people with lived experience of stroke, or of being a carer for a person with stroke, who took part in the initial roundtable and provided valuable contributions in discussions of implementation and research priorities for secondary stroke prevention. These participants also helped to prepare this manuscript, providing helpful feedback to ensure that priorities, barriers and enablers for secondary stroke prevention from a lived experience perspective were centred.
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