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Annals of Indian Academy of Neurology
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ORIGINAL ARTICLE
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Systematic development of structured semi-interactive stroke prevention package for secondary stroke prevention


1 Department of Clinical Neurosciences, Alberta Health Services, Edmonton, Canada
2 Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
3 Department of Neurology, Sri Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
4 Department of Neuroscience, All India Institute of Medical Sciences, New Delhi, India
5 Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
6 Department of Neurology, Zydus Hospital, Ahmedabad, Gujarat, India
7 Department of Neurology, Grant Government Medical College, Mumbai, Maharashtra, India
8 Department of Neurology, National Institute of Mental Health and Neuro-Sciences, Bangalore, Karnataka, India
9 Department of Neurology, Christian Medical College, Vellore, Tamil Nadu, India
10 Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
11 Department of Neurology, Guwahati Neurological Research Centre, Dispur, Assam, India
12 Department of Neurology, Bangur Institute of Neurosciences, Kolkata, West Bengal, India
13 Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India

Correspondence Address:
Jeyaraj Durai Pandian,
Department of Neurology, Christian Medical College, Brown Road, Ludhiana - 141008, Punjab
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aian.AIAN_639_19

Background: Lack of compliance to medication and uncontrolled risk factors are associated with increased risk of recurrent stroke and acute coronary syndrome in patients with recent stroke. Multimodal patient education may be a strategy to improve the compliance to medication and early adoption of nonpharmacological measures to reduce the vascular risk factor burden in patients with stroke. We thus aim to develop multilingual short messaging services (SMS), print, and audio-visual secondary stroke prevention patient education package. The efficacy of the package will be tested in a randomized control trial to prevent major cardiovascular and cerebrovascular events. Methods: In the formative stage, intervention materials (SMS, video, and workbook) were developed. In the acceptability stage, the package was independently assessed and modified by the stakeholders involved in the stroke patient care and local language experts. The modified stroke prevention package was tested for implementation issues (implementation stage). Results: Sixty-nine SMS, six videos, and workbook with 11 chapters with 15 activities were developed in English language with a mean ± SD SMOG index of 9.1 ± 0.4. A total of 355 stakeholders including patients (24.8%), caregivers (24.8%), doctors (10.4%), nurses (14.1%), local language experts (2.8%), physiotherapists (13.2%), and research coordinators (9.8%) participated in 10 acceptability stage meetings. The mean Patient Education Material Assessment Tool understandability score in all languages for SMS, video scripts, and workbook was 95.2 ± 2.6%, 95.2 ± 4.4%, and 95.3 ± 3.6%, respectively. The patients [n= 20, mean age of 70.3 ± 10.6 years and median interquartile range (IQR) baseline NIHSS 1 (0–3)] or the research coordinators (n = 2) noted no implementation issues at the end of 1 month. Conclusion: An implementable complex multilingual patient education material could be developed in a stepwise manner. The efficacy of the package to prevent major adverse cardiovascular events is being tested in the SPRINT INDIA study.


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