Effectiveness of the Protection Motivation Theory-based Education Program among People at Risk of Stroke: A Randomized Controlled Trial

Authors

  • Patcharin Khomkham Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.
  • Linchong Pothiban Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.
  • Tipaporn Wonghongkul Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.
  • Waraporn Boonchieng Faculty of Public Health, Chiang Mai University, Thailand.
  • Weeraporn Suthakorn Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.

DOI:

https://doi.org/10.60099/prijnr.2024.264945

Keywords:

Adherence, Clinical outcomes, Nursing, Protection Motivation Theory, Risk of stroke, Adherence to stroke prevention

Abstract

Stroke is a serious health issue that causes mortality and disability in the world’s population. People at risk of stroke need to manage the risk factors of stroke and adherence to stroke prevention, which are the key to success in improving clinical outcomes, particularly blood sugar and blood pressure levels. This randomized controlled trial, with a two-arm preand post-test, aimed to investigate the effectiveness of the Protection Motivation Theory-based Education Program on adherence to prevention and clinical outcomes among people at risk of stroke. The sample consisted of 58 adults visiting diabetes and hypertension clinics at a health-promoting hospital in a province in southern Thailand. They were recruited using multi-stage random sampling and randomly assigned into two arms. The experimental arm received the four-week Protection Motivation Theory-based Education Program (n = 29), and the control arm received only usual care (n = 29). Data were collected using a Demographic Data Form, the Morisky Medication Adherence Scale, the Adherence to Preventive Behavior Scale for Thai persons with prehypertension, a mercury sphygmomanometer, and a laboratory test recording form. Data were analyzed using descriptive statistics, Mixed Model ANOVA, and independent t-test.

The results showed that after receiving the program, the experimental arm had higher adherence to stroke prevention, lower blood pressure, and lower HbA1C levels than before receiving the program and the control arm after the program completion. The findings indicate the program’s effectiveness in improving adherence to stroke prevention among people at risk of stroke, which results in better clinical outcomes. Thus, nurses can use this program in clinical practice with further testing in other settings with larger groups before it can be widely used.

References

Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, et al. Heart disease and stroke statistics—2021 update: a report from the American Heart Association. Circulation. 2021; 143(8):e254-e743. doi: 10.1161/CIR.0000000000000950. DOI: https://doi.org/10.1161/CIR.0000000000000950

Feigin VL, Brainin M, Norrving B, Martins S, Sacco RL, Hacke W, et al. World Stroke Organization (WSO): global stroke fact sheet 2022. Int J Stroke. 2022; 17(1): 18–29. doi: 10.1177/17474930211065917. DOI: https://doi.org/10.1177/17474930211065917

Tiamkao S, Ienghong K, Cheung LW, Celebi I, Suzuki T, Apiratwarakul K. Stroke incidence, rate of thrombolytic therapy, mortality in Thailand from 2009 to 2021. Open Access Maced J Med Sci. 2022; 10(E), 110–15. doi: 10.3889/oamjms.2022.8051. DOI: https://doi.org/10.3889/oamjms.2022.8051

World Health Organization. World Stroke Day 2019. 2019 October 29 [cited 2023 Aug 27]. Available from: https://www.who.int/southeastasia/news/speeches/detail/world-stroke-day-2019#:~:text=By%20Dr%20Poonam%20Khetrapal%20Singh,WHO%20South%2DEast%20Asia%20Region&text=Preventing%20and%20managing%20stroke%20is,second%20leading%20cause%20of%20death.

Tai WA. Stroke: primary prevention. FP Essent. 2022;512:11-17.

Thananuwatsak R, Harnchaipibulkul S, Worakijthamrongchai T. The primary prevention of stroke. J Thai Stroke Soc. 2019;18(2): 29–39 (in Thai).

Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018; 49(3): e46-e99. doi: 10.1161/STR.0000000000000158Stroke. DOI: https://doi.org/10.1016/j.jvs.2018.04.007

Chang WW, Fei SZ, Pan N, Yao YS, Jin YL. Incident stroke and its influencing factors in patients with type 2 diabetes mellitus and/or hypertension: a prospective cohort study. Front Cardiovasc Med. 2022;9:770025. doi: 10.3389/fcvm.2022.770025. DOI: https://doi.org/10.3389/fcvm.2022.770025

Division of Non-communicable Diseases, Ministry of Public Health. Five-year national strategic plan for prevention and control of non-communicable diseases (2017-2021). Bangkok: Emotion Art;2017 (in Thai).

Sakboonyarat B, Rangsin R, Kantiwong A, Mungthin M. Prevalence and associated factors of uncontrolled hypertension among hypertensive patients: a nation-wide survey in Thailand. BMC Res Notes. 2019;12(1):380. doi: 10.1186/s13104-019-4417-7. DOI: https://doi.org/10.1186/s13104-019-4417-7

Sakboonyarat B, Pima W, Chokbumrungsuk C, Pimpak T, Khunsri S, Ukritchon S, et al. National trends in the prevalence of glycemic control among patients with type 2 diabetes receiving continuous care in Thailand from 2011 to 2018. Sci Rep. 2021;11(1). doi:10.1038/s41598-021-93733-4. DOI: https://doi.org/10.1038/s41598-021-93733-4

World Health Organization. Adherence to long term therapies: evidence for action. Geneva: World Health Organization;2003.

Sendekie AK, Netere AK, Kasahun AE, Belachew EA. Medication adherence and its impact on glycemic control in type 2 diabetes mellitus patients with comorbidity: a multicenter cross-sectional study in northwest Ethiopia. PLoS One. 2022; 17(9): e0274971. doi: 10.1371/journal.pone.0274971. DOI: https://doi.org/10.1371/journal.pone.0274971

Choudhry NK, Kronish IM, Vongpatanasin W, Ferdinand KC, Pavlik VN, Egan BM, et al. Medication adherence and blood pressure control: a scientific statement from the American Heart Association. Hypertension. 2022;79(1):e1-e14. doi: 10.1161/HYP.0000000000000203. DOI: https://doi.org/10.1161/HYP.0000000000000203

Tam HL, Wong EML, Cheung K. Effectiveness of educational interventions on adherence to lifestyle modifications among hypertensive patients: an integrative review. Int J Environ Res Public Health. 2020;17(7):2513. doi: 10.3390/ijerph17072513. DOI: https://doi.org/10.3390/ijerph17072513

Algabbani FM, Algabbani AM. Treatment adherence among patients with hypertension: findings from a cross-sectional study. Clin Hypertens. 2020;26:18. doi: 10.1186/s40885-020-00151-1. DOI: https://doi.org/10.1186/s40885-020-00151-1

Andualem A, Gelaye H, Damtie Y. Adherence to lifestyle modifications and associated factors among adult hypertensive patients attending chronic follow-up units of Dessie Referral Hospital, North East Ethiopia, 2020. Integr Blood Press Control. 2020;13:145-56. doi: 10.2147/IBPC.S275575. DOI: https://doi.org/10.2147/IBPC.S275575

Meekusol S, Maneesriwongul W, Orathai P, Pongthavornkamol K, Sharps PW. Factors predicting women’s adherence to hypertensive treatment. Pac Rim Int J Nurs Res. 2020;25(1):131-42.

Oluma A, Mosisa G, Abadiga M, Tsegaye R, Habte A, Abdissa E. Predictors of adherence to self-care behavior among patients with diabetes at public hospitals in west Ethiopia. Diabetes Metab Syndr Obes. 2020;13:3277-88. doi: 10.2147/DMSO.S266589. DOI: https://doi.org/10.2147/DMSO.S266589

Shiraly R, Khani Jeihooni A, Shirazi RB. Perception of risk of hypertension-related complications and adherence to antihypertensive drugs: a primary healthcare based cross-sectional study. BMC Prim Care. 2022;23(1):303. doi: 10.1186/s12875-022-01918-1. DOI: https://doi.org/10.1186/s12875-022-01918-1

Shin J, Chia YC, Heo R, Kario K, Turana Y, Chen CH, et al. Current status of adherence interventions in hypertension management in Asian countries: a report from the HOPE Asia Network. J Clin Hypertens. 2020;23(3):584–94. doi: 10.1111/jch.14104. DOI: https://doi.org/10.1111/jch.14104

Waelveerakup W, Lapvongwatana P, Leelacharas S, Davison J. Factors predicting stroke pre-hospital delay behavior intention among people with high risk of stroke. Pac Rim Int J Nurs Res. 2019; 23(3), 271–84.

Maninet S, Desaravinid C. Relationships between illness perception, functional status, social support, and self-care behavior among Thai people at high risk of stroke: a cross-sectional study. Belitung Nurs J. 2023;9(1):62-8. doi: 10.33546/bnj.2434. DOI: https://doi.org/10.33546/bnj.2434

Rogers RW. Cognitive and physiological processes in fear appeals and attitude change: a revised theory of protection motivation. 1983. In Cacioppo, J., Petty, R. Social psychophysiology; Guilford Press; 1983, pp. 153-177.

Brouwer-Goossensen D, den Hertog HM, Mastenbroek-de Jong MA, van Gemert-Pijnen LJEWC, Taal E. Patient perspectives on health-related behavior change after transient ischemic attack or ischemic stroke. Brain Behav. 2021;11(4):e01993. doi: 10.1002/brb3.1993. DOI: https://doi.org/10.1002/brb3.1993

Morowatisharifabad MA, Asadpour M, Zakeri MA, Abdolkarimi M. The effect of integrated intervention based on protection motivation theory and implementation intention to promote physical activity and physiological indicators of patients with type 2 diabetes. Biomed Res Int. 2021;6637656. doi: 10.1155/2021/6637656. DOI: https://doi.org/10.1155/2021/6637656

Siriket R, Sittipakorn S, Hornboonherm P. Effects of the protection motivation program on protective behavior of the high risk stroke. Srinagarind Med J. 2015;30(3):299–304 (in Thai).

Khiawkhwao P, Thiangtham W, Boonyamalik P. The effect of the cerebral vascular disease prevention program in high-risk group patients. JHNR. 2019; 35(3): 120-32 (in Thai).

Polit DF, Beck CT. Nursing research: generating and assessing evidence for nursing practice. 11th ed. Philadelphia: Wolters Kluwer; 2021.

Train the Brain Forum Committee. Thai Mental State Examination (TMES). Siriraj Hospital Gaz. 1993; 45(6):359-74 (in Thai).

Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens. 2008;10(5):348-54. doi: 10.1111/jch.14718. DOI: https://doi.org/10.1111/j.1751-7176.2008.07572.x

Chukumnird S. Development and evaluation of the adherence to preventive behavior scale for Thai persons with prehypertension [Dissertation]. [Thailand]: Prince of Songkla University; 2016.

Diabetes Association of Thailand under the Patronage of Her Royal Highness Princess Maha Chakri Sirindhorn, the Endocrine Society of Thailand. Clinical practice guideline for diabetes 2023. Bangkok: Srimuang Printing; 2023.

Plichta SB, Kelvin EA, Munro BH. Munro’s statistical methods for health care research. Philadelphia: Wolters Kluwer Health/ Lippincott Williams & Wilkins; 2012.

Amdemariam LK, Watumo AM, Sibamo EL, Agide FD. Perception towards cardiovascular diseases preventive practices among bank workers in Hossana town using the health belief model. PLoS One. 2022;17(2):e0264112. doi: 10.1371/journal.pone.0264112. DOI: https://doi.org/10.1371/journal.pone.0264112

Detboon S, Kitsripisarn S, Muengtaweepongsa S. The effects of a motivational program using a mobile application for adherence behaviors in the prevention of recurrent stroke and blood pressure among stroke patients with hypertension. Nurs J CMU. 2023; 50(1):97-111 (in Thai).

Lo SHS, Chau JPC. Exploring community-dwelling stroke survivors' experiences of receiving a nurse-led theory-based stroke self-management programme: a qualitative study. Medicine. 2021;100(37):e27256. doi: 10.1097/MD.0000000000027256. DOI: https://doi.org/10.1097/MD.0000000000027256

Maltinsky W, Swanson V. Behavior change in diabetes practitioners: an intervention using motivation, action planning and prompts. Patient Educ Couns. 2020;103(11):2312-19. doi: 10.1016/j.pec.2020.04.013. DOI: https://doi.org/10.1016/j.pec.2020.04.013

Tozivepi SN, Takawira S, Chikaka E, Mundagowa P, Chadambuka EM, Mukora-Mutseyekwa F. The nexus between adherence to recommended lifestyle behaviors and blood pressure control in hypertensive patients at Mutare Provincial Hospital, Zimbabwe: a cross-sectional study. Patient Prefer Adherence. 2021;15:1027-37. doi: 10.2147/PPA.S306885. DOI: https://doi.org/10.2147/PPA.S306885

Chin SS, Lau SW, Lim PL, Wong CM, Ujang N. Medication adherence, its associated factors and implication on glycemic control in patients with type 2 diabetes mellitus: a cross-sectional study in a Malaysian primary care clinic. Malays Fam Physician. 2023;18:14. doi: 10.51866/oa.88. DOI: https://doi.org/10.51866/oa.88

Downloads

Published

2023-12-21

How to Cite

1.
Khomkham P, Pothiban L, Wonghongkul T, Boonchieng W, Suthakorn W. Effectiveness of the Protection Motivation Theory-based Education Program among People at Risk of Stroke: A Randomized Controlled Trial. PRIJNR [Internet]. 2023 Dec. 21 [cited 2024 Nov. 13];28(1):202-18. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/264945