Effects of a Transtheoretical Model-Based Intervention on Stroke Prevention Behaviors among People at Risk in a Community of Nakhon Phanom Province, Thailand
Article Sidebar
Main Article Content
Abstract
Objective: Transtheoretical model (TTM) is one of the most commonly used methods for behavioral change. This Quasi-experimental research with a one-group pretest-posttest design aimed to examine the effects of a Transtheoretical model-based Intervention on stroke prevention behaviors, systolic blood pressure (SBP), diastolic blood pressure (DBP) and body mass index (BMI) among people at risk in community of Nakhon Phanom province. Methods: Twenty participants were selected by a purposive sampling method. The eligible participants were those with aged 55 years or older, diagnosed with chronic illness, without history of stroke or transient ischemic attack (TIA), with Thai Cardio-Vascular (CV) risk of 10% or higher, classified in the stage of “not ready for change” and willing to participate in the research project. The participants received an intervention from June to November 2020 once a week. The intervention was divided into 4 activity sessions and one booster session on week 16. The intervention was made commensurate with the constructs of processes of change and appropriate content. The outcomes were evaluated at six months after the intervention. The data were collected by a demographic data form, a stroke prevention behavior questionnaire, blood pressure level and BMI record. The data were analyzed using descriptive statistics and t-test statistics. Results: After completion of the intervention, the results showed that the mean stroke prevention behavior scores of the participants were statistically significantly greater than before attending the intervention (p < .001). SBP level was also lower than that before intervention with statistical significance (p < .01). Mean DBP and BMI of the participants after the intervention decreased without statistical significance. Conclusion: The Transtheoretical model-based Intervention showed effectiveness in stroke prevention of people at risk. The findings of this study are of importance for further practice in that the proposed intervention may be
applied for stroke preventive care.
Article Details
References
Kim J, Thayabaranathan T, Donnan GA. et al. Global stroke statistics 2019. Int J Stroke. 2020; 15(8): 819-38. doi: 10.1177/1747493020909545.
Ministry of Public Health. Strategy and Planning Division. Public Health Statistics A.D. 2017 [Internet]. 2018 [cited 2020 Feb 10]; Available from: https://bps.moph.go.th/new_bps/sites/default/files/statistics60.pdf.
Boehme AK, Esenwa C, Elkind MS. Stroke risk factors, genetics, and prevention. Circ Res. 2017; 120(3): 472-95.
doi: 10.1161/CIRCRESAHA.116.308398.
American Heart Association. American Stroke Association. Stroke Symptoms [internet]. 2019 [cited2020Mar2]; Available from: https://www.stroke.org/en/about-stroke/stroke-symptoms.
Katan M, Luft A. Global burden of stroke. Semin Neuro. 2018; 38: 208-11. doi: 10.1055/s-0038-1649503.
Miller EL, Murray L, Richards L, et al. Comprehensive overview of nursing and interdisciplinary rehabilitation care of the stroke patient: a scientific statement from the American Heart Association. Stroke. 2010; 41(10): 2402-48. doi: 10.1161/STR.0b013e3181e7512b.
Bushnell C, McCullough LD, Awad IA, et al. Guidelines for the prevention of stroke in women: a statement for
healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014; 45(5): 1545-88. doi: 10.1161/01.str.0000442009.06663.48.
O’Donnell M, Chin S, Rangarajan S, et al. Global and regional effects of potentially modifiable risk factors
associated with acute stroke in 32 countries (interstroke): A case-control study. Lancet. 2016; 388(10046): 761-75.
doi: 10.1016/S0140-6736(16)30506-2.
Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997; 12(1): 38-48. doi: 10.4278/0890-1171-12.1.38.
Jiménez-Zazo F, Romero-Blanco C, Castro-Lemus N, et al. Transtheoretical model for physical activity in older adults: Systematic review. Int J Environ Res Public Health. 2020; 17(24): 9262. doi: 10.3390/ijerph17249262.
Sjattar EL, Arafat R. Transtheoretical model on the self-care behavior of hypertension patients: A systematic review. J Health Res. 2021. doi: 10.1108/JHR-01-2021-0053.
Rodriguez MA, Wang B, Hyoung S, et al. Sustained Benefit of Alternate Behavioral Interventions to Improve
Hypertension Control: A Randomized Clinical Trial. Hypertension. 2021; 77(6): 1867-76. doi: 10.1161/HYPER
TENSIONAHA.120.15192.
Hawkes RE, Miles LM, French DP. The theoretical basis of a nationally implemented type 2 diabetes prevention programme: how is the programme expected to produce changes in behaviour? Int J Behav Nutr Phys Act. 2021; 18(1): 1-12. doi: 10.1186/s12966-021-01134-7.
Alzeidan R, Shata Z, Hassounah MM, et al. Effectiveness of digital health using the transtheoretical model to prevent or delay type 2 diabetes in impaired glucose tolerance patients: protocol for a randomized control trial. BMC public health. 2019; 19(1): 1-11. doi: 10.1186/s12889-019-7921-8.
Numpoon J. Applications of the Trans-theoretical Modelin adult patients with metabolic syndrome. TRCN
J. 2020; 13(2): 15-28. Thai.
Gong J, Chen X, Li S. Efficacy of a Community-Based Physical Activity Program KM2H 2 for Stroke and Heart Attack Prevention among Senior Hypertensive Patients: A Cluster Randomized Controlled Phase-II Trial. PLoS One. 2015; 10(10): e0139442. doi: 10.1371/journal.pone.0139442.
Mattayakorn K. Affecting changes in exercise behavior following the Trans-theoretical Model (TTM) of stages of behavior change. Academic Journal Institute of Physical Education. 2018; 10(2): 107-18. Thai.
Cheumnok W, Khampolsiri T, Tamdee D. Health beliefs and health behaviors among Phu Tai and Thai Isanolder persons with hypertension. Nursing J. 2017; 44(Suppl 1): 57-68. Thai.
NakhonPhanom Provincial Health Office. Thai CV risk score Report [Internet]. 2021 [cited 2020 Jul 11]. Available from: http://203.157.176.15/chronic/rep_thaicvdriskscreen.php.
Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model
of change. J Consult Clin Psychol. 1983; 51(3): 390-5. doi: 10.1037//0022-006x.51.3.390.
BurnsN, Grove SK. (2017). The practice of nursing research: appraisal, synthesis and generation of evidence
(8 th ed.). Missouri: Saunders Elsevier.
Mahidol University. Faculty of Medicine Ramathibodi Hospital. Thai CV risk scores [Internet]. 2015 [cited 2020
Jun 1]. Available from: https://med.mahidol.ac.th/cardio_vascular_risk/thai_cv_risk_score/.
Eshah NF. Readiness for behavior change in patients living with ischemic heart disease. J Nurs Res. 2019; 27(6): 1-8. doi: 10.1097/jnr.0000000000000336.
Motlagh Z, Hidarnia A, Kaveh MH, et al. Influence of a trans-theoretical model based intervention on physical
activity in hypertensive patients: A randomised clinical trial. Asian J Sports Med. 2017; 8(2): e42655. doi: 10.5812/
asjsm.42655.
Pragodpol P, Intana J. The effect of the stroke warning signs program on stroke’s awareness, knowledge, and practice to decrease the stroke risk in hypertensive patients. JPNC. 2019; 30(2): 88-100. Thai.
Thonglong T. Sources of Stress and stress management behavior of middle-age people in the ruralUbonratchathani Province. Thaksin Journal. 2018; 21(1): 89-95. Thai.
Pattanaporkrattana W. Effectiveness of a behavioral reformative program for stroke prevention among hypertensive patients in KohPhangan Hospital, Suratthani. Reg 11 Med J. 2019; 29(1): 145-53. Thai.
Dishman RK, Vandenberg RJ, Motl RW, et al. Using constructs of the transtheoretical model to predict classes
of change in regular physical activity: A multi-ethnic longitudinal cohort study. Ann Behav Med. 2010; 40(2):
-63. doi: 10.1007/s12160-010-9196-2.
Du X, Wang C, Ni J, et al. Association of blood pressure with stroke risk, stratified by age and stroke type, in a
low-income population in China: A 27-year prospective cohort study. Front Neurol. 2019; 10: 564. doi: 10.3389/
fneur.2019.00564.
Salas-Salvadó J, Díaz-López A, Ruiz-Canela M, et al. Effect of a lifestyle intervention program with energyrestricted Mediterranean diet and exercise on weight loss and cardiovascular risk factors: one-year results of the PREDIMED-plus trial. Diabetes Care. 2019; 42(5): 777-88. doi: 10.2337/dc18-0836.