Effectiveness of a Health Education Program to Reduce Recurrence of Stroke by Controlling Modifiable Risk Factors in a Specialized Hospital in Bangladesh: Randomized Controlled Trial
BackgroundHealth education could be an effective way to increase knowledge regarding behavioral changes to prevent the recurrence of stroke; however, the evidence is ambiguous. A lack of both knowledge and compliance with treatment to control modifiable risk factors and unhea...
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JMIR Publications
2025-05-01
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| Series: | JMIR Public Health and Surveillance |
| Online Access: | https://publichealth.jmir.org/2025/1/e72233 |
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| author | Mahabuba Afrin K A T M Ehsanul Huq Sharif Uddin Khan Subir Chandra Das Mohammad Shah Jahirul Hoque Chowdhury Yasuko Fukuoka Yasuko Fukushima Michiko Moriyama |
| author_facet | Mahabuba Afrin K A T M Ehsanul Huq Sharif Uddin Khan Subir Chandra Das Mohammad Shah Jahirul Hoque Chowdhury Yasuko Fukuoka Yasuko Fukushima Michiko Moriyama |
| author_sort | Mahabuba Afrin |
| collection | DOAJ |
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BackgroundHealth education could be an effective way to increase knowledge regarding behavioral changes to prevent the recurrence of stroke; however, the evidence is ambiguous. A lack of both knowledge and compliance with treatment to control modifiable risk factors and unhealthy lifestyles increases the risk of stroke recurrence.
ObjectiveThis study aimed to evaluate the effectiveness of a health education program among patients with stroke postdischarge and their family caregivers in a tertiary specialized hospital in Bangladesh to reduce stroke recurrence by controlling modifiable risk factors.
MethodsA parallel (1:1), open-label, prospective randomized controlled trial was conducted in Bangladesh. A total of 432 patients with first-time stroke, aged ≥18 years and a modified Rankin Scale (mRS) score of 0-4, were randomly enrolled at the National Institute of Neuroscience & Hospital. We stratified the patients by age and type of stroke and randomly allocated to an intervention group (IG) and a control group (CG). We collected sociodemographic and clinical data by using a structured questionnaire. The IG received (self) management education, including monitoring blood pressure (BP), medication, diet, and exercise for 12 months, and the CG received usual care. The outcomes were (1) recurrence after 28 days of stroke and (2) all adverse events related to stroke after 12-month follow-up.
ResultsOf 432 patients (n=216, 50%, in each group), stroke recurrence was observed 14 (6.5%) patients in the IG and 8 (3.7%) patients in the CG, and the difference was not significant (P=.19). Death was lower in the IG (n=39, 18.1%, vs n=56, 25.9%) compared to the CG. In Cox regression analysis, the unadjusted model showed death was significant (hazard ratio [HR] 1.531, 95% CI 1.017-2.304; P=.04); however, the difference was not significant after adjusting the mRS score at baseline (HR 0.818, 95% CI 0.540-1.238; P=.34). Patients’ medication adherence significantly improved at 6-month (P<.001) and 12-month (P=.002) follow-up after the intervention.
ConclusionsThis study failed to demonstrate the effectiveness of health education in reducing recurrence, death, and stroke-related adverse events. However, health education enhanced medication adherence. Some causes of death could not be diagnosed due to inadequate health care systems. Further research with diagnostic facilities and a long observation period is necessary to explore the underlying cause of recurrence. The results suggest the importance of structuring acute care management for patients with stroke into the health care system of Bangladesh.
Trial RegistrationClinicalTrials.gov NCT05520034; https://clinicaltrials.gov/ct2/show/NCT05520034 |
| format | Article |
| id | doaj-art-12cb6f0024714cfcaf9cf98665656337 |
| institution | OA Journals |
| issn | 2369-2960 |
| language | English |
| publishDate | 2025-05-01 |
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| series | JMIR Public Health and Surveillance |
| spelling | doaj-art-12cb6f0024714cfcaf9cf986656563372025-08-20T01:56:45ZengJMIR PublicationsJMIR Public Health and Surveillance2369-29602025-05-0111e7223310.2196/72233Effectiveness of a Health Education Program to Reduce Recurrence of Stroke by Controlling Modifiable Risk Factors in a Specialized Hospital in Bangladesh: Randomized Controlled TrialMahabuba Afrinhttps://orcid.org/0009-0007-5136-3062K A T M Ehsanul Huqhttps://orcid.org/0000-0002-7637-0759Sharif Uddin Khanhttps://orcid.org/0009-0006-9440-6395Subir Chandra Dashttps://orcid.org/0000-0002-9406-0690Mohammad Shah Jahirul Hoque Chowdhuryhttps://orcid.org/0000-0003-0275-2276Yasuko Fukuokahttps://orcid.org/0000-0001-5235-1142Yasuko Fukushimahttps://orcid.org/0000-0003-3693-4799Michiko Moriyamahttps://orcid.org/0000-0002-9190-8705 BackgroundHealth education could be an effective way to increase knowledge regarding behavioral changes to prevent the recurrence of stroke; however, the evidence is ambiguous. A lack of both knowledge and compliance with treatment to control modifiable risk factors and unhealthy lifestyles increases the risk of stroke recurrence. ObjectiveThis study aimed to evaluate the effectiveness of a health education program among patients with stroke postdischarge and their family caregivers in a tertiary specialized hospital in Bangladesh to reduce stroke recurrence by controlling modifiable risk factors. MethodsA parallel (1:1), open-label, prospective randomized controlled trial was conducted in Bangladesh. A total of 432 patients with first-time stroke, aged ≥18 years and a modified Rankin Scale (mRS) score of 0-4, were randomly enrolled at the National Institute of Neuroscience & Hospital. We stratified the patients by age and type of stroke and randomly allocated to an intervention group (IG) and a control group (CG). We collected sociodemographic and clinical data by using a structured questionnaire. The IG received (self) management education, including monitoring blood pressure (BP), medication, diet, and exercise for 12 months, and the CG received usual care. The outcomes were (1) recurrence after 28 days of stroke and (2) all adverse events related to stroke after 12-month follow-up. ResultsOf 432 patients (n=216, 50%, in each group), stroke recurrence was observed 14 (6.5%) patients in the IG and 8 (3.7%) patients in the CG, and the difference was not significant (P=.19). Death was lower in the IG (n=39, 18.1%, vs n=56, 25.9%) compared to the CG. In Cox regression analysis, the unadjusted model showed death was significant (hazard ratio [HR] 1.531, 95% CI 1.017-2.304; P=.04); however, the difference was not significant after adjusting the mRS score at baseline (HR 0.818, 95% CI 0.540-1.238; P=.34). Patients’ medication adherence significantly improved at 6-month (P<.001) and 12-month (P=.002) follow-up after the intervention. ConclusionsThis study failed to demonstrate the effectiveness of health education in reducing recurrence, death, and stroke-related adverse events. However, health education enhanced medication adherence. Some causes of death could not be diagnosed due to inadequate health care systems. Further research with diagnostic facilities and a long observation period is necessary to explore the underlying cause of recurrence. The results suggest the importance of structuring acute care management for patients with stroke into the health care system of Bangladesh. Trial RegistrationClinicalTrials.gov NCT05520034; https://clinicaltrials.gov/ct2/show/NCT05520034https://publichealth.jmir.org/2025/1/e72233 |
| spellingShingle | Mahabuba Afrin K A T M Ehsanul Huq Sharif Uddin Khan Subir Chandra Das Mohammad Shah Jahirul Hoque Chowdhury Yasuko Fukuoka Yasuko Fukushima Michiko Moriyama Effectiveness of a Health Education Program to Reduce Recurrence of Stroke by Controlling Modifiable Risk Factors in a Specialized Hospital in Bangladesh: Randomized Controlled Trial JMIR Public Health and Surveillance |
| title | Effectiveness of a Health Education Program to Reduce Recurrence of Stroke by Controlling Modifiable Risk Factors in a Specialized Hospital in Bangladesh: Randomized Controlled Trial |
| title_full | Effectiveness of a Health Education Program to Reduce Recurrence of Stroke by Controlling Modifiable Risk Factors in a Specialized Hospital in Bangladesh: Randomized Controlled Trial |
| title_fullStr | Effectiveness of a Health Education Program to Reduce Recurrence of Stroke by Controlling Modifiable Risk Factors in a Specialized Hospital in Bangladesh: Randomized Controlled Trial |
| title_full_unstemmed | Effectiveness of a Health Education Program to Reduce Recurrence of Stroke by Controlling Modifiable Risk Factors in a Specialized Hospital in Bangladesh: Randomized Controlled Trial |
| title_short | Effectiveness of a Health Education Program to Reduce Recurrence of Stroke by Controlling Modifiable Risk Factors in a Specialized Hospital in Bangladesh: Randomized Controlled Trial |
| title_sort | effectiveness of a health education program to reduce recurrence of stroke by controlling modifiable risk factors in a specialized hospital in bangladesh randomized controlled trial |
| url | https://publichealth.jmir.org/2025/1/e72233 |
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