Behavioral Interventions for Stroke Prevention
The Need for a New Conceptual Model
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
- behavior modification
- primary prevention
- risk factors
- secondary prevention
- social determinants of health
Social and behavioral factors, also termed social determinants of health, are increasingly established risk factors for incident and recurrent stroke, both ischemic and hemorrhagic stroke, yet improvement in addressing these factors remains insufficient.1 There is a lack of clarity on who should share in accountability for reducing risk (eg, patients, providers, or health systems) and what interventions are practical, cost-effective, and scalable.2 For the purpose of this review, we will use the definition of an intervention as a set of actions with a coherent objective to bring about change or produce identifiable outcomes.3 We first review the published literature to summarize the relevant research on previous behavioral interventions for prevention of stroke and other related conditions, the theoretical frameworks underpinning these behavioral interventions, and then propose a new conceptual model for more effective implementation of social and behavioral interventions for stroke prevention. Successful implementation will require adequately addressing the known inherent barriers to behavioral interventions and the ambiguity of financial responsibility and accountability among the various stakeholders. Because new tools, such as digital phenotyping, social network analysis, machine learning, and gamification, have emerged for facilitating, measuring, and improving existing behavioral interventions, a promising new paradigm in behavioral change has emerged.
Behavioral Interventions in Stroke
Table 1 categorizes the various behavioral interventions by operational level, risk factor targets, and tactics that range from the simple (eg, provider referral for behavior change program) to the complex (eg, multifaceted, multidomain intervention).4 Table 2 summarizes the prior interventions specific to stroke prevention covered in 3 major systematic Cochrane reviews. Because the evidence suggests that modifiable risk factors are often not effectively managed after a stroke or transient ischemic attack, the first review sought to identify interventions for improving control of 6 major modifiable risk factors5 of blood pressure, lipids, atrial fibrillation, diabetes mellitus, …