The effect of a mobile-based educational program on knowledge of stroke prevention, lifestyle changes and health-related quality of life among middle-aged adults at risk of stroke in China / Liu Cui

Lyu , Fang Fei (2024) The effect of a mobile-based educational program on knowledge of stroke prevention, lifestyle changes and health-related quality of life among middle-aged adults at risk of stroke in China / Liu Cui. PhD thesis, Universiti Malaya.

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Abstract

Stroke is a significant global public health concern, ranking as the primary cause of both death and disability. Alarmingly, most stroke-related fatalities are concentrated in low- and middle-income nations. China currently bears the highest burden of stroke cases and associated mortality worldwide, accounting for nearly 30% of all stroke-related deaths. The purpose of this study is to develop and evaluate a mobile-based educational program on knowledge of stroke prevention, lifestyle changes, and health-related quality of life among middle-aged adults at risk of stroke in China. This study adopted an exploratory mixed-method design which includes 2 phases. Phase 1 was to design and develop the mobile-based educational program which included qualitative focus group discussions to assess the needs of participants at risk of stroke, evaluation by a panel of multidisciplinary experts, development, and usability test of the program. The outcomes of phase 1 indicated that the mobile-based educational program provides a simple platform that can be easily operated by a wide variety of users with a risk of stroke and the content is highly relevant to their physical condition and daily life. Phase 2 was a quasi-experimental study, employing a non-randomized concurrent controlled trial, to assess the impact of mean differences within and between the intervention and control groups on dietary intake, physical activity, knowledge related to stroke prevention, and health-related quality of life. Four instruments were used in this study including the Stroke Knowledge Questionnaire, the Simplified Food Frequency Questionnaire Chinese version (FFQ-25), the International Physical Activity Questionnaire short form (IPAQ-SF), the abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-BREF) Chinese version. The results of phase 2 showed that the mobile-based educational program had effectively increased the food intake among these middle-aged adults, followed by the difference of change in mean value between intervention and control groups in physical activity, and there was an increase in the post-stroke prevention knowledge scores, with the intervention group obtaining a higher score than the control group. This study has provided a promising mobile application intervention solution for middle-aged individuals at risk of stroke. This research has the potential to offer more effective tools for stroke prevention and management, improving the lifestyle of at-risk individuals, raising awareness of health issues, and reducing the risk of stroke. Keywords: Primary stroke prevention; Diet; physical activity; Health-related quality of life; Middle-aged adults consequences of primary osteoporosis in older patients. This study was based on the theory of functional consequences and adopted a quantitative design comprising two phases. Phase one is an adaptation and feasibility study for the ME programme while phase two is a randomised controlled trial to assess the effects of the exercise programme. Phase one was conducted between October 2022 to February 2023, and phase two was conducted between February 2023 to October 2023 at the Pain Department of the First Affiliated Hospital of Yunnan University of Chinese Medicine. A total of 128 patients who met the study criteria were enrolled and randomised to the control or intervention group. Scores on the heart rate and rating of perceived exertion were assessed during the first week of the intervention to ensure the strenuousness of the exercise programme. The other variables (pain, balance, mindfulness, kinesiophobia, anxiety and depression) were measured using the Chinese version of validated instruments (Global Pain Scale, Timed Up and Go test, Five Facet Mindfulness Questionnaire-Short Form, Tampa Kinesiophobia-11 Scale, Hospital Anxiety and Depression Scale) at five-time points: T0 (baseline: pre-intervention), T1 (Week 4: during), T2 (Week 8: during), T3 (Week 12: immediately post-intervention) and T4 (Week 16: 4 weeks post-intervention). Descriptive statistics were computed for all variables. Normality and homogeneity of the variances were tested using the Shapiro-Wilk and Levene tests, respectively. The data was analysed using the generalized estimating equation (GEE) model to test the main and interaction effects of group (independent factor) and time (repeated-measures factor) on the variables. The results revealed significant improvements in pain dimension of the GPS (T3, and T4), feelings dimension of the GPS (T3), balance (T3), mindfulness (T1, T2, T3, and T4), kinesiophobia (T2, T3, and T4), anxiety (T2, T3, and T4) and depression (T3, and T4) in the intervention group compared with the control group (all p < 0.05). No significant between-group differences at T3 in clinical outcomes and activities dimension of the GPS were identified (all p > 0.05). This study rigorously investigated the effectiveness of an adapted ME programme in enhancing both physical and psychological outcomes among older patients with primary osteoporosis. In addition, the findings of this study provided the baseline information and influence factors on all the study parameters in the Chinese context to raise awareness of osteoporosis. Besides that, the study furnished evidence-based insights into the effectiveness of the ME programme for older patients, particularly in alleviating pain, anxiety, and depression, while also enhancing balance ability.

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