Secondary prevention of stroke following Transient Ischaemic Attack : a mixed methods study

The purpose of this thesis was to inform the development of a complex intervention for improving secondary stroke prevention in people who have experienced a Transient Ischaemic Attack (TIA). The work was guided by the Medical Research Council (MRC) framework for the development and evaluation of complex interventions. A mixed methods approach was taken, incorporating three inter-related studies. The first study was an audit investigating the quality of secondary stroke prevention in primary care following diagnosis of TIA in a specialist clinic. The second study was a systematic review of randomised controlled trials evaluating the effectiveness of stroke service interventions for secondary stroke prevention. The third study was a qualitative study, involving 20 interviews with TIA patients, using a discursive psychology approach to explore barriers and facilitators to secondary stroke prevention. Key findings: • Results of the audit demonstrated that monitoring and achievement of risk factor control in primary care was suboptimal; potential areas for quality improvement included blood pressure (BP) control, lipid control and provision of dietary and exercise advice. • Findings from the systematic review indicated that organisational interventions were associated with significant reductions in mean systolic BP, diastolic BP and body mass index (BMI). • The qualitative study, through an analysis of the ‘action-orientation’ of participants’ accounts, identified discursive features that functioned to justify adherence or non-adherence to recommendations for secondary stroke prevention. The key findings from these studies indicated that an organisational intervention should be developed based on the principles of integrated care. The qualitative study provided insights for understanding and optimising the intervention. Based on these findings, recommendations are made for further intervention development work. The findings also have relevance to the development and application of the MRC framework; efforts should be directed towards developing practical guidance for the integration of mixed methods research.