Said, Mohamad Zarudin Mat
(2022)
The effectiveness of
structured intervention programme
for stroke (sips) in improving stroke
awareness and reducing stroke risk
among adult population in Malaysia:
a cluster randomised controlled trial.
PhD thesis, Universiti Sains Malaysia.
Abstract
Background: Stroke is an enormous public health problem with an alarming
mortality rate, the burden of morbidity and disability worldwide. The scenario is
strong evidence that currently used primary prevention strategies are not sufficiently
compelling. The Stroke Riskometer™ app represents a new stroke prevention
strategy potentially bridging the gap between mass and high-risk population
approaches that can motivate and empower people to reduce their risk of stroke and
cardiovascular disease (CVD).
Objective: This study aimed to evaluate the effectiveness of the Stroke Riskometer™
app as part of the Structured Intervention Programme for Stroke (SIPS) in improving
stroke awareness and reducing stroke risk among the adult population in Malaysia.
Methods: A parallel-group cluster randomised controlled trial (RCT) was conducted
in Kelantan, Malaysia, with a six-week follow-up. Total 116 participants were
randomised to either the intervention group (n = 58) equipped with free Stroke
Riskometer™ app and informational leaflets or the control group (n = 58) that
received standard management. The primary outcome was stroke risk awareness
level assessed using the ABCD-M risk questionnaire at the baseline, 2–4 weeks and
sixth-week post-intervention. The secondary outcome measure was the 5- and 10-
years stroke risk probability measured using the Stroke Riskometer™ app (the control group will use the same assessment translated into the question set). Linear
mixed-effect random intercept models were used to assess the effect of the
intervention on the stroke awareness (measured by ABCD-M score), 5- and 10-year
stroke risk probability using the lme4, geepack and nlme packages. The intention-totreat
principle and the level of significance at 5% were used.
Results: The mean age of participants was 32 (SD 10.0). There were no significant
differences in baseline characteristics except monthly income. The risk awareness
was successfully improved by about 10%–12%, with the intervention group achieved
as early as the third week. The risk probability of the intervention group was
significantly reduced (–26.3%) together with the improvement of several risk factors:
body mass index (–18.5%), diastolic blood pressure (–19%), healthy diet (19%),
physical activity (22%). However, there was no significant difference between the
intervention group (awareness: β = 1.25; 95% CI, –1.42–3.92; probability (5 years):
β = –0.14; 95% CI, –0.47–0.18; probability (10 years): β = 0.03; 95% CI, –0.40–
0.46).
Conclusion: The SIPS has shown significant improvement in stroke risk awareness
and reduced the 10-years stroke risk probability. The Stroke Riskometer™ app is a
potentially effective mass app-based primary prevention strategy that can be used not
only for stroke and CVD prevention but also for primary prevention of other noncommunicable
diseases (NCDs) in Malaysia and other low- and middle-income
countries as well.
| Item Type: |
Thesis
(PhD)
|
| Uncontrolled Keywords: |
stroke |
| Subjects: |
R Medicine |
| Divisions: |
UNSPECIFIED |
| Depositing User: |
Mr Abdul Hadi Mohammad
|
| Date Deposited: |
29 Jun 2022 08:32 |
| Last Modified: |
29 Jun 2022 08:32 |
| URI: |
http://eprints.usm.my/id/eprint/53175 |
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