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

• Main Author: Said, Mohamad Zarudin Mat
• Format: Thesis
• Language: English
• Published: 2022
• Subjects: R Medicine
• Online Access: http://eprints.usm.my/53175/1/Mohamad%20Zarudin%20Mat%20Said-24%20pages..pdf; http://eprints.usm.my/53175/
• Institution: Universiti Sains Malaysia

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.