Dorien Brouwer

101 Health education in patients with recent stroke or transient ischemic attack PART 2 Improving health education in stroke and TIA patients Basic knowledge of stroke and TIA patients of their disease and associated risk factors is not sufficient. This is observed in patients with CAD and in the general population as well. The preventive effect on the occurrence of major vascular events of interventions focusing on improvement of stroke knowledge has not been conclusively demonstrated, but a tendency towards a positive effect on knowledge of warning signs and vascular risk factors in public and patients can be observed. No specific method of HE is superior, although the individual and repetitive, active methods seemmore successful. There is no conclusive effect of active information aimed at stroke patients on the modification of health behavior, risk reduction or outcome measurements. Trials in patients with CAD have provided promising results. [80,81] Two randomized trials showed considerable improvement in lifestyle. Compared with trials in stroke patients, these trials includedmore patients, involved partners more actively and used intensive and repetitive ways of HE with active participation of the patients. Moreover, they had a longer follow-up period than trials in stroke patients. Knowledge is a necessary factor for inducing change, but the process of modification of risk factors is a multistaged and complex one, requiring the right attitude, motivation and capacity to change behavior. HE provides a different approach to the reduction of stroke death and disability. Moreover, HE may be used to improve medication compliance. The first step in modification of risk factor behavior is improvement of the quality of the provided information. The HE provided by physicians is often based upon what health professionals think patients should know. Reports have demonstrated that patients are dissatisfied with the content of stroke information. [12] The question is whether this is only due to quality of the information or to the mental and emotional status of the patient, who may have difficulty in retaining information. Three levels should be discerned when one provides HE to stroke patients, HE about nature and manifestations of stroke, about prognosis and rehabilitation and about risk factor management and prevention. It is likely that patients are generally more interested in their prognosis and rehabilitation possibilities, and physicians in risk factor modulation and lifestyle advices. Many educational programmes are hospital based, the time when patients are least able to retain information. HE about stroke should start during the acute phase, and should be continued after discharge, and should preferably be provided by the same persons. Interactive stroke-specific software may offer an opportunity, with possibility of accessibility, repetition, but with the disadvantage of missing personal information. Stroke specialist nurses or nurse practitioners may play an important role in providing information in HE to TIA and stroke patients. In conclusion, the information should address the patients’ issues, needs and concerns. The information should be patientcentred, interactive, personalized, flexible and repetitive. It should create opportunities to apply the new knowledge that leads to attitude changes. HE is a time-consuming way of preventive medicine for stroke physicians. Studies