Dorien Brouwer

93 Health education in patients with recent stroke or transient ischemic attack PART 2 or handicaps after stroke often result in increased needs of personal care and training at home or in a rehabilitation facility. Physical handicaps like even a mild paresis or language disorder as a consequence of stroke make it difficult to induce physical behavioral changes. Cognitive impairment after stroke may reduce the patient’s ability to understand, retain and apply information provided through HE. Stroke and TIA patients and their partners generally wish to be informed about all aspects of their disease. Although information is provided to patients in hospital or after discharge, the patients’ quest for information often cannot be met. A review indicated that patients and family are often dissatisfied with the content and quality of the provided stroke information about the causes, consequences and secondary preventive measures of stroke. [12] The HE for patients with stroke and TIA may fulfill information needs at least at three different levels. On the first level, patients wish to be informed about the manifestations and nature of their disease. On the second, patients need information about short- and long-term prognosis, including rehabilitation options. On the third level comes the need for HE focused on risk factor management and prevention of recurrent vascular events, which is more often a doctor’s concern than a patient’s need. During their disease, stroke and TIA patients experience different phases. The coping strategies are often aimed at actively adjusting circumstances to personal preferences and thus striving to maintain life as it was before the stroke (assimilative coping). Once the options of changing one’s situation have been exhausted, coping changes into attempting to accept the consequences of the stroke by adjusting personal preferences and goals (accommodative coping). [13] In these different phases, different information is needed. It is likely that information concerning long-term risk and related health behavior will only meet fertile grounds when patients are in the phase of accommodative coping. We have reviewed the status and effect of HE in patients with stroke and TIA on different targets as indicated in Fig. 1. We will first focus on studies of HE in stroke and TIA patients, aiming at feasibility, and effectiveness at the level of knowledge, attitude and skills, health behavior changes and stroke outcome. Progress in affiliated health domains, such as coronary artery disease (CAD), may help and inspire the development of HE in stroke and TIA patients. Second, we will describe the current status of HE for patients with recent CAD and we will summarize what is known about effective and feasible approaches to public HE in stroke.