The Relationships Between External Risk Factors and Awareness of Stroke on Attitude of Stroke Recurrent Preventative Behavior in Patients with Stroke
Keywords:
external risk factors, awareness, attitude toward recurrence prevention behaviorsAbstract
This correlational research aimed to investigate the relationships between external risk factors, awareness of stroke recurrence, and attitudes toward recurrence prevention behaviors among stroke patients at Debaratana Nakhon Ratchasima Hospital, Nakhon Ratchasima Province. A purposive sample of 104 participants was recruited. Data were collected between March and April 2024 using a four-part questionnaire including sections on Personal Data, External Risk Factors, Awareness for Recurrence Prevention, and Attitudes toward Recurrence Prevention. The questionnaire demonstrated high reliability, with section reliabilities of 0.96, 0.78, and 0.93, respectively, and an overall reliability of 0.88. Data analysis involved descriptive statistics (frequencies, percentages, means, standard deviations). The relationships between external risk factors and behavioral attitudes were analyzed using Chi-squared tests, while the relationships between awareness and behavioral attitudes were analyzed using Spearman’s rank correlations.
The findings revealed that stress was the only extrinsic risk factor significantly associated with the participants’ attitudes toward recurrent stroke prevention behaviors (p< .05). Regarding the relationship between awareness of stroke occurrence and attitudes toward prevention behaviors, the results indicated that beliefs (r= 0.43) and self-practices (r= 0.31) had moderate positive correlations with the participants’ attitudes toward prevention behaviors with statistical significance (p< .01). In contrast, knowledge about the disease was not significantly associated with their attitudes toward prevention behaviors (p> .05). The study suggests that health teams should emphasize stress reduction and strengthen self-efficacy (or confidence in prevention), as well as support correct self-ractices. This should be provided alongside health education to promote a positive attitude toward recurrence prevention.
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References
World Stroke Organization. What is stroke? [Internet]. 2020 [cited 2020 Jan 19]. Available from: http://www.worldstrokecampaign.org/Facts/Pages/WhatisStroke.aspx
World Stroke Organization. Global Stroke Fact Sheet 2025. [Internet]. London: World Stroke Organization; 2025 [cited 2025 Jul 10]. Available from: https:// doi.org/10.1177/17474930241308142.
Panwilai J, Maneeratana N, Puanphai S, Srisawat S, Duangsanjun W. Correlation between knowledge, health belief and stroke prevention behavior among older people with stroke risk in Chiang Mai Neurological Hospital. Regional Health Promotion Center 9 Journal. 2022;16(3):882-95. (in Thai)
Department of Disease Control, Ministry of Public Health, Thailand. Health statistics report 2023: stroke cases, mortality rate [Internet]. Nonthaburi: DDC; 2025 Jan 15 [cited 2025 Aug 30]. Available from: https://spd.moph.go.th/wpcontent/uploads/2025/01/
Department of Disease Control. Stroke situation report, Health Region 9, 2023. Nakhonratchasima: Office of Disease Prevention and Control 9; 2023. (in Thai)
Phumithaworn N, Butrchumsang A, Rungreung S, editors. Annual Report 2024, Division of Non-communicable Diseases. Bangkok: Strategic Planning and Evaluation Group, Akson Graphic & Design Publishing; 2024. (in Thai)
Temprom P, Phonphet C, Suwanno J, Chaimay B, Woradet S. Prevalence of high risk of recurrent stroke and factors associated with high risk of recurrent stroke among acute ischemic stroke patients. Thai Journal of Cardio-Thoracic Nursing. 2021;32(2):59-72. (in Thai)
Roth GA, Johnson C, Abajobir A, Abd-Allah F, Abera SF, Abyu G, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. Journal of the American College of Cardiology, 2017;70(1):1-25. doi:10.1016/j.jacc.2017.04.052.
Chareonsin S. Factors affectings stroke prevention behavior in hypertension patients, Mueang District, Nakhon Sawan Province [Master’s thesis]: Naresuan University of Thailand; 2021. (in Thai)
Puthkhao P, Hanchaiphiboolkul S, Theerawanviwat D. Factors predicting stroke mortality in Thailand: Thai Epidemiologic Stroke Study. Journal of the Medical Association of Thailand 2020;103(12):1335-44. (in Thai)
Taweephol T, Saksit P, Hiransuthikul A, Vorasayan P, Akarathanawat W, Chutinet A. Incidence of recurrent ischemic stroke and its associated factors in a tertiary care center in Thailand: A retrospective cohort study.BioMed Central neurology. 2024;24(1):1-9. doi:10.1186/s12883-024-03640-0.
Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D, et al. Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline from the American Heart Association/American Stroke Association. Stroke. 2021;52(7):e364-7. doi:10.1161/STR.0000000000000375.
Chantkran W, Chaisakul J, Rangsin R, Mungthin M, Sakboonyarat B. Prevalence of and factors associated with stroke in hypertensive patients in Thailand from 2014 to 2018: A nationwide cross-sectional study. Scientific Reports. 2021;11:17614. doi:10.1038/s41598-021-96878-4.
Samuthpongtorn C, Jereerat T, Suwanwela NC. Stroke risk factors, subtypes and outcome in elderly Thai patients. BioMed Central neurology. 2021;21:322. doi:10.1186/s12883-021-02353-y.
Ong-aram U, Niphawan S. Influences of caregivers' preparedness, caregivers' burden and caregivers' rewards on adaptation of caregivers caring for patients with stroke. Journal of Nursing Division. 2019;46(3):73-87. (in Thai)
Banchanon K, Toskulkao T, Changmai S. Factors influencing recurrent preventative behavior of stroke patients based on transition theory. Thai Journal of Nursing. 2022;71(3):54-62. (in Thai)
Banchanon K. Factors influencing recurrent preventive behavior and well-being of stroke patients based on transition theory. Master of Nursing Science. Thailand: Christian University of Thailand; 2022. (in Thai)
Information Center, Debaratana Nakhon Ratchasima Hospital. Service Quality Development Work. Nakhon Ratchasima. Debaratana Hospital Nakhon Ratchasima Hospital; 2024. (in Thai)
Yamane T. Statistics: An Introductory Analysis. 2nd ed. New York: Harper and Row; 1973.
Stults-Kolehmainen MA, Sinha R. The effects of stress on physical activity and exercise. Sport and Exercise Medicine. 2014;44(1):81-121. doi:10.1007/s40279-013-0090-5.
Tangnitipong S, Vuttanon N, Pothiban L, Chintanawat R. Effectiveness of a home-based coping enhancement program for stroke Survivors: A randomized controlled trial. Pacific Rim International Journal of Nursing Research. 2022;26(4):585-99. (in Thai)
Detkaew A, Samartkit N, Masingboon K. Relationships of perceived self-efficacy, lifestyle stress, and social support to health behaviors in adults with acute coronary syndrome post percutaneous coronary intervention. The Journal of Faculty of Nursing Burapha University. 2021;29(2):71-80. (in Thai)
Pinkaeo T, Thiangthum W, Pichayapinyo P. The effects of the application of the health belief model and family support program on recurrence stroke prevention among first episode stroke survivors dwelling in a rural community. Nursing Journal of the Ministry of Public Health. 2022;32(3):36-51. (in Thai)
Sittiyodying C. Prevention of stroke among patients with uncontrolled hypertension: The correlations between health beliefs and self-care behaviors. Journal of Health Sciences and Pedagogy. 2022;2(2):46-60. (in Thai)
Wongchana T. Factors affecting to preventive behavior of stroke patients among uncontrolled-hypertensive patients in Muang District, Phitsanulok Province [Master’s thesis ]: Naresuan University of Thailand; 2021. (in Thai)
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