Abstract
Introduction: We recently completed an intervention study (n=3,843) demonstrating that a monetarily incentivized mailing is associated with patient activation, defined as calling a stroke coordinator to discuss risk reduction. This study was carried out in two diverse healthcare systems: Eskenazi Health System (EHS) and the Richard L. Roudebush Veterans’ Administration Medical Center (VA). The purpose of this secondary analysis was to identify factors associated with readiness to change stroke risk behaviors among patients who called the coordinator. Methods: Patients who responded to a mailed stroke risk message participated in a standardized interview assessing their perceptions of stroke risk, possible risk reduction behaviors, and readiness to change. The stroke coordinator rated patients’ readiness to change based on the Transtheoretical Model stages of change: pre-contemplation, contemplation, preparation, action, or maintenance. Readiness (yes/no) was defined as being in the action or maintenance stage. Additional data collected included demographics, stroke risk factors, Framingham Stroke Risk Score, Charlson Comorbidity Index, and median income/percent poverty by zip code. We used Fisher’s exact test for categorical variables and either a two-sample T-test or Wilcoxon rank-sum test for continuous variables to analyze differences between readiness to change by site. Logistic regression was conducted with readiness to change as the outcome, adjusting for site and significant variables from bivariate associations. Results: 238 EHS and 387 VA patients called the coordinator. 87 (37%) EHS and 172 (44%) VA patients were categorized as ready to change. Self-reported excellent/very good health was associated with readiness to change (OR 2.30, 1.40-3.77, p=0.001), as was having personally made significant health changes or knowing someone who had (OR 1.74, 1.24-2.44, p=0.001). Smoking was negatively associated with readiness to change (OR 0.46, 0.29-0.73, p=0.001). Site, gender, race, and income/poverty were not associated with readiness to change. Conclusions: Less than half of high-risk patients who called a stroke coordinator were ready to change stroke risk-related behaviors. Behavioral modification interventions may benefit from focusing on modifying self-perceptions of health and on making small health changes to improve patients’ readiness to change modifiable stroke risk factors.
Published Version
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