SystemChangeTM-Stroke: A Systems Approach to Healthy Living after Stroke in Thailand.

다국어 초록 (Multilingual Abstract)

Stroke is a chronic disease and stroke recovery is a dynamic process that requires long-term lifestyle changes. For stroke patients, modifying lifestyle behaviors and daily routines are key to stroke recovery and secondary prevention. However, to date, the best strategy to maximize lifestyle changes in Thai stroke patients remains unknown. There is an emphasis on using individualized and systems approaches to change habits. Recently, evidence suggests SystemCHANGE(tm) as a promising new behavior change approach focusing on modifying families’ daily routines by using a series of small self-designed experiments. The purpose of this study was to investigate the effectiveness of SystemCHANGE(tm) on healthy eating, physical activity, and medication adherence over a 3-month period in Thai adults following stroke. A hundred and ten subjects were randomly recruited from a list of consecutive patients discharged from stroke units at King Chulalongkorn Memorial Hospital (KCMH), Bangkok, and Hua-Hin Hospital (HHH), Prachuap Khiri Khan, Thailand to the study. Subjects were randomly assigned to SystemCHANGE(tm)-Stroke and Enhanced Usual Care equally. The SystemCHANGE(tm)-Stroke intervention consisted of an initial home visit, 4 face-to-face group sessions, and 3 coaching telephone calls delivered by trained registered nurses (RNs). Data were collected at baseline and at 3 months following completion of the program using an in-person interview about health behaviors, potential mediators and potential moderators. A hundred and eight subjects completed the study. Data were analyzed using analysis of covariance and multiple linear regression.Results indicated that SystemCHANGETM-Stroke was effective to change healthy eating, number of MET-minutes/day, number of minutes/day in moderate and vigorous physical activity, number of minutes/day in walking and medication adherence. Systems thinking, social support and patient activation were found to be underlying mechanisms of SystemCHANGETM. Lower income households consumed less healthy food as compared to those who earned more income. Subjects in KCMH had greater response to the SystemCHANGETM- Stroke intervention on physical activity. Findings from this study provide empirical evidence that support the effectiveness of SystemCHANGE(tm), specifically in Thai people. SystemCHANGE(tm), focusing on systems thinking skills and process improvement, shows promise to promote health behavior change. Future research should consider examining the effectiveness of SystemCHANGE(tm) over a longer period and in different populations, as well as the inclusion of systems thinking as an important factor for health behavior change.