Improving Stroke Prevention 
Transient Ischaemic attack (TIA) is a major risk factor for stroke. When a patient is diagnosed with a TIA there is an opportunity to make changes to lifestyle and medication to reduce the risk of future stroke. Whilst the use of medication to reduce the risk of stroke, for example by reducing cholesterol or reducing blood pressure, is well established, the impact of advice addressing lifestyle risk factors, such as diet, exercise, smoking and drinking is unclear. This study explores patients’ experiences of receiving TIA follow up advice and the impact this had on their subsequent behaviour. 

Methods
This was mixed methods research. A quantitative study was carried out to describe the profile of patients using TIA services and the patterns of referral to those services. This study collected non identifiable patient data from TIA services in one large Hospital Trust between 2008 - 2010 and used this to provide a detailed description of patients seen for TIA follow up during this period. 

A qualitative study was carried out at the same time. This study used in depth interviews with a sample of patients (n=40) from five hospital and community Trusts across South Yorkshire. Interview topics included events immediately after the TIA, follow up received, changes to behaviour made or not made and reasons for this. 

Ethical approval was granted in 2010 by the South Yorkshire REC. 

Results
From the quantitative study we found that men, ethnic minority populations and the very poorest in Sheffield appear not to be accessing TIA services to the extent that the prevalence of stroke in this population might suggest that they should. We do not know whether this is because those groups do not seek help when they experience symptoms or whether they do seek help but are not referred on to TIA services appropriately.

Some of the findings from the qualitative study include the features of follow up care that influenced whether or not patients made positive changes to their lifestyle after a TIA. These were the degree to which advice resonated with patients’ previously held understandings of health and actions necessary to maintain good health; the consistency of advice given including consistency with that given in relation to co-morbidities; the timing of advice; the perceived expertise of the person giving the advice and the patient’s previous experience of TIA.

Ongoing Work
We are now working to disseminate our findings to clinicians and other health care staff, commissioners and academics.

For more information please contact:

Dr Elizabeth Croot
Email: l.croot@sheffield.ac.uk
Tel : 0114 222 8356