Background: There is an urgent need to develop effective strategies to improve stroke outcomes in Sub-Saharan Africa (SSA), where use of evidence-based therapies among patients receiving conventional care is poor. Designs of behavioral interventions to improve stroke care in SSA need to be sensitive to both individual and community factors (including local perceptions and public policies) contributing to the likelihood of compliance with recommended therapeutic goals. This article presents a community-based participatory research protocol that will evaluate systems and processes affecting the continuum of stroke-preventive care in an SSA country.
Methods: Phase 1 of the Tailored Hospital-based Risk Reduction to Impede Vascular Events study will be implemented from 2013 to 2014 at 4 different types of hospital settings in Nigeria. Six adult stroke survivor focus group discussions and six caregiver focus group discussions, each lasting about 120 minutes will be conducted. Each group will comprise 6 to 8 participants. We will also conduct 22 semi-structured key informant interviews (informed by the Theoretical Domains Framework) with several types of providers and hospital administrators. Purposive and maximum variation sampling will be used to identify and recruit participants from participating hospitals. Transcript data will be analyzed by reviewers in an iterative process to identify recurrent and unifying themes using a constructivist variant of the grounded theory methodology, and will involve participatory co-analysis with key stakeholders to enhance authenticity and veracity of findings.
Discussion: On the basis of the results of Tailored Hospital-based Risk Reduction to Impede Vascular Events phase 1, we intend to develop a culturally sensitive, system-appropriate, multipronged intervention whose efficacy to boost adherence to evidence-based stroke-preventive care will be tested in a future randomized trial (phase 2).
From the *Department of Medicine, University of Ibadan, Nigeria; †Department of Medicine, Federal Medical Center, Abeokuta, Nigeria; ‡Department of Family and Preventive Medicine, University of California, San Diego, CA; §Department of Health Promotion and Education, University of Ibadan, Ibadan, Nigeria; ¶Department of Economics, University of Ibadan, Ibadan, Nigeria; ‖Division of Biostatistics and Epidemiology, Medical University of South Carolina, Charleston, SC; and **Department of Neurosciences, Medical University of South Carolina, Charleston, SC.
Supported by National Institute of Neurological Disorders and Stroke (NINDS)—Award Number U01 NS079179.
Reprints: Bruce Ovbiagele, MD, MSc, MAS, Department of Neurosciences, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB 301, MSC 606, Charleston, SC 29425. E-mail: firstname.lastname@example.org.