Perceptions of recurrence risk and behavioural changes among first-ever and recurrent stroke survivors: A qualitative analysis

Beilei Lin, Zhenxiang Zhang, Yunfei Guo, Wenna Wang, Yongxia Mei, Shanshan Wang, Yao Tong, Nazia Shuaib, Daphne Cheung

Research output: Journal article publicationJournal articleAcademic researchpeer-review

1 Citation (Scopus)


Background: Among stroke survivors, the risk of stroke recurrence is high, and stroke survivors' perception of the risk of recurrence is crucial to promote healthy behaviours. 

Objectives: This study aimed to explore the perceptions of stroke survivors about their risk of recurrence and healthy behavioural modifications. 

Design: A qualitative interview study was carried out. 

Results: We interviewed 19 stroke survivors from 3 hospitals. Thematic analysis showed that the perceptions of recurrence risk and healthy behavioural changes differed between first-ever and recurrent stroke survivors. Three themes were generated from the data of first-ever stroke survivors: indifference to and unawareness of the risk of stroke recurrence, the need for professional information support and different awareness of the importance of different healthy behaviours. For first-relapse stroke patients: worry but feel powerlessness towards recurrent event, accurate information is still warranted, regret of unhealthy behaviour patterns. For the survivors suffered two or more times recurrences: perceived severity of recurrences, increased psychological care need, incorrect perceptions of healthy behaviour. 

Discussion and Conclusion: Stroke survivors with or without recurrence hold different perceptions towards the risk of recurrence and behavioural changes. The need for information related to warning signs, recurrence risk and risk factors remained consistently unmet. The benefits of healthy behaviours could be a double-edged sword for the prevention of stroke recurrence if the survivors fail to understand these accurately. It is strongly recommended that a specific recurrence risk communication tool and related health education plan be explored on the basis of the number of times patients have experienced stroke recurrence to inform secondary prevention of stroke in the future. 

Patient/Public Contribution: The patients were involved in the formulation of interview questions and conduct of this study. No public was involved in this study.

Original languageEnglish
Pages (from-to)1962-1970
Number of pages9
JournalHealth Expectations
Issue number6
Publication statusPublished - Dec 2021


  • healthy behaviour
  • perception
  • qualitative
  • recurrent risk
  • stroke

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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