Influences on Preventive Health Behaviors After Stroke with Telemonitoring: Patient Perceptions and Practices in an Urban Underserved Population

Background Although Blood Pressure (BP) self-management and physical activity (PA) are secondary stroke preventive behaviors, adherence gaps exist. This study explored factors influencing these behaviors after telemonitoring experience among patients in an underserved urban community. Methods We conducted semi-structured interviews with purposive sampling of patients discharged home after mild stroke who had hypertension and participated in the Telehealth After Stroke Care (TASC) trial. Self-reported short form (SF) surveys included Patient Reported Outcomes Measurement Information System-Physical Function-SF, International Physical Activity Questionnaire-SF, and University of Rhode Island Change Assessment. The first interview assessed knowledge of BP and PA guidelines with perceived barriers, facilitators and BP telemonitoring experience, while the second was after PA monitoring for one month. We performed open (inductive) and social cognitive theory-based (deductive) coding. Results We included 14 participants: mean age 59 ± 9.6 years; 7 women (50%); 57% Black, 29% Hispanic; 29% ≤ high school education, 43% Medicaid or no insurance. Mean daily step count was 5147 ± 2534. Three themes interpreted included: 1) positive outcome expectations; 2) self-efficacy; and 3) agency. Participants associated BP control with reduced recurrence risk and PA to functional recovery (1) but lacked knowledge of specific targets (2). High self-efficacy individuals (2) used action planning to navigate environmental constraints. Both BP and PA monitoring with feedback facilitated self-regulation, goal setting and problem solving (3). Conclusion Gaps between knowledge of and participation in health behaviors after stroke persist. Targeting outcome expectations, self-efficacy, and agency through educated training, tailored support, and telemonitored feedback may promote sustained positive health behaviors.