الفهرس 
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Abstract
Summary
Cerebrovascular stroke (CVS) is a devastating disease and a medical emergency situation sometimes called a brain attack. It is the second leading cause of death and the major cause of long term, physical, psychological and social disability in the elderly around the world. Nearly
17 million people worldwide are affected with CVS annually with a mortality rate among them up to 6 million, and about 25% of all CVS are considering recurrent stroke. Stroke is an injury to the brain that has significant effects that extend far beyond the health of individual to the family and the community (World Health Organization (WHO), 2018).
Poor compliance to life style modifications remains a significant problem facing health care providers in all settings as it can lead to unnecessary disease progression and occurrence of complications, more over reduced functional abilities & quality of life, and increase time of hospital stay and hospital cost. It has been reported that compliance to life style modifications and therapeutic regimen may be less than 50%. Furthermore, half of patients after stroke stop taking medications as well as two third of patients also stop follow up with physicians
(Nguyen, Caze and Cottrell, 2014).
Aim of the study:
This study aimed to assess factors affecting compliance with life style modifications among patients suffering from recurrent cerebrovascular stroke through:
1. Assessing patients’ knowledge regarding stroke and its associated life style modifications.
2. Assessing patients’ compliance to life style modifications.
3. Assessing the factors affecting compliance to life style modifications among patients suffering from recurrence of cerebrovascular stroke.
Research questions:
This study was conducted for answering the following questions:
1. What is the level of compliance with life style modifications among patients suffering from recurrence of cerebrovascular stroke?
2. What are the factors affecting compliance with life style modifications among patients suffering from recurrence of cerebrovascular stroke?
Research design:
A descriptive exploratory design was used in conducting this study.
Setting:
This study was conducted at stroke out patients’ clinic at Tanta University Hospitals/ Egypt.
Subject:
A purposive sample of 70 adult patients, with old cerebrovascular stroke was selected to conduct this study through the following inclusion criteria; patients who suffering from recurrent cerebrovascular stroke and also who able to comprehend the instructions, free from another neurological disorders.
Tools for data collection:
Two tools were used in this study as the following:
1) Stroke patients’ structured interview questionnaire: (Appendix I)
This tool was developed by the researcher and written in a simple Arabic language after reviewing the relevant literatures and it was divided into the following four parts:
Part I:
• This part used to assess demographic characteristics of the studied patients such as age, gender, marital status, level of education, residence place, occupation, nature of living, and monthly income.
Part II:
• This part was concerned with assessing patients’ medical data including present and past medical history, based on the related literature Mahmoud & Abd Elaziz, 2016, Lewis, et al., 2015, Linton, 2015 and Hinkle & Cheever, 2014.
Part III:
• This part was concerned with assessing patients’ knowledge regarding stroke and its associated life style modifications, based on the related literature Grotta, et al., 2016, Ignatavicius & Workman, 2015, and Chapman & Bogle, 2014.
Part IV:
• This part was concerned with assessing factors affecting patients’ compliance to life style modifications among patients suffering from recurrent cerebrovascular stroke,
based on the related literature Guidelines for the Primary Prevention of Stroke, 2016, Martino, et al., 2016, Kamal, et al., 2015, and National Stroke Association, 2015.
2) Patients’ compliance with life style modifications assessment tool: (Appendix, II)
This tool was developed by the researcher after reviewing the relevant literatures World Health Organization (WHO), 2017, American Stroke Association 2016, National Institution of Health Stroke Scale (NIHSS) 2016, and Health Promotion & Stroke Prevention, 2014, and it was used to assess compliance with life style modifications among patients suffering from recurrence of cerebrovascular stroke.
Results of the study:
The main results of this study revealed that:
More than half of the studied patients (58.6%) had unsatisfactory level of knowledge regarding recurrent cerebrovascular stroke.
Majority of the studied patients (64.3%) had unsatisfactory level of compliance regarding recurrent cerebrovascular stroke.
The studied patients had multiple factors affecting their compliance with life style modifications as the following: about 61.4% had patient related factors, 40.0% had health care related factors, 81.4% had therapy related factors and 61.4% had disease related factors.
There was a significant relation between patients’ total level of knowledge and their educational level, nature of living, and monthly income.
There was a significant relation between patients’ total level of compliance with life style modifications and both of their residence place and type of stroke.
There was no significant correlation between total level of knowledge, total factors and total compliance regarding cerebrovascular stroke and its recurrent.
Conclusion:
Based up on the results of current study, it concluded that:
Less than two third of the studied patients who suffering from recurrent CVS had unsatisfactory level of knowledge and hadn’t compliance with life style modifications. As well as there were many factors affecting
their compliance with life style modifications; the most was therapy related factors, followed by patients’ related factors and disease related factors. While, health care related factors was the least. Moreover, there was a significant relation between total level of patients’ compliance and both of their residence place and type of stroke.
Recommendations:
The results of this study projected the following recommendations:
Replication of the study on large sample and in different hospitals settings in order to generalize the result.
Establishing health education programs in the hospital concerned with teaching patients importance of compliance and modifying their life styles, as well as knowing how to overcome factors affecting compliance with life style modifications as possible.
Further study is recommended to evaluate the reflection of the educational training programs regarding recurrent cerebrovascular stroke and its associated life style modifications.
Establishing cerebrovascular stroke counseling professional team to provide knowledge about recurrent cerebrovascular stroke and its associated life style
modifications.
Establishing a hot line for serious conditions that could abruptly occur.
Submission of educational handouts, posters, booklets and brochures about recurrent cerebrovascular stroke and its associated life style modifications.