Motivational Interviewing Stroke Trial

INTERVENTION: Motivational interviewing (MI) is a structured, patient‐focused, and cost‐effective intervention designed to motivate patients to adhere to medication and life‐style change recommendations. The MI group will have 4 interviews with trained research nurses. The initial interview will be in‐person with patient & family caregivers the day before hospital discharge. Remaining interviews will be done via telephone at 3, 6, and 9 months. Interviews will take up to 1 hr. The intervention will be standardised and sessions will be monitored via standard MI coding, with detailed instructions to guide sessions and ensure consistency across research nurses. Though this study examines the impact of MI on individuals’ post‐stroke, recommendations for lifestyle/medication change often fail without support from significant others. Thus, caregivers will be invited to attend the initial session, but this will not be required. Caregiver attendance will be recorded. CONDITION: stroke PRIMARY OUTCOME: adherence to medication and lifestyle changes recommended by treating physicians at and after hospital discharge in stroke patients 12 months post‐randomisation, indicated by change in systolic blood pressure (BP) and low‐density cholesterol (LDL) levels. SECONDARY OUTCOME: (1) to examine change in systolic BP levels at 3, 6 and 9 months follow‐up, and LDL‐cholesterol levels at 6 months follow‐up (2) self‐reported adherence (self‐reported use of anti‐platelet, statin and BP lowering therapy as prescribed) (3) self‐reported barriers to adherence (4) cardiovascular events (new stroke or coronary heart disease, both fatal and non‐fatal). This outcome will be assessed by means of questionnaire and extraction of data from medical records. (5) quality of life as measured by the Short Form 36 (SF‐36) questionnaire (6) change in other lipid fractions high‐density cholesterol, total cholesterol, triglycerides. This outcome will be assessed by means of blood test and extraction of relevant data from medical records. (7) healthcare resource consumption and cost‐effectiveness. The resourse consumption will be estimated from the investigators' point of view. Costs will assessed by means of questionnaires and data from medical records (health service databases) and will include all rehabilitative and medical services, General Medical Service benefit (or other Primary Health Organisation reimbursement), private prescription charges, co‐payments, costs for hospitalisations, and resource utilisation costs. INCLUSION CRITERIA: (1) First‐ever stroke (excluding subarachnoid haemorrhage) (2) discharged from hospital (3) consented to participate in the trial