"Everyone's Responsibility and No-One's Responsibility": A Thematic Analysis of a Roundtable on the Complex Problem of Secondary Stroke Prevention in Australia.

BACKGROUND

Around one in four people with stroke will have a recurrent stroke. The risk can be reduced through medication and lifestyle changes, but many have poor risk factor control post-stroke. There is no nationally recognised model of care for stroke secondary prevention, and inadequate secondary prevention may be a complex problem that cannot be effectively dealt with by addressing various contributing factors independently. We sought to understand implementation and research priorities to address gaps in stroke secondary prevention in Australia.

METHODS

An online roundtable and four follow-up small group discussions were conducted between March and April 2023. Participants were people with lived experience of stroke, researchers, health professionals and representatives from stroke advocacy organisations and the Australian federal government. Participants were given pre-discussion questions on stroke secondary prevention priorities, barriers and enablers. Moderated discussion invited reflection on system-level connections between priorities and shared understanding of diverse perspectives, rather than consensus-building. Discussions were recorded, transcribed and analysed following Braun and Clarke's thematic analysis methodology.

RESULTS

In the roundtable and small-group discussions, 25 people participated (68% women). Most priorities related to the inductive theme, 'models of care', including programmes, interventions and health system settings. Perceived barriers and enablers related to the following inductive themes: 'coordination', 'resourcing', and the 'research translation pipeline'. Identified priorities were heterogeneous and extensive. Tensions existed between some priorities, but others were shared by participants.

CONCLUSION

Our roundtable identified a range of priorities for stroke secondary prevention, coming from diverse perspectives. Stroke secondary prevention is a complex problem with interacting system elements that make improvement challenging. A model of care for stroke secondary prevention in Australia is needed that accounts for this complexity while building upon shared priorities.

PATIENT OR PUBLIC CONTRIBUTION: This project embedded people with lived experience of stroke. This included three people with lived experience of stroke, or of being a carer for a person with stroke, who took part in the initial roundtable and provided valuable contributions in discussions of implementation and research priorities for secondary stroke prevention. These participants also helped to prepare this manuscript, providing helpful feedback to ensure that priorities, barriers and enablers for secondary stroke prevention from a lived experience perspective were centred.