Background: Hypertension is the premier modifiable risk factor for recurrent stroke. In sub-Saharan Africa (SSA)\nwhere the stroke burden is escalating, little is known about the role of behavioral interventions in enhancing blood\npressure (BP) control after stroke.\nOur objective is to test whether an m-Health technology-enabled, nurse-led, multilevel integrated approach is\neffective in improving BP control among Ghanaian stroke patients within 1 month of symptom onset compared\nwith standard of care.\nMethods: This two-arm cluster randomized controlled feasibility pilot trial will involve 60 recent-stroke survivors.\nUsing a computer-generated sequence, patients will be randomly allocated into four clusters of 15 patients each\nper physician: two clusters in the intervention arm and two in the control arm. Patients in the intervention arm will\nreceive a simple pillbox, a Blue-toothed UA-767Plus BT BP device and smartphone for monitoring and reporting\nBP measurements and medication intake under nurse guidance for 3 months. Tailored motivational text messages\nwill be delivered based upon levels of adherence to the medication intake. Both groups will be followed up for\n6 months to compare BP control at months 3, 6 and 9 as primary outcome measure. Physicians assessing BP\ncontrol will be blinded to arms into which patients are allocated. Secondary outcome measures will include\nmedication adherence scores and Competence and Autonomous Self-regulation Scale scores. A qualitative study\nis planned after follow-up to explore the lived experiences of participants in the intervention arm.\nDiscussion: A feasible and preliminarily effective intervention would lead to a larger more definitive efficacy/\neffectiveness randomized controlled trial powered to look at clinical events, with the potential to reduce\nstroke-related morbidity and mortality in a low- to middle-income country.
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