An Evaluation of the Video Narrative Technique on the Self-Efficacy of Medication Understanding and Use Among Post-Stroke Patients: A Randomized-Controlled Trial

Figures & data

Figure 1 Flowchart of the trial. **Patients available for analysis. Nevertheless, intention-to-treat analysis (ITT) was undertaken. Therefore, finalized number of patients for analysis were 108 of them from each group.

Abbreviations: T0, baseline; T2, 6th month; T4, 12th month.

Table 1 Socio-Demographic Data of Patients at Baseline (n=216)

Characteristics		Control n=108 (%)	Intervention n=108 (%)
Gender	Male	73 (67.6)	69 (63.9)
	Female	35 (32.4)	39 (36.1)
Age (years)	≥ 60	52 (48.1)	45 (41.7)
	40 - 59	46 (42.6)	51 (47.2)
	≤ 39	10 (9.3)	12 (11.1)
		57 ± 12.2^c	54 ± 12.4^c
Ethnicity	Malay	63 (58.3)	77 (71.3)
	Chinese	11 (10.2)	14 (13.0)
	Indian	31 (28.7)	16 (14.8)
	Others	3 (2.8)	1 (0.9)
Education completion	Primary	22 (20.4)	20 (18.5)
	Secondary	62 (57.4)	59 (54.6)
	Tertiary	24 (22.2)	29 (26.9)
Health literacy^a	Adequate	85 (78.7)	84 (77.8)
	Limited	23 (21.3)	24 (22.2)
Employment	Employed	44 (40.7)	47 (43.5)
	Unemployed	64 (59.3)	61 (56.5)
Types of stroke^b	Ischemic	91 (84.2)	93 (86.1)
	Hemorrhagic	3 (2.8)	6 (5.6)
	TIA	14 (13.0)	9 (8.3)
Stroke comorbidities	Hypertension	30 (27.8)	29 (26.9)
	Hypertension and other risks*	69 (63.9)	73 (67.5)
	Diabetes and other risks*	9 (8.3)	6 (5.6)
Prescribed medication (types)	≤ 2	15 (13.9)	18 (16.7)
	≥ 3	93 (86.1)	90 (83.3)
Systolic pressure (mmHg) MUSE score SKT score BIPQ score BMQ score BP monitoring frequency		141 (20.7)^c	140 (21.3)^c
		23 (5.3)^c	23 (5.4)^c
		7 (3.5)^c	6 (3.6)^c
		51 (11.1)^c 51 (6.2)^c 2 (0.8)^c	50 (12.1)^c 50 (6.2)^c 2 (0.9)^c

Notes: ^aAssessed based on The Newest Vital Sign, ^bStroke code ICD-10, ^cMean ± SD. *Inclusive of modifiable stroke risk factors other than hypertension, eg, diabetes, heart diseases, hyperlipidemia, current smoking/alcohol.

Abbreviations: BIPQ, Brief Illness and Perception Questionnaire; BMQ, Belief About Medicine Questionnaire; BP, blood pressure; MUSE, medication understanding and use self-efficacy; SKT, Stroke Knowledge Test; TIA, transient ischemic attack.

Table 2 Groups’ Comparison at Various Timelines

		Timeline (Month)			Within Group			Between Groups			(Timeline*Group)
		T0 (SD)	T2 (SD)	T4 (SD)	F	p	ƞ2	F	p	ƞ2	F	p	ƞ2
MUSE^a	I	22.97 (5.17)	27.27 (3.25)	27.81 (2.52)	97.00	<0.001**	0.475	12.41	0.001**	0.055	42.99	<0.001**	0.167
	C	23.71 (5.44)	24.62 (4.03)	24.42 (4.02)	5.61	0.010*	0.050
MUSE^b	I	25.00 (5.85)	27.82 (2.96)	28.38 (3.23)	42.05	<0.001**	0.282	5.10	0.025*	0.023	6.91	0.005*	0.205
	C	24.75 (5.80)	26.29 (4.97)	26.28 (4.88)	14.76	<0.001**	0.121
MUSE^c	I	25.61 (5.71)	28.88 (3.43)	28.19 (3.18)	49.11	<0.001**	0.315	7.25	0.008*	0.033	12.22	<0.001**	0.195
	C	25.29 (5.61)	26.39 (5.02)	26.25 (4.73)	8.22	0.003*	0.071
Sys/BP	I	141.68 (20.21)	134.26 (14.96)	135.71 (13.88)	35.67	<0.001**	0.250	0.35	0.552	0.002	8.537	0.001**	0.038
	C	139.89 (21.31)	137.59 (15.78)	138.11 (15.73)	3.37	0.055	0.031
SKT	I	7.47 (3.40)	9.34 (3.09)	9.79 (3.11)	137.64	<0.001**	0.563	11.54	0.001**	0.051	32.39	<0.001**	0.131
	C	6.83 (3.59)	7.49 (3.36)	7.81 (3.28)	42.93	<0.001**	0.286
BIPQ	I	52.08 (10.06)	47.44 (9.29)	47.79 (8.81)	53.84	<0.001**	0.335	1.73	0.190	0.008	34.16	<0.001**	0.104
	C	50.76 (12.12)	51.08 (11.89)	51.15 (12.77)	0.42	0.594	0.004
BMQ	I	51.46 (6.22)	48.22 (6.31)	47.57 (6.15)	51.39	<0.001**	0.324	15.93	<0.001**	0.069	71.76	<0.001**	0.251
	C	50.91 (6.22)	52.76 (7.11)	53.74 (8.00)	23.82	<0.001**	0.182
BP/Mon	I	2.41 (0.94)	2.76 (0.98)	2.87 (1.04)	27.34	<0.001**	0.204	5.23	0.023*	0.024	12.49	<0.001**	0.055
	C	2.33 (0.89)	2.44 (0.91)	2.44 (0.89)	5.74	0.006*	0.051

Notes: ^a(all medication), ^b(antiplatelet), ^c(antihypertensive), *The mean difference is significant at p<0.05, **Adjustment for multiple comparisons: Bonferroni p<0.001.

Abbreviations: BIPQ, Brief Illness and Perception Questionnaire; BMQ, Belief About Medicine Questionnaire; BP, blood pressure; BP/Mon-BP monitoring; CI, confidence interval; C, control group; I, intervention group; MUSE, medication understanding and use self-efficacy; SKT, stroke knowledge test; Sys/BP-systolic BP; T0, baseline; T2, 6th month; T4, 12th month.

Table 3 Pair Wise Comparison Between Timelines (T0, T2, T4)

		T0 vs T2			T0 vs T4			T2 vs T4
		∆ T2-T1(SE)	CI	p	∆ T4-T0(SE)	CI	p	∆ T4-T2(SE)	CI	p
MUSE^a	Intervention	–4.29* (0.36)	-5.17- -3.42	<0.001	–4.83* (0.47)	-5.97- -3.69	<0.001	–0.54 (0.29)	-1.25- 0.18	0.211
	Control	–0.91* (0.32)	-1.67- -0.13	0.017	–0.70 (0.33)	-1.51- 0.10	0.110	0.20 (0.17)	-0.22- 0.62	0.720
MUSE^b	Intervention	–2.82* (0.46)	-3.94- -1.71	<0.001	–3.39* (0.46)	-4.51- -2.27	<0.001	–0.57* (0.22)	-1.11- -0.02	0.038
	Control	–1.54* (0.39)	-2.49- -0.59	<0.001	–1.53* (0.38)	-2.47- -0.58	<0.001	0.01 (0.13)	-0.29- 0.32	1.00
MUSE^c	Intervention	–3.27* (0.39)	-4.21- -2.33	<0.001	–2.57* (0.43)	-3.62- -1.53	<0.001	0.69* (0.16)	0.29- 1.09	<0.001
	Control	–1.10* (0.34)	-1.93- -0.27	0.005	–0.95* (0.35)	-1.82- -0.09	0.025	0.15 (0.14)	-0.19- 0.49	0.887
Systolic BP	Intervention	7.42* (1.06)	4.85- 9.99	<0.001	5.96* (1.11)	3.27- 8.65	<0.001	–1.45* (0.51)	-2.69- -0.22	0.015
	Control	2.31 (1.08)	-0.31- 4.92	0.103	1.79 (1.09)	-0.86- 4.43	0.310	–0.52 (0.52)	-1.78- 0.74	0.954
SKT	Intervention	–1.87* (0.16)	-2.26- -1.48	<0.001	–2.32* (0.18)	-2.75- -1.88	<0.001	–0.44* (0.09)	-0.66-0.234	<0.001
	Control	–0.66* (0.11)	-0.92- -0.39	<0.001	–0.98* (0.13)	-1.31- -0.66	<0.001	–0.32* (0.08)	-0.51- -0.14	<0.001
BIPQ	Intervention	4.64* (0.52)	3.36- 5.91	<0.001	4.28* (0.57)	2.90- 5.67	<0.001	–0.35 (0.38)	-1.28- 0.58	1.000
	Control	–0.32 (0.43)	-1.38- 0.73	1.000	–0.39 (0.57)	-1.77- 0.99	1.000	–0.07 (0.33)	-0.87- 0.74	1.000
BMQ	Intervention	3.24* (0.41)	2.23- 4.25	<0.001	3.89* (0.51)	2.66- 5.12	<0.001	–0.98* (0.31)	-1.74--0.22	<0.001
	Control	–1.85* (0.42)	-2.86- -0.84	<0.001	–2.83* (0.50)	-4.05- -1.61	<0.001	0.65 (0.28)	0.04- 1.34	0.072
BP monitoring	Intervention	–0.35* (0.07)	-0.51- -0.19	<0.001	–0.46* (0.08)	-0.66- -0.27	<0.001	–0.11 (0.05)	-0.23- 0.01	0.068
	Control	–0.10* (0.04)	-0.19- -0.01	0.021	–0.10* (0.04)	-0.19- -0.01	<0.001	0.00 (0.03)	-0.06- 0.06	1.000

Notes: ^a(all medication), ^b(antiplatelet), ^c(antihypertensive), *The mean difference (∆) is significant at p<0.05, Adjustment for multiple comparisons: Bonferroni p<0.001, CI 95% .

Figure 2 Changes in mean score, measurement and frequency of outcome measures within timeline for control and intervention groups. (A) Changes in mean score of the medication understanding and use self-efficacy (MUSE) “all medications” within timeline. (B) Changes in mean score of the medication understanding and use self-efficacy (MUSE) “antiplatelet” within timeline. (C) Changes in mean score of the medication understanding and use self-efficacy (MUSE) “antihypertensive” within timeline. (D) Changes in the blood pressure (BP) measurement within timeline. (E) Changes in mean score of the brief illness and perception questionnaire (BIPQ) within timeline. (F) Changes in mean score of the stroke knowledge test (SKT) within timeline. (G) Changes in mean score of the belief about medicine questionnaire (BMQ) within timeline. (H) Changes in the blood pressure (BP) monitoring frequency within timeline.

Abbreviations: T0, baseline; T2, 6th month; T4, 12th month.