Background:​ Recurrent strokes, which may comprise up to a fifth of all stroke, are more severe than first events. Optimal secondary stroke prevention may require changes to healthrelated behaviours and improved vascular risk factor control. While patients’ knowledge regarding stroke, health-related behaviours, and cardiovascular risk may improve with secondary prevention strategies, there is little information available to guide programs for patient and family education for stroke prevention.

Purpose:​ First, to assess the knowledge of individuals with a recent stroke about stroke symptoms, risk factors, and prevention. Second, to explore the association between stroke knowledge and health behaviours and cardiovascular risk factor control. Last, to explore perceived barriers and facilitators for participation in secondary prevention programs for stroke survivors and their caregivers, and to examine the effectiveness of nursing interventions on modification of stroke risk factors among stroke survivors.

Methods:​ A prospective cross-sectional study was conducted to assess the knowledge of individuals with recent stroke and its relation to health-related behaviours and cardiovascular disease risk. Then, a longitudinal qualitative study was conducted using individual interviews with stroke survivors and their caregivers to understand changes in their perceptions regarding secondary stroke prevention in the stroke recovery period. Lastly, a meta-analysis of randomized controlled trials was conducted investigating the role of nurses in secondary stroke prevention.

Results:​ The cross-sectional study revealed that stroke patients lacked knowledge about stroke, and those who had better stroke knowledge had better health-related behaviours. Those who were physically active prior to their stroke had better cardiovascular risk factor control. In the qualitative study, stroke was perceived as a soul-searching experience by stroke survivors and their caregivers, motivating them to consider its causes. Despite experiencing some barriers, stroke survivors made lifestyle adjustments, transitioning through different stages of change. The meta-analysis found that nursing interventions were associated with improvements in blood pressure control, diet, physical activity, medication adherence, and knowledge of stroke risk factors.

Conclusions:​ The findings demonstrate the importance of strengthening current programs for secondary stroke prevention. Further, the findings suggest that developing patient- and familycentered programs may improve the knowledge and health-related behaviours to optimize secondary stroke prevention.