Date of Award


Document Type

Scholarly Project

Degree Name

Master of Occupational Therapy (MOT)


Occupational Therapy

First Advisor

Julie Grabanski


Health Literacy; Ischemic Attack, Transient -- prevention & control; Risk Factors; Socioeconomic Factors; Stroke -- prevention & control


The purpose of this scholarly project was to provide secondary prevention in an outpatient setting to individuals who have experienced a transient ischemic attack (TIA) and are of lower socioeconomic status (SES). Stroke is the fifth leading cause of death in the United States and the leading cause of long-term disability (National Stroke Association, 2018). An estimated 795,000 plus Americans experience a stroke each year (Benjamin et al., 2017). Of this estimation, about 185,000 Americans experience a recurrent stroke (Benjamin et al., 2017). Roughly, one half of patients fail to seek medical attention within 24 hours of a TIA (Sharry et al., 2014). More than one third of the individuals who experience a TIA and do not seek treatment have a major stroke within a year (American Stroke Association, 2016). Individuals of lower SES are at a higher risk for stroke (Addo et al, 2012; Khare, 2016). Therefore, there is a lack of awareness of what a TIA is and the presentation of symptoms that can impact the wellbeing of individuals and their risk for a recurrent stroke. Research studies have been conducted on the effectiveness of implemented secondary prevention programs for individuals who experienced a TIA or stroke. These studies have provided promising results and are cost-effective (Hill et al., 2017; Holzemer et al., 2011; Leistner et al., 2013).

An extensive literature review was completed to gather information related to secondary prevention specifically for individuals who have experienced a TIA, are 55 plus, and are of a lower SES. Information obtained from the review of literature revealed the effectiveness of secondary prevention programs for TIA or strokes. Early implementation of secondary prevention programs and follow-up sessions are necessary for individuals of lower SES. This program took health literacy rates into consideration for individuals of lower SES.

The final product of this group protocol was a set of six detailed group sessions tailored for individuals who have experienced a TIA, are 55 plus, and are of lower SES. Overarching themes discussed in the group sessions were modifiable risk factors, self-management, establishing healthy routines, and holistic wellness all included in the final product. Each group session consisted of a step-by-step guideline for the facilitator and included activities with discussion questions. The group protocol was developed with the intention that registered occupational therapists would implement the group protocol in an outpatient setting. A seventh session consisted of an at home follow-up. This session addressed barriers for participants to maintain a healthy lifestyle, occupational identity, and occupational competency.