NIHR Global Health Research Group on Improving Stroke Care, University of Central Lancashire

Stroke is a worldwide health problem and, with heart disease, is now the most common cause of death globally. In low to middle-income countries (LMICs) like India, the number of people having and dying from stroke is increasing. India now has the third-highest number of people dying from stroke of any country. People in India also tend to have strokes younger than people in wealthier countries like the UK in their 50s rather than in their 70s. This often causes immense hardship for them and their family. There has been great progress in stroke audit and research in the UK in the past 20 years, which has led to major improvements in stroke service organisation and care. These improvements have reduced death and disability from stroke. This project aims to share knowledge and skills with LMIC countries to assist in improving stroke care.

Our GHRG works in partnership across the UK and India (with support from key colleagues in Australia) to improve stroke care in India. The group brings together multidisciplinary researchers with expertise in a range of methodological approaches, with differing professional backgrounds, experience, at different stages of their research careers, and with expertise in truly collaborative global health research and development. We are co-designing, developing, supporting and undertaking a programme of research relevant to the needs of patients, carers and health professionals in India.

Whilst this research will work with India’s current stroke services and systems, it will have the potential to support system change and through implementing research findings in practice will reduce the burden of stroke in India. This research will gain global recognition and inform stroke care across the world.

There are 3 key stages: –

1.) We have worked in partnership and agreed research priorities using co-developed criteria. The areas selected aim to benefit as many people as possible, and are affordable and achievable in acute stroke setting in India. We will develop and explore the feasibility and acceptability (staff, patients and carers) of delivering these evidence-based interdisciplinary care bundles for the management of stroke.

We have now agreed the three care bundles, which are:

– 1. Assessment and management of swallowing problems;

– 2. Monitoring and management of neurological and physiological signs and symptoms;

– 3. Education and training of relatives in supporting acute stroke care.

2.) We have assessed the feasibility of implementing the care bundles at the three centres in India. We are working together to develop new systems for collecting research data in India. We are providing opportunities for healthcare staff in India who wish to develop their skills and experience in undertaking research, and interested in implementing findings in practice.

3.) We are reinforcing our partnership through developing a longer-term, sustainable, programme of stroke research and service development with teams in India and other LMICs. We will pursue further funding, and ensure that the research findings are available to healthcare staff and policy makers. In addition to the research described above, we have been successful in gaining funding for a further 12-month project with a range of partners in the UK, Australia and India. Together with 8 hospitals in India the project aims to:

-1. Understand how to best give care in hospital for hydration (drinking) and swallowing problems after stroke for people in India.

-2. Understand what care is needed for hydration and swallowing, and for emotional and social support, when people return home from hospital after a stroke.

-3. Explore how ethical approval processes for research in India could be streamlined. This is most important for research which is conducted at several sites. As well as completing the research we plan to develop links with other health professionals and hospitals in India and other countries, gain further funding to continue our research in this area, provide training and support to all staff involved in the project, produce results that will help to inform future stroke services and research, improving the lives of stroke patients and their families.