Improving Stroke Care in India
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. Research partnerships between UK researchers and those in low and middle- income countries can ensure that such capacities are built among researchers and global challenges such as stroke addressed effectively.
Aims and objectives
The University of Central Lancashire (UCLAN) in collaboration with the George Institute for Global Health, India has now embarked on a three-year research program to create a global partnership that can improve stroke care in India. The program will be supported by existing stroke units at Christian Medical College, Ludhiana; All India Institute for Medical Sciences, New Delhi and Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum and other stroke researchers from the UK, India and Australia
The project involves setting up a Global Health Research Group (GHRG) that will focus on addressing priorities in stroke care in India via high quality research. The group will demonstrate the effectiveness of this approach by conducting an innovative and co-designed study of stroke care initiated in acute hospital settings
The GHRG will work 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.
The idea is to co-design, develop, support and undertake 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 will be 3 key stages:
1) In the first stage, the GHRG will work in partnership to agree on research priorities using co-developed criteria. These criteria are likely to include elements of stroke unit care that will benefit as many people as possible, and which are affordable and achievable in Indian healthcare settings. Priorities are likely to include elements of emergency stroke care (e.g. assessment), acute care (e.g. monitoring), rehabilitation (e.g. self-practice) and the organisation of care. An agreement on the exact priorities will be arrived at after consulting with patients, carers, and a multidisciplinary group of healthcare providers and professionals in India.
2) The second stage will see robust feasibility studies on these priorities at three centres in India. As well as having experience of setting up large global studies, the researchers who are part of the group have expertise in feasibility studies of simple and complex interventions. They will therefore work together to develop new systems for collecting research data in India. They will also provide 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) In the third stage, the partnership will be reinforced through developing a longer-term, sustainable, programme of stroke research and service development with teams in India and other LMICs. Lastly, the group will pursue further funding, and ensure that the research findings are available to healthcare staff and policy makers.
Members of the Stroke Research Team from the Faculty of Health and Wellbeing of the University of Central Lancashire recently visited New Delhi and met with their collaborators for the NIHR Global Health Research Group for Improving Stroke Care in India. The visit involving all collaborators took place, to review, prioritise and progress work in order to assist with planning and scheduling of the programme of research. This was followed by attendance at and presentation of abstracts relating to the work at the Indian National Stroke Conference. Collaborators also delivered a Masterclass focusing on stroke research and evidence for best practice which was well attended by conference delegates and resulted in thought provoking discussion with the panel of speakers.
Patient and Carer Involvement (PCPI) is recognised as a valuable but as yet an unfamiliar concept within Indian Health Services. The Global Health Research Group aims to put patients and carers at the heart of all they do. To this end they held an engagement event at AIIMS, a public hospital. Approximately 40 patients and their carers attended the event and gave first-hand accounts of their individual stories and experience. These accounts were of direct relevance to development, implementation and evaluation within the research programme and will inform plans for further engagement activities.