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Canadians are worried about the future of the health care system, and provincial governments are questioning the ability of the existing system to support Canadians health care needs in the 21st Century(Industry Canada, 2011). Health care providers and system administrators are both driving and experiencing a paradigm shift; moving away from paternalism and toward an egalitarian approach. In order to practice patient centredness, health care providers must prioritize patient needs; provide information regarding treatments while taking patient preferences into account (Romanow, 2002). While there is a growing body of literature regarding patient centredness, there is scant information from the patient perspective. If the most effective and acceptable health services are those that realize the expectations of the users, this is an important area of study. Using phenomenological research methods and the theory of planned behaviour as a theoretical framework, the purpose of the study was to explore the influence of beliefs, attitudes and experiences on behaviour from the perspective of patients in primary health care or stroke rehabilitation. A second purpose was to explore the degree to which beliefs, attitudes and behaviour were similar between clinical contexts. The theory of planned behaviour was unsuitable for understanding peoples' beliefs, attitudes and behaviour about being a patient. Being a patient was not a single, observable behaviour, but rather a set of contextually dependent strategies patients' directed at a particular goal. The goal for each participant group was different; rehabilitation patients focused on the specific goal of recovery and discharge, while PHC patients focused on a broader goal of accessing and receiving best health care possible. These goals were reflected in their respective approaches to accessing health care services, an experience they described as socially oriented, governed and reinforced. Although patients described themselves as actively engaged, they did not approach ...

Abstract

Background
Community-based culturally tailored education (CBCTE) programs for chronic diseases may reduce health disparities; however, a synthesis across chronic diseases is lacking. We explored (1) the characteristics and outcomes of CBCTE programs and (2) which strategies for culturally appropriate interventions have been used in CBCTE programs, and how they have been implemented.

Methods
A systematic review was conducted by searching three databases to identify empirical full-text literature on CBCTE programs for Black communities with cardiovascular disease, hypertension, diabetes, or stroke. Studies were screened in duplicate, then data regarding study characteristics, participants, intervention, and outcomes were extracted and analyzed. Cultural tailoring strategies within programs were categorized using Kreuter and colleagues' framework.

Results
Of the 74 studies, most were conducted in the USA (97%) and delivered in one site (53%; e.g., church/home). CBCTE programs targeted diabetes (65%), hypertension (30%), diabetes and hypertension (1%), cardiovascular disease (3%), and stroke (1%). Reported program benefits included physiological, medication-related, physical activity, and literacy. Cultural tailoring strategies included peripheral (targeted Black communities), constituent-involving (e.g., community informed), evidential (e.g., integrated community resources), linguistic (e.g., delivered in community's dialect/accent), and sociocultural (e.g., integrated community members' religious practices).

Conclusions
CBCTE programs may have beneficial outcomes, but a small sample size limited several. The strategies identified can be adopted by programs seeking to culturally tailor. Future interventions should clearly describe community members' roles/involvement and deliver programs in multiple locations to broaden reach.

Trial Registration
PROSPERO CRD42021245772.

Abstract
Background
Stroke service disparities experienced by individuals of African descent highlight the need to optimize services. While qualitative studies have explored participants' unique experiences and service needs, a comprehensive synthesis is lacking. To address current knowledge gaps, this review aimed to synthesize existing literature on the experiences of individuals of African descent impacted by a stroke living in high-income economy countries in terms of stroke prevention, management, and care.

Methods
A qualitative meta-synthesis incorporating a meta-study approach was conducted to obtain comprehensive and interpretive insights on the study topic. Four databases were searched to identify qualitative English-language studies published in the year 2022 or earlier on the experiences of adults of African descent who were at risk or impacted by a stroke and living in high-income economy countries. Study methods, theory, and data were analyzed using descriptive and interpretive analyses.

Results
Thirty-seven studies met our inclusion criteria, including 29 journal articles and 8 dissertations. Multiple authors reported recruitment as a key challenge in study conduct. Multiple existing theories and frameworks of health behaviours, beliefs, self-efficacy, race, and family structure informed research positionality, questions, and analysis across studies. Participant experiences were categorized as (1) engagement in stroke prevention activities and responses to stroke symptoms, (2) self-management and self-identity after stroke, and (3) stroke care experiences.

Conclusions
This study synthesizes the experiences and needs of individuals of African descent impacted by stroke. Findings can help tailor stroke interventions across the stroke care continuum, as they suggest the need for intersectional and culturally humble care approaches.