Strengths and limitations
stroke, cardiovascular disease
STROKE, CARDIOVASCULAR DISEASE, STAGGERING
One of the strengths of this study was the inclusion of an ethnically diverse urban group of stroke caregivers, who are at increased risk of stroke i.e. the immediate family members of stroke patients. The heterogeneity of the sample population may increase generalizability of results to cardiovascular disease prevention in other settings. However, there were limitations where the short duration of follow up for our study (three months) was inadequate to observe any sustainable improvement in the intervention group. Secondly there was a possible chance of contamination between intervention and control group who might be able to download the app upon exposure during baseline assessment. It is possible that they may have accessed other mobile health application that is similar to SRA™ during the study period (i.e.,7 out of 37 in control arm had downloaded the SRA™). Caregivers among the same family members may be more inspired or motivated to reduce their risk of stroke by adopting a healthier lifestyle and managing their risk factors together as a group.The main processes that may have led to contamination in this study were health professionals delivering both active and comparator treatments and communication between clinicians and participants from the different trial arms. Contamination can be avoided by carrying out a clustered study design, where clusters were defined by geography, holding treatment sessions at different times in different locations, staggering the arrangement of data collection schedules so that participants do not meet in the waiting room [O Meldevdev and colleagues concluded that the SRA™ consistently captures stroke risk across various countries including Asian. Thus, users can depend on its capability to measure their stroke risks, but as it is a novel stroke prevention approach, the SRA™ should continue to evolve and more research is required to further augment precision and validity of this advantageous tool [Future work should also focus on a qualitative study to explore how the participants felt the mobile application helped in initiating or maintaining the lifestyle changes. A cohort-based study measuring sustainability of life style changes and its impact on stroke risk reduction among Malaysians would support further evidence for its usability and acceptability.