Although acknowledging that educating patients with stroke or TIA about their condition and the causesoftheirstrokeisanimportantaspectofstroke care, evidence does not support its role in modifying health risk behaviors. The Cochrane review of inter- ventions for improving modifiable risk factor control in the secondary prevention of stroke identified that patient education alone does not lead to improve- ments in modifiable risk factor control or the pre- vention of recurrent cardiovascular events.829 The recent STANDFIRM trial (Shared Team Approach Between Nurses and Doctors for Improved Risk Factor Management for Stroke Patients; N=563) of specialist review and nurse education found no effect on attainment of cardiometabolic targets for Similarly, the ExStroke trial (N=314 ambulatory participants with stroke) identified that repeated encouragement with verbal instruction on being physically active over a 2-year period after stroke was not an effective means of increasing physical activity participation.129 Knowledge Gaps and Future Research Current knowledge gaps in this area include the following: The optimal behavior change intervention to reduce recurrent stroke is unknown at present, as is the optimal window to deliver interventions of this nature. Multiple systematic reviews of lifestyle-based behavioral interventions identify an existing knowl- edge gap relating to the potential of the inter- ventions reported to date to affect outcomes of recurrent stroke and other cardiovascular end points in the longer term, beyond the intervention Many behavioral interventions in published tri- als after stroke fail to identify whether a behavior change theory underpinned the intervention deliv- ered, making it difficult to ascertain successful and unsuccessful components of complex behavior A significant knowledge gap exists with respect to the specific or allied role of family caregivers and dyads in stroke secondary prevention in both the promotion and maintenance of health behaviors after stroke. 