Physical complaints and emotional symptoms in the context of series watching: a multicenter latent profile and network analysis in Brazil and Canada.

Stroke is a common cerebrovascular disease characterized by high incidence, high disability, high mortality, a heavy disease burden, multiple comorbidities, and a steadily increasing recurrence rate (). It has become the second leading cause of mortality and the third leading cause of death and disability combined globally, making it an urgent public health concern (, ). Ischemic stroke is the most common subtype, accounting for approximately 77.8% of all stroke cases (). Recurrence is a critical factor that further increases the burden of stroke. A global systematic review and meta-analysis published in JAMA in 2025 reported that the five-year risk of stroke recurrence in patients with transient ischemic attack or minor stroke was 12.8%, rising to 19.8% at 10 years, with approximately 10% of recurrent strokes being fatal (). Studies conducted in Chinese populations have further confirmed that recurrent stroke is often associated with more severe functional disability and poor health outcomes (). Medication adherence is defined as the extent to which patients take their medications as prescribed by healthcare providers, including dosage, frequency, and timing (). One research has indicated that the standardized implementation and sustained adherence to effective secondary preventive pharmacotherapy can reduce the risk of stroke recurrence (), which is crucial for lowering recurrence risk and managing stroke-related complications. Medication adherence is therefore the key to ensuring the effectiveness of secondary prevention measures (). Despite the well-documented benefits of pharmacological therapy in lowering stroke incidence, recurrence, and adverse outcomes, adherence to secondary prevention medications among patients with ischemic stroke remains suboptimal and tends to decline over time, underscoring an urgent need for targeted interventions (, ). Medication adherence is a dynamic process influenced by multiple factors, including patients’ perception of their disease, health beliefs, social support, and medication-specific beliefs (, ). After hospital discharge, patients face distinct challenges at different stages of recovery (). In the early post-discharge period, some patients may reduce or discontinue medication on their own because they perceive symptom improvement. During the chronic disease management stage, cognitive and behavioral barriers gradually become prominent, including forgetting to take medication, difficulty adhering to complex treatment regimens, and concerns about potential adverse drug reactions. This suggests that medication adherence management requires stage-specific and individualized support strategies. Furthermore, current intervention studies have mainly focused on unimodal strategies, including standalone health education, post-discharge telephone follow-up, and information technology-based medication counseling (). These interventions often fail to adequately address the distinct medication management challenges faced by patients and their primary caregivers at different stages of the disease trajectory, while also overlooking patients’ baseline cognitive levels related to medication adherence (, ). The Timing It Right Theory (TIR), introduced by Cameron and colleagues () in 2008, emerged from their investigation into the evolving needs of stroke caregivers and provides a conceptual framework to guide the delivery of timely, targeted support services to patients and their caregivers across diverse healthcare environments. TIR delineates the disease trajectory into five sequential stages: Diagnosis, stabilization, discharge preparation, implementation, and adaptation. A central tenet of the theory is that the type and intensity of interventions and support should be dynamically consistent with the evolving needs of patients and their caregivers at each distinct stage. TIR theory has demonstrated favorable effectiveness in home-based rehabilitation and caregiver support for stroke survivors (, ). Furthermore, the theory has gradually been extended to the management of other chronic diseases, such as diabetes mellitus and acute myocardial infarction (), demonstrating promising application value (). Therefore, this study developed a medication management program grounded in TIR, shifting adherence interventions for stroke patients from generalized guidance toward precision support. By addressing the evolving medication management needs of patients and caregivers at each stage of the disease trajectory, the program enhances their understanding of and beliefs about medication adherence, reduces medication-related concerns, and ultimately promotes better medication-taking behaviors.