Living with an Open-Ended Risk of Stroke: A Qualitative Study of Adults Identified as Being at High Risk of Stroke Without Prior Stroke or TIA in China

Abstract Background Stroke screening can identify adults without previous stroke or transient ischaemic attack (TIA) as being at high risk and bring them into preventive care. Yet little is known about how people without a cerebrovascular event interpret and live with this risk status. Guided by the “patients-in-waiting” concept, this study explored how adults at high risk of stroke understood their risk classification, integrated risk management into everyday life, and sustained prevention over time. Methods This qualitative descriptive study, informed by naturalistic inquiry, used individual semi-structured interviews. Using maximum-variation purposive sampling, we recruited 21 adults without previous stroke or TIA from two community health centres in Chengdu, China. Interviews conducted from May to June 2026 were analyzed using theory-informed thematic analysis guided by Braun and Clarke’s six-phase framework. The “patients-in-waiting” concept informed interpretation while the analysis remained open to findings beyond the concept. Results Three themes were identified. Making sense of being at high risk showed that participants accepted, distanced themselves from, or recalibrated the classification according to bodily experience, family history, perceived control, and uncertainty about future stroke. Fitting risk management into everyday life showed that participants incorporated manageable practices into routines, negotiated recommendations against enjoyment, relationships, work, and personal priorities, and sometimes made prevention a shared family practice. Maintaining direction in ongoing risk management showed that sustaining prevention depended on accessible care, actionable guidance, usable information, and follow-up feedback that helped participants interpret changes in modifiable risk factors and health indicators over time. Conclusions High-risk classification did not automatically produce a stable patient identity. Instead, participants lived with an open-ended and negotiated risk state in which future stroke remained uncertain and prevention had to be continually interpreted and fitted into everyday life. Primary stroke prevention should extend beyond risk identification by providing accessible, tailored, actionable, and sustained follow-up support.