Perspectives of People with Stroke, Caregivers and Healthcare Professionals on an Adaptive mHealth Intervention for Physical Activity in the Prevention of Secondary Stroke: A Qualitative Study

Abstract

Nathan Cardy,1 Andrew Hunter,2 Daniel Carter,1 Mairead O’Donoghue,1 Márcia Carvalho,3 Emma Carr,1 Jane C Walsh,3 Julie Bernhardt,4 Claire Fitzsimons,5 Ita Richardson,6 Jon Salsberg,7 Liam Glynn,7 Cathal Walsh,8 Edina O’Driscoll,9 Pauline Boland,1 Nora Cunningham,10 John Forbes,7 Rose Galvin,1 Sara Hayes1 1School of Allied Health, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland; 2School of Nursing and Midwifery, University of Galway, Galway, Ireland; 3School of Psychology, University of Galway, Galway, Ireland; 4Florey Institute of Neuroscience and Mental Health, University of Melbourne, Victoria, Australia; 5Physical Activity for Health Research Centre, Institute Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, Scotland; 6Department of Computer Science and Information Systems, University of Limerick, Limerick, Ireland; 7School of Medicine, University of Limerick, Limerick, Ireland; 8School of Medicine, Trinity College Dublin, Dublin, Ireland; 9Health Service Executive, Dublin, Ireland; 10University Hospital Limerick, Limerick, IrelandCorrespondence: Sara Hayes, Email [email protected]: Engaging in regular physical activity (PA) is associated with lower mortality following stroke, and PA reduces the chance of recurrent stroke. Despite recent guidelines to optimise PA following stroke, people with stroke are known to be less active than their age-matched counterparts. Given the heterogenous nature of stroke, adaptive PA interventions are recommended for people with stroke. Empirical data is lacking on adaptive PA or behavioural change interventions following stroke. Suggested strategies in the prevention of stroke recommend the use of mobile health (mHealth) interventions in the primary prevention of stroke. A structured stakeholder consultation process is key to successful implementation of complex interventions. This paper reports the findings of our consultation process to inform the development of an adaptive mHealth PA.Methods: We used a qualitative study design to explore the perspectives of key stakeholders on the development of an adaptive PA intervention delivered via mHealth post-stroke. Healthcare workers, carers and people with stroke participated in semi-structured one-to-one or focus group interviews. A reflexive thematic analysis was undertaken on transcribed interviews; key themes and sub-themes were developed using coding and summarised by two researchers, then reviewed by the full research team.Results: Twenty-eight stakeholders were interviewed and three main themes were identified; Key feature of a mHealth intervention, delivering a mHealth intervention, Challenges to development and use. There was widespread agreement across stakeholder groups that an adaptive mHealth PA intervention following stroke would be beneficial to people with stroke, following discharge from acute care.Conclusion: Our consultation supports the development of an adaptive PA programme that addresses specific impairments that can hinder exercise participation after stroke.Keywords: physical activity, stroke, adaptive intervention, intervention design

Keywords

• physical activity
• stroke
• adaptive intervention
• intervention design