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. 2024 Jan 4;13(1):300.
doi: 10.3390/jcm13010300.

Building Bridges between People with Stroke, Families, and Health Professionals: Development of a Blended Care Program for Self-Management

Carla Mendes Pereira  1   2 , Mara Matos  1 , Daniel Carvalho  3 , Patricia Macedo  4   5 , José M Calheiros  6 , Janice Alves  7 , Luís Paulino Ferreira  8 , Teresa L Dias  1 , Rui Neves Madeira  4   9 , Fiona Jones  10
Affiliations

Building Bridges between People with Stroke, Families, and Health Professionals: Development of a Blended Care Program for Self-Management

Carla Mendes Pereira et al. J Clin Med. .

Abstract

Evidence-informed interventions for stroke self-management support can influence functional capability and social participation. People with stroke should be offered self-management support after hospital discharge. However, in Portugal, there are no known programs of this nature. This study aimed to develop a person-centered and tailored blended care program for post-stroke self-management, taking into account the existing evidence-informed interventions and the perspectives of Portuguese people with stroke, caregivers, and health professionals. An exploratory sequential mixed methods approach was used, including qualitative methods during stakeholder consultation (stage 1) and co-production (stage 2) and quantitative assessment during prototyping (stage 3). After ethical approval, recruitment occurred in three health units. Results from a literature search led to the adaptation of the Bridges Stroke Self-Management Program. In stage one, 47 participants were interviewed, with two themes emerging: (i) Personalized support and (ii) Building Bridges through small steps. In stage two, the ComVida program was developed, combining in-person and digital approaches, supported by a workbook and a mobile app. In stage three, 56 participants evaluated prototypes, demonstrating a strong level of quality. Understandability and actionability of the developed tools obtained high scores (91-100%). The app also showed good usability (A-grade) and high levels of recommendation (5 stars).

Keywords: change behavior; co-production; eHealth; mHealth; quality; self-efficacy; self-management; stroke; usability.

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Conflict of interest statement

C.M.P., M.M., D.C., J.M.C., J.A., P.M., R.N.M., T.L.D. and L.P.F. declare no conflicts of interest. F.J. is founding director and CEO of Bridges Self-Management, a social enterprise run in partnership with St Georges University of London and Kingston University, conducting research and training in self-management support in health and social care. F.J.’s research is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South London at King’s College Hospital NHS Foundation Trust. The funders had no role in the design of the study, in the collection, analyses, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Description of the study stages. Wb = workbook; mApp = mobile app; PEMAT-P = Patient Education Materials Assessment Tool—for Printable materials; PEMAT-AV = Patient Education Materials Assessment Tool—for Audiovisual materials; uMARS = Mobile App Rating Scale-user version; SUS = System Usability Scale.
Figure 2
Figure 2
Thematic analysis: themes and sub-themes.
Figure 3
Figure 3
Illustrative examples of the ComVida workbook. (a) Cover of the workbook; (b) Peers stories: the story of Ana, 46, who suffered a stroke that affected her balance (chapter 1); (c) Common questions and tips: “how to socialize again?”, including strategies people with stroke found useful (chapter 2); (d) Hopes and ideas, giving examples and space for people to write their hopes for the future (chapter 3); (e) Small steps and taking action: set goals (chapter 4); and (f) Looking back: with a list of achievements that have worked for Diana (chapter 5).
Figure 4
Figure 4
Screenshots of the ComVida app. (a) Front page of the app; (b) testimonials page; (c) glossary page; (d) goals page; and (e) notifications.
Figure 5
Figure 5
Violin plots of uMARS subdomains of objective quality of the ComVida app.
See this image and copyright information in PMC

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