Abstract
Purpose
Worldwide, stroke is a leading cause of disease burden. Many survivors have unmet needs after discharge from hospital. Electronic communication technology to support post-discharge care has not been used for patients with stroke. In this paper, we describe the development of a novel electronic messaging system designed for survivors of stroke to support their goals of recovery and secondary prevention after hospital discharge.
Participants and methods
This was a formative evaluation study. The design was informed by a literature search, existing data from survivors of stroke, and behavior change theories. We established two working groups; one for developing the electronic infrastructure and the other (comprising researchers, clinical experts and consumer representatives) for establishing the patient-centered program. Following agreement on the categories for the goal-setting menu, we drafted relevant messages to support and educate patients. These messages were then independently reviewed by multiple topic experts. Concurrently, we established an online database to capture participant characteristics and then integrated this database with a purpose-built messaging system. We conducted alpha testing of the approach using the first 60 messages.
Results
The initial goal-setting menu comprised 26 subcategories. Following expert review, another 8 goal subcategories were added to the secondary prevention category: managing cholesterol; smoking; physical activity; alcohol consumption; weight management; medication management; access to health professionals, and self-care. Initially, 455 health messages were created by members of working group 2. Following refinement and mapping to different goals by the project team, 980 health messages across the health goals and 69 general motivational messages were formulated. Seventeen independent reviewers assessed the messages and suggested adding 73 messages and removing 16 (2%). Overall, 1,233 messages (18 administrative, 69 general motivation and 1,146 health-related) were created.
Conclusion
This novel electronic self-management support system is ready to be pilot tested in a randomized controlled trial in patients with stroke.
Video abstract
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Acknowledgments
We thank Frank Lan (engineer) for his contributions to the iVERVE messaging system. We also acknowledge Mariko Carey and Amy Waller (University of Newcastle) for their contributions to working group 2 and also the independent review panel members who provided their time in giving feedback on the messages or offering suggestions for additional messages. This study was funded by a Monash University Faculty Strategic Grant (SG516-0431). The following authors were also supported by fellowships from the National Health and Medical Research Council: DAC (1063761 co-funded by Heart Foundation), NEA (1072053), AGT (1042600), MFK (1109426), and the Heart Foundation MLH (100034). Some prevention messages were adapted with permission from the National Heart Foundation of Australia (Managing High blood Pressure [2013]; Measuring your blood pressure at home [2016]; Blood Cholesterol; Replace unhealthy fats; Be active every day [2016]; Walking; Am I active enough? [2016]; Get active. Melbourne: National Heart Foundation of Australia). Several of the messages were also adapted from educational materials from the Stroke Foundation and EnableMe websites.
Author contributions
All authors have contributed to various or all aspects of conception, design, drafting or revising of the article, final approval for publication and agree to be accountable for the accuracy and integrity of the work.
Disclosure
The authors report no conflicts of interest in this work.