Date Presented 03/27/20
Physical activity is a key component of primary and secondary stroke prevention. However, stroke survivors frequently do not meet physical activity guidelines, and calls have been made for the use of mobile and wireless devices, i.e., mobile health, to support participation in physical activity. The current study explores the perspectives of stroke survivors and health professionals on the use of mobile health to support engagement in physical activity.
Primary Author and Speaker: Daniel Carter
Contributing Authors: Katie Robinson, John Forbes, Jane Walsh, Sara Hayes
PURPOSE: Stroke mortality in the United States continues to decline (Yang et al., 2017), resulting in greater numbers of stroke survivors. Physical activity (PA) is important for a variety of health outcomes, including the secondary prevention of stroke; however, stroke survivors frequently do not meet PA guidelines (Billinger et al., 2014). PA is a health behavior and occupation underpinned by client factors, performance patterns and skills, as well as environment and context; therefore, occupational therapists have a clear role in supporting clients who aspire to increase participation in PA (Bailey, 2017). A joint statement by the American Heart Association/ American Stroke Association has called for the development of novel PA interventions which capitalize on technology (e.g. smartphones and mobile health [mHealth] applications) (Billinger et al., 2014). The current study aims to develop the evidence base for a PA intervention by exploring the perspectives of two key stakeholder groups, stroke survivors and healthcare professionals, on the use of mHealth applications to support participation in PA.
DESIGN/METHOD: The study employs a qualitative descriptive approach. Recruitment is taking place in Ireland and is currently ongoing. It will continue until data saturation is reached. Community-dwelling stroke survivors are being recruited through stroke support groups, while clinicians are being recruited through the stroke service of a regional hospital, Twitter, and the Irish professional bodies for occupational therapists and physiotherapists. Topic guides for both stakeholder groups were informed by relevant literature and explore participants’ perspectives on PA and the use of mHealth applications to support participation in same. Stroke survivor participants are also participating in a “think aloud” session within each focus group where they have the opportunity to interact with a healthy living mHealth application. Data are being analyzed iteratively using thematic analysis in NVivo 12.
RESULTS: Preliminary analysis indicates that stroke survivors are interested in mHealth applications and some had prior positive experiences of using mHealth applications to self-monitor step count without support from health professionals. Stroke survivors collectively noted that while a mHealth application with opportunities for goal-setting and feedback might be useful for supporting PA, an application alone would not motivate them to be more physically active. Healthcare professionals (clinical psychology, medicine, nursing, occupational therapy, and physiotherapy) reported that mHealth applications could be used to support patient autonomy and that the inclusion of objective outcome measures would be particularly useful, particularly as patients frequently inaccurately report PA. They acknowledged that mHealth applications are increasingly being incorporated into everyday life, but remained skeptical that a single mHealth application would suit the needs of all stroke survivors.
CONCLUSION: Overall, both stakeholder groups were, in the main, receptive to using mHealth applications for the delivery of a PA intervention. However, this is tempered by findings from both groups which suggest it is unlikely that a single mHealth application will meet the needs of all stroke survivors. This is in line with previous findings suggesting that occupational therapists prescribe applications by considering client factors rather than adopting a one-size-fits-all approach (Seifert, Stotz, & Metz, 2017). Further collection of data is required to develop themes and to ensure data saturation is reached.
References
Yang, Q., Tong, X., Schieb, L., Vaughan, A., Gillespie, C., Wiltz, J. L., . . . Hong, Y. (2017). Vital signs: recent trends in stroke death rates—United States, 2000–2015. MMWR. Morbidity and mortality weekly report, 66(35), 933. doi:10.15585/mmwr.mm6635e1
Billinger, S. A., Arena, R., Bernhardt, J., Eng, J. J., Franklin, B. A., Johnson, C. M., . . . Roth, E. J. (2014). Physical activity and exercise recommendations for stroke survivors: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 45(8), 2532-2553. doi:10.1161/STR.0000000000000022
Bailey, R. R. (2017). Promoting Physical Activity and Nutrition in People With Stroke. American Journal of Occupational Therapy, 71(5), 7105360010p7105360011-7105360010p7105360015. doi:10.5014/ajot.2017.021378
Seifert, A. M., Stotz, N., & Metz, A. E. (2017). Apps in therapy: occupational therapists’ use and opinions. Disability and Rehabilitation: Assistive Technology, 12(8), 772-779. doi:10.1080/17483107.2016.1262912
