Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
The audience will learn about a researcher–stakeholder collaboration to create a mobile health (mHealth) self-management intervention for individuals with stroke. This paper will demonstrate a systematic process to apply adaptation and implementation frameworks to generate a feasible, appropriate, and acceptable mHealth self-management intervention.
Primary Author and Speaker: Ryan J. Walsh
Additional Authors and Speakers: Olivia Depaul
Contributing Authors: Carolyn Baum, Ginger E. Nicol, Katie Keenoy, Michelle Klein, and Alex Wong
PURPOSE: Stroke survivors manage long-term chronic conditions and impairments that are barriers to community participation (Ezekiel et al., 2019). Mobile health (mHealth) may facilitate effective health management among individuals in clinical and community settings (Lyon et al., 2016). Self-management interventions such as the Improving Participation after Stroke Self-management (IPASS; Wolf et al., 2016) program teach self-management skills to manage barriers, health, and community participation, but such interventions are not fully examined in mHealth formats. Applying adaptation and implementation frameworks, such as intervention mapping (IM; Bartholomew et al., 1998) and the Contextualized Technology Adaptation Process (CTAP; Lyon et al., 2016), may rapidly generate feasible, appropriate, and acceptable mHealth interventions. Therefore, this study aims to present an adaptation of the IPASS into a mHealth self-management intervention called the Mobile Technology for Improving Participation after Stroke Self-management (MyIPASS) program for future implementation in a pragmatic trial.
DESIGN: This study described the systematic process of developing a mHealth self-management program for individuals with stroke.
METHOD: We formulated a community advisory board (CAB) to co-develop the MyIPASS program. The CAB consisted of an occupational therapist and a director in the stroke clinic, a technology partner, and stroke peer advocates. We applied iterative IM procedures (Bartholomew et al., 1998) and the CTAP (Lyon et al., 2016) to adapt, implement, and evaluate the MyIPASS program. These steps included: (1) conducting a needs assessment; (2) specifying outcomes and objectives; (3) designing program components; (4) producing and refining the program; (5) developing a program implementation plan; and (6) developing a program evaluation plan.
RESULTS: Informed by our meta-analysis, expert recommendations, and secondary analyses of other stroke data, we prioritized specific needs, key program goals, behavioral determinants, and strategies of the MyIPASS program. First, theory-based mHealth self-management interventions, especially those applying cognitive behavioral theory, were effective in enhancing patient outcomes. Second, text messages involving low cognitive demand would facilitate participant engagement. Third, several behavioral change techniques were incorporated into self-management, including information provision (e.g., health tips), self-monitoring (e.g., activity monitoring and scheduling), and problem-solving (e.g., structured action plans to address contextual barriers). Fourth, social support from peers via group sessions would increase access to local resources. Fifth, ecological needs assessment via mHealth would be integrated into the MyIPASS program. Currently, we are engaging with the CAB to generate and refine our program to optimize acceptability, appropriateness, and feasibility. We also selected key implementation and outcome measures to evaluate the MyIPASS program in a pragmatic trial. In the future, we will complete steps to develop implementation and evaluation plans.
CONCLUSION: We have demonstrated the application of IM and the CTAP to generate a feasible, appropriate, and acceptable mHealth self-management program. As we have adopted the implementation science frameworks to guide the mHealth adaptation, rehabilitation stakeholders may adopt these frameworks to adapt other evidence-based programs for target populations.
IMPACT STATEMENT: This study demonstrates the potential for adaptation and implementation frameworks to expand mHealth self-management programs. If successful, this study will generate evidence for expanding mHealth services to optimize post-stroke daily life participation.
References
Bartholomew, L. K., Parcel, G. S., & Kok, G. (1998). Intervention mapping: A process for developing theory- and evidence-based health education programs. Health Education & Behavior: The Official Publication of the Society for Public Health Education, 25(5), 545–563. https://doi.org/10.1177/109019819802500502
Ezekiel, L., Collett, J., Mayo, N. E., Pang, L., Field, L., & Dawes, H. (2019). Factors associated with participation in life situations for adults with stroke: A systematic review. Archives of Physical Medicine and Rehabilitation, 100(5), 945-955. https://doi.org/10.1016/j.apmr.2018.06.017
Lyon, A. R., Wasse, J. K., Ludwig, K., Zachry, M., Bruns, E. J., Unützer, J., & McCauley, E. (2016). The Contextualized Technology Adaptation Process (CTAP): Optimizing health information technology to improve mental health systems. Administration and Policy in Mental Health, 43(3), 394–409. https://doi.org/10.1007/s10488-015-0637-x
Wolf, T. J., Baum, C. M., Lee, D., & Hammel, J. (2016). The development of the Improving Participation after Stroke Self-management program (IPASS): An exploratory randomized clinical study. Topics in Stroke Rehabilitation, 23(4), 284–292. https://doi.org/10.1080/10749357.2016.1155278
