Co-design of a multicomponent support program for secondary prevention using digital health technology for people living with stroke or transient ischaemic attack (Preprint)

Abstract

Few individuals (<2%) who experience a stroke or Transient Ischemic Attack (TIA) participate in secondary prevention lifestyle programs. Novel strategies need to be offered by clinicians to support secondary prevention in people living with stroke or TIA. To be successful, these strategies must be acceptable to clinicians and people living with stroke/TIA.

To co-design with people with lived experience of stroke or TIA (referred to as consumers), and clinicians a multicomponent digital technology support program for stroke secondary prevention.

A consumer user needs survey (108 items) was distributed through the Australian Stroke Clinical Registry and the Stroke Association of Victoria. A user needs survey (135 items) for clinicians was circulated via the authors’ research networks and established collaborative relationships, online professional forums, Twitter, and LinkedIn. Following the surveys, two rounds of user experience workshops (design and usability testing workshops) were completed with representatives from each end-user group (consumers and clinicians). Feedback gathered after each round informed the final design of the digital health program.

Overall, 112 consumers (56% male) and 54 clinicians (80% female) completed the survey; all items were completed by 76% of consumers and 78% of clinicians. Most clinicians (94%) indicated the importance of monitoring health and lifestyle measures more frequently than current practice, particularly physical activity, weight, and sleep. Most consumers (79%) and clinicians (54%) agreed that providing alerts about potential deterioration in the individual’s condition were the preferred functions for a digital program. Clinicians and consumers reported regular monitoring of lifestyle habits, physiological measures (e.g., heart rate) and mental health symptoms as the most important measures of a digital secondary prevention program. Intention to use a digital program for stroke prevention and discussing the data collected during face-to-face consultations was high (consumers: 81%; clinicians 86%). In addition, a total of seven consumers (male = 5) and nine clinicians (female = 6) took part in the user experience workshops. Participants highlighted the need for an app that is easy to use with iconography to facilitate user engagement and functions such as a regular health check-in and medication reminders. Capturing blood pressure to share during clinical consultations was noted as a priority for stroke prevention. Clinician feedback also highlighted the need for a customizable clinician dashboard that captures an individual’s goals and health data, with color-coded ‘flags’ when patient’s data is out of normal bounds.

Following an iterative co-design process, supported by evidence from user needs surveys and user experience workshops, a consumer-facing mobile application (app) that integrates wearable activity trackers, and a clinical web portal were designed and developed to support secondary prevention of stroke. Feasibility testing is currently in progress to assess acceptability and usage.