A mixed-method feasibility study of a new digital health support package for people after stroke: The Recovery-focused Community support to Avoid readmissions and improve Participant are Stroke (ReCAPS) intervention

Abstract

Background: Evidence for digital health programs to support people living with stroke is limited. We assessed the feasibility of a protocol and procedures for the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) intervention. Method: We conducted a mixed-method feasibility study. Participants with acute stroke were recruited from three hospitals (Melbourne, Australia). Eligibility: Adults discharged home within 10 days of hospital admission, modified Rankin Score 0-4, and prior use of Short Message System (SMS) or email. While in hospital participants contributed to structured person-centred goal setting with clinicians, provided responses to surveys including assessment of self-management skills and health-related quality of life. Participants were randomised 7-14 days after discharge via REDCap® (1:1 allocation). Following randomisation, the intervention group received a 12-week program of personalised electronic support messages (average 66 messages sent by SMS or email) aligned to their goals. The control group received six electronic administrative messages. Feasibility outcomes included: number of patients screened and recruited, study retainment, completion of outcome measures, number of electronic messages delivered, and acceptability of the ReCAPS intervention and trial procedures (participant satisfaction survey, clinician interviews and researcher communications). We undertook inductive thematic analysis of interview/open-text survey data, and descriptive analysis of closed survey questions.Results: Between November 2018 and October 2019, 312 patients were screened; 37/105 (35%) eligible patients provided consent (mean age 61 years; 32% female); 33 were randomised (17 to intervention). Outcome assessments at 12-weeks were completed by 88% of participants with 16 also completing the satisfaction survey (intervention=10). Overall, trial participants felt that the study was worthwhile and most would recommend it to others. Six clinicians participated in one of three focus group interviews; while they reported that the trial and the process of goal setting acceptable, they raised concerns regarding the additional time required to personalise goals. Conclusion: The study protocol and procedures were feasible with acceptable retention of participants. Consent and goal personalisation procedures should be centralised for the Phase III trial to reduce the burden on hospital clinicians. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12618001468213 (Date 31/08/2018); Universal Trial Number: U1111-1206-7237