Using Intervention Mapping and Behavior Change Techniques to Develop a Digital Intervention for Self-Management in Stroke: Development Study

Abstract

Background Digital therapeutics, such as interventions provided via smartphones or the internet, have been proposed as promising solutions to support self-management in persons with chronic conditions. However, the evidence supporting self-management interventions through technology in stroke is scarce, and the intervention development processes are often not well described, creating challenges in explaining why and how the intervention would work. Objective This study describes a specific use case of using intervention mapping (IM) and the taxonomy of behavior change techniques (BCTs) in designing a digital intervention to manage chronic symptoms and support daily life participation in people after stroke. IM is an implementation science framework used to bridge the gap between theories and practice to ensure that the intervention can be implemented in real-world settings. The taxonomy of BCTs consists of a set of active ingredients designed to change self-management behaviors. Methods We used the first 4 steps of the IM process to develop a technology-supported self-management intervention, interactive Self-Management Augmented by Rehabilitation Technologies (iSMART), adapted from a face-to-face stroke-focused psychoeducation program. Planning group members were involved in adapting the intervention. They also completed 3 implementation measures to assess the acceptability, appropriateness, and feasibility of iSMART. Results In step 1, we completed a needs assessment consisting of assembling a planning group to codevelop the intervention, conducting telephone surveys of people after stroke (n=125) to identify service needs, and performing a systematic review of randomized controlled trials to examine evidence of the effectiveness of digital self-management interventions to improve patient outcomes. We identified activity scheduling, symptom management, stroke prevention, access to care resources, and cognitive enhancement training as key service needs after a stroke. The review suggested that digital self-management interventions, especially those using cognitive behavioral theory, effectively reduce depression, anxiety, and fatigue and enhance self-efficacy in neurological disorders. Step 2 identified key determinants, objectives, and strategies for self-management in iSMART, including knowledge, behavioral regulation, skills, self-efficacy, motivation, negative and positive affect, and social and environmental support. In step 3, we generated the intervention components underpinned by appropriate BCTs. In step 4, we developed iSMART with the planning group members. Especially, iSMART simplified the original psychoeducation program and added 2 new components: SMS text messaging and behavioral coaching, intending to increase the uptake by people after stroke. iSMART was found to be acceptable (mean score 4.63, SD 0.38 out of 5), appropriate (mean score 4.63, SD 0.38 out of 5), and feasible (mean score 4.58, SD 0.34 out of 5). Conclusions We describe a detailed example of using IM and the taxonomy of BCTs for designing and developing a digital intervention to support people after stroke in managing chronic symptoms and maintaining active participation in daily life.

A Digital Intervention to Promote Self-Management Self-Efficacy Among Community-Dwelling Individuals With Stroke: Pilot Randomized Controlled Trial

“…Finally, to ensure iSMART should be applied to the selected behavioral change techniques, we developed a set of empirically supported strategies and integrated these strategies into different parts of the 3 treatment components. Details of the intervention development of iSMART, including the theoretical framework, mechanisms of action, behavioral change techniques, and the set of empirically supported strategies, are described elsewhere [ 22 ].…”

“…Figure 2 provides snapshots of these messages. We formed a planning group, including 2 stroke rehabilitation clinicians, a stroke survivor, a technologist, and a self-management expert, to guide the intervention adaptation using a systematic intervention-mapping process [22,36]. During this adaptation process, we applied the behavior change wheel [37] and behavioral change technique taxonomy [38] to specify strategies that help individuals change self-management behaviors.…”

“…To harness the benefits of the mHealth delivery, we developed a technology-supported self-management intervention, the interactive Self-Management Augmented Rehabilitation Technologies (iSMART) intervention, adapted from the face-to-face, stroke-focused psychoeducation program Improving Participation after Stroke Self-Management (IPASS) [11,13]. iSMART simplified the original IPASS psychoeducation sessions and added text messaging and behavioral coaching components [22]. We integrated SMS text messaging into iSMART because it is easily customized to individual needs and accessible to anyone with a cell phone [23,24].…”

Building Bridges between People with Stroke, Families, and Health Professionals: Development of a Blended Care Program for Self-Management

“…Research on stroke, particularly regarding the application of novel digital interventions, has predominantly concentrated on secondary prevention (e.g., [ 29 , 30 , 31 ]). Moreover, while recent studies have investigated the potential of digital tools to enhance post-stroke self-management interventions, the practical implementation of these digital components has been largely confined to electronic messaging, smartphone push notifications, and video conferencing [ 32 , 33 , 34 , 35 ].…”