Keeping Active with Texting after Stroke: Development of a co-designed intervention to increase post-rehabilitation physical activity

Introduction: Post-stroke physical activity reduces disability and risk of further stroke. Many people with stroke feel abandoned by services after rehabilitation and struggle to be physically active. This study co-designed a novel text message intervention (KATS) to promote physical activity and provide support when formal rehabilitation ends.

Method: KATS was co-designed by a Collaborative Working Group involving people with stroke, rehabilitation therapists, representatives from stroke charities and academics. A four-step framework was used: formative research on physical activity post-stroke; creation of KATS; pre-testing; and refinement. Formative research, reported here, included in-depth interviews with 14 people with stroke to clarify what support is needed. KATS was based on the Health Action Process Approach (HAPA). Pre-testing included review and revision by 15 volunteers (people with stroke, their spouses and rehabilitation therapists).

Results: People with stroke desired easy to process short messages. They wanted help with motivation and encouragement in goal-setting without therapist input, to provide continuity with rehabilitation, whilst fostering independence. They preferred encouragement to daily exercise prescription and suggested potentially beneficial and enjoyable activities. Messages reflecting experiences of other people with stroke would be valued. A series of 95 messages mapped to HAPA constructs, to be delivered over twelve weeks, was developed.

Conclusion: Co-design was critical in intervention development. People with stroke and health professionals provided insights into perceived barriers post-rehabilitation and identified strategies to overcome them. The structured multi-step approach highlighted areas for improvement through successive rounds of review. The intervention will be piloted prior to a randomised controlled trial.