Development and Evaluation of a Smartphone-enabled, Carer-supported Educational Intervention for Management of Disabilities Following Stroke in India

Background The incidence and prevalence of stroke in India has reached epidemic proportions and is considered a major public health problem. Given the nature of the condition, affected individuals often become disabled, with profound effects on their quality of life. This study aimed to develop an educational intervention for management of post-stroke disability in India and to evaluate the feasibility and acceptability of delivering this intervention using Smartphone technology and caregiver support. Objectives:- To systematically develop a Smartphone-enabled, carer-supported, educational intervention that is multi-disciplinary, patient-centred and culturally-sensitive for management of disabilities following stroke in India. -To evaluate the feasibility and acceptability of the intervention by stroke survivors and their caregivers in the Indian context. Methodology The study was conducted in Chennai, India, and was implemented in three phases: Phase 1: Development of the intervention Phase 2: Field-testing and finalising of the intervention Phase 3: Piloting of the intervention and assessment of feasibility and acceptability. A mixed methods approach was used to develop and evaluate the intervention. Results The intervention was systematically developed and titled ‘Care for Stroke’. It was delivered through a web-based, Smartphone-enabled application. During field-testing, key uncertainties, such as issues with connectivity, video streaming, picture clarity, quality of the videos and functionality of the application, were identified. The intervention was reviewed, revised and finalised before pilot-testing. Findings from the pilot-testing showed that the ‘Care for Stroke’ intervention was feasible and acceptable in an Indian context. Over 90% of the study participants felt that the intervention was relevant, comprehensible and useful. About 95% of the stroke survivors and all the caregivers (100%) rated the intervention to be excellent, based on its overall credibility, usability and user-friendliness. Discussion ‘Care for Stroke’ is an innovative educational intervention that can empower stroke survivors and their families to be cognisant of their disability, ways to manage it and how to make appropriate decisions on their road to recovery. The current context for stroke rehabilitation provides a reasonable opportunity for public health practitioners to optimise interventions such as ‘Care for Stroke’ to efficiently bridge the gaps in accessibility of stroke rehabilitation services and enhance the continuum of care for stroke survivors worldwide. The intervention is specifically pertinent to India and many other Low and Middle-Income Countries (LIMCs) where resources for improving access to stroke rehabilitation services are inadequate. Conclusion ‘Care for Stroke’ is an innovative effort towards the global need for research to develop interventions that bridge the barriers to the provision of stroke rehabilitation services and meet the needs of affected individuals. This application and similar approaches that harness the potential of current technology need to be researched further to bridge the gaps in access to stroke services worldwide.