JMIR Publications

ABSTRACT

Background:

The debilitating effects of recurrent stroke among aging patients have urged researchers to explore medication adherence among these patients. Video narratives built upon Health Belief Model (HBM) constructs have displayed potential impact on medication adherence adding a plus-point to patient education efforts. However, its effect on medication understanding and use self-efficacy have not been tested.

Objective:

The researchers believed that culturally sensitive video narratives which catered specific niche would reveal a personalized impact on medication adherence. This study aimed to develop and validate video narratives for this purpose.

Methods:

This study adapted Delphi method to develop a consensus on the video scripts contents of learning outcomes and HBM questions. The panel of experts consisted of eight members representing a mix of experiences in stroke in Malaysia. The Delphi method involved three rounds of discussion. Once consensus was achieved, the researchers drafted the initial scripts in English which were then back-translated to the Malay language. Ten bilingual patients within inclusion criteria screened the scripts for comprehension. Subsequently, an actual doctor and patient narrated the scripts while they were filmed; to add the realism of the narratives. Then, the video narratives underwent a few cycles of editing after some feedback on video engagement by the bilingual patients. Few statistical analysis were applied to confirm the validity of the video narratives.

Results:

Initially, the researchers proposed eight learning outcomes and nine HBM questions for the video scripts content. However, following Delphi rounds 1 to 3, few statements were omitted and rephrased. Complete agreement (>80%) arrived for five learning outcomes and five HBM questions. Kendall's coefficient of concordance, W; was above 0.7 which indicated a firm agreement, and SD values within a range of below 1.5 confirmed satisfactory content and construct validity of learning outcomes and HBM questions. Also, the video engagement scores were above average which indicated that the video narratives had a good link with perceived realism.

Conclusions:

The Delphi method was proven to be helpful in conducting discussion systematically and providing precise contents for the development of video narratives. Whereas, the video engagement scale had helped to create realistic video styles and emotions which the researchers believed could positively impact medication understanding and use self-efficacy among patients with stroke. A feasibility and acceptability study in an actual stroke care center is warranted. Clinical Trial: Approvals have been obtained from the Malaysian Medical Research and Ethics Committee – MREC (NMRR ID-15-851-24737) and the Monash University Human Research Ethics Committee - MUHREC (ID 9640), whereas MyStrokeStory trial was registered with the Australian New Zealand Clinical Trials Registry- ANZCTR (ACTRN12618000174280) with Universal Trial Number (UTN) U1111-1201-3955.