JMIR Publications

ABSTRACT

Background:

Stroke is a common cause of death and disability in adults, resulting in both physical disability and psychological distress. Stroke impact can be minimized through rehabilitation, but it is a long-term process making it difficult for patients to adhere to treatment. Thus, a better understanding of long-term behavior change interventions for stroke patients is needed, as well as how such interventions can support not only rehabilitation of motoric functions but also mental well-being.

Objective:

The aim of this study was to understand both the most important Behavior Change Technique (BCT) clusters for long-term stroke rehabilitation in general as well as which are most relevant for each aspect of stroke rehabilitation: behavioral, cognitive, and emotional.

Methods:

We apply the 16 BCT clusters proposed by Michie et al. 1. The study used a two round Delphi survey to obtain a reliable consensus among a group of twelve international experts. Experts represented three main backgrounds involved in behavioral intervention in the health context: i) specialists in behavioral science, (n 4); ii) behavioral designers (n 4); and iii) expert healthcare professionals (n 4). In the first round online questionnaires were used to collect data from the experts. This was followed by a personalized second round. Consensus was determined by statistically aggregating the responses and evaluation of interquartile range (IQR) and percentage consensus. BCT clusters reaching consensus (IQR  1 and percentage  50%) were then ranked.

Results:

In total 12 (out of 16) BCT clusters reached consensus for general importance in stroke rehabilitation; with 11, 9, and 6 respectively achieving consensus for the specific behavioral, cognitive, and emotional aspects of rehabilitation. The overall most relevant BCT clusters were repetition and substitution, social support, feedback and monitoring, and self-belief, with similar outcomes for behavioral and cognitive rehabilitation. For emotional rehabilitation social support and identity were emphasized. The least relevant BCT clusters were natural consequences, covert learning, and comparison of behavior.

Conclusions:

This expert panel study using a two round Delphi survey ranked the importance of BCT clusters for long-term stroke rehabilitation. The process yielded a number of insights highlighting differences in importance between general rehabilitation and that specifically focused on the behavioral, cognitive, and emotional aspects of stroke recovery. This provides a first but important step towards evidencing the prioritization of BCT clusters for long-term intervention contexts such as stroke rehabilitation and enables effective intervention mapping. Clinical Trial: N/A