Accepted for/Published in: JMIR Serious Games
Date Submitted: Mar 26, 2026
Date Accepted: Sep 24, 2026
Digital resilience-based course-game sequential intervention for social participation in stroke survivors: development and usability study
ABSTRACT
Background:
Social participation is a key goal of stroke rehabilitation, yet effective interventions remain limited.
Objective:
This study aimed to develop and evaluate the usability of a digital resilience-based course-game sequential intervention to improve social participation in stroke survivors.
Methods:
Following the first four steps of Intervention Mapping (IM), we: (1) conducted a needs assessment, identifying psychological resilience as a key determinant of social participation; (2) defined performance and change objectives based on Kumpfer’s Resilience Framework; (3) selected theory-based methods and practical applications; and (4) developed an intervention prototype through four phases: initial design integrating course learning and gamified modules, expert review and refinement, development of the digital system, and finalization of comprehensive intervention scripts. Usability was evaluated with 14 stroke survivors through five representative tasks, the System Usability Scale (SUS), and qualitative interviews.
Results:
The intervention, delivered via a WeChat mini-program, comprises two sequential modules: a seven-session course module targeting five resilience factors (cognitive, emotional, spiritual, behavioral, and physical), and a gamified “supermarket shopping” module enabling contextualized skill application. Each weekly session lasted 60 minutes. The duration of a single game experience was 20 minutes. All participants completed the usability tasks successfully. The mean SUS score was 73.6 indicating good usability. Qualitative feedback supported the intervention’s acceptability.
Conclusions:
This study systematically developed a theory-driven, digital course-game sequential intervention with demonstrated usability for stroke survivors. By integrating resilience training with contextualized gamified practice, the intervention addresses key gaps in existing approaches. These findings support progression to efficacy testing through randomized controlled trials.
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