User-Centered Mobile Applications for Stroke Survivors (MAPPS): A Mixed-Methods Study of Patient Preferences

Knowledge, attitude, and practice of stroke patients' family members towards stroke rehabilitation: A cross-sectional study

BACKGROUND

This study aimed to explore the knowledge, attitude, and practice (KAP) among family members of stroke patients regarding stroke rehabilitation.

METHODS

A cross-sectional study was conducted on the family members of stroke patients at the China Rehabilitation Research Center from February 15 to May 2, 2024. This study collected demographic data and KAP scores through a self-designed questionnaire.

RESULTS

The study enrolled 517 family members, of which 344 (66.54%) were male. The mean scores for knowledge, attitude, and practice were 12.01 ± 5.46 (possible range: 0-20), 49.40 ± 4.96 (possible range: 11-55), and 41.93 ± 7.49 (possible range: 10-50), respectively. Correlation analyses demonstrated a significant positive relationship between knowledge and attitude (r = 0.501, P < 0.001), knowledge and practice (r = 0.471, P < 0.001), and attitude and practice (r = 0.441, P < 0.001). Structural Equation Modeling indicated that showed that knowledge directly affected attitude (β = 0.481, P = 0.004) and practice (β = 0.351, P = 0.009), and attitude directly affected practice (β = 0.244, P = 0.007). Additionally, knowledge indirectly affected practice through attitude (β = 0.117, P = 0.006).

CONCLUSIONS

This study identified significant gaps in knowledge, despite generally positive attitudes and proactive practices among family members of stroke patients regarding stroke rehabilitation. This highlights the necessity for tailored educational programs for family members to address these knowledge gaps.

Current Status of Barriers to mHealth Access Among Patients With Stroke and Steps Toward the Digital Health Era: Systematic Review

BACKGROUND

Mobile health (mHealth) offers significant benefits for patients with stroke, facilitating remote monitoring and personalized health care solutions beyond traditional settings. However, there is a dearth of comprehensive data, particularly qualitative insights, on the barriers to mHealth access. Understanding these barriers is crucial for devising strategies to enhance mHealth use among patients with stroke.

OBJECTIVE

This study aims to examine the recent literature focusing on barriers to mHealth access among patients with stroke.

METHODS

A systematic search of PubMed, MEDLINE, Web of Science, and CINAHL Plus Full Text was conducted for literature published between 2017 and 2023. Abstracts and full texts were independently screened based on predetermined inclusion and exclusion criteria. Data synthesis was performed using the convergent integrated analysis framework recommended by the Joanna Briggs Institute.

RESULTS

A total of 12 studies met the inclusion criteria. The majority were qualitative studies (about 42%), followed by mixed methods (25%), pilot studies (about 17%), nonrandomized controlled trials (about 8%), and observational studies (about 8%). Participants included patients with stroke, caregivers, and various health care professionals. The most common mHealth practices were home-based telerehabilitation (30%) and poststroke mHealth and telecare services (20%). Identified barriers were categorized into two primary themes: (1) at the patient level and (2) at the health provider-patient-device interaction level. The first theme includes 2 subthemes: health-related issues and patient acceptability. The second theme encompassed 3 subthemes: infrastructure challenges (including software, networking, and hardware), support system deficiencies, and time constraints.

CONCLUSIONS

This systematic review underscores significant barriers to mHealth adoption among patients with stroke. Addressing these barriers in future research is imperative to ensure that mHealth solutions effectively meet patients' needs.

mHealth App to improve medication adherence among older adult stroke survivors: Development and usability study

Background

Effective medication adherence is vital for older adult stroke survivors, yet 20-33% cease treatment within a year post-discharge, increasing risks of recurrent strokes and mortality. A mobile health (mHealth) app could be a novel tool to improve medication adherence among stroke survivors because of its potential to increase patient empowerment. A few stroke-related apps provide information and support to stroke survivors. However, none have focused on medication adherence and documented their development and evaluation process, particularly those focused on this older population.

Objective

This study aims to design and develop a smartphone app called OASapp to improve medication adherence among older adult stroke survivors and evaluate its usability.

Methods

OASapp was developed in a three-phase development process. Phase 1 is the exploration phase (including a cross-sectional survey, a systematic review, a search for stroke apps on the app stores of Apple App Store and Google Play Store, and a nominal group technique). In phase 2, a prototype was designed based on the Health Belief Model and Technology Acceptance Model. In phase 3, Alpha and Beta testing was conducted to validate the app.

Results

Twenty-five features for inclusion in the app were collected in round one, and 14 features remained and were ranked by the participants during nominal group technique. OASapp included five core components (medication management, risk factor management, health information, communication, and stroke map). Users of OASapp were satisfied based on reports from Alpha and Beta testing. The mean Usability Metric for User Experience (UMUX) score was 71.4 points (SD 14.6 points).

Conclusion

OASapp was successfully developed using comprehensive, robust, and theory-based methods and was found to be highly accepted by users. Further research is needed to establish the clinical efficacy of the app so that it can be utilized to improve clinically relevant outcomes.