Using Intervention Mapping and Behavior Change Techniques to Develop a Digital Intervention for Self-Management in Stroke: Development Study

Alex W.K. Wong*, Mandy W.M. Fong, Elizabeth G.S. Munsell, Christopher L. Metts, Sunghoon I. Lee, Ginger E. Nicol, Olivia DePaul, Stephanie E. Tomazin, Katherine J. Kaufman, David C. Mohr

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Background: Digital therapeutics, such as interventions provided via smartphones or the internet, have been proposed as promising solutions to support self-management in persons with chronic conditions. However, the evidence supporting self-management interventions through technology in stroke is scarce, and the intervention development processes are often not well described, creating challenges in explaining why and how the intervention would work. Objective: This study describes a specific use case of using intervention mapping (IM) and the taxonomy of behavior change techniques (BCTs) in designing a digital intervention to manage chronic symptoms and support daily life participation in people after stroke. IM is an implementation science framework used to bridge the gap between theories and practice to ensure that the intervention can be implemented in real-world settings. The taxonomy of BCTs consists of a set of active ingredients designed to change self-management behaviors. Methods: We used the first 4 steps of the IM process to develop a technology-supported self-management intervention, interactive Self-Management Augmented by Rehabilitation Technologies (iSMART), adapted from a face-to-face stroke-focused psychoeducation program. Planning group members were involved in adapting the intervention. They also completed 3 implementation measures to assess the acceptability, appropriateness, and feasibility of iSMART. Results: In step 1, we completed a needs assessment consisting of assembling a planning group to codevelop the intervention, conducting telephone surveys of people after stroke (n=125) to identify service needs, and performing a systematic review of randomized controlled trials to examine evidence of the effectiveness of digital self-management interventions to improve patient outcomes. We identified activity scheduling, symptom management, stroke prevention, access to care resources, and cognitive enhancement training as key service needs after a stroke. The review suggested that digital self-management interventions, especially those using cognitive behavioral theory, effectively reduce depression, anxiety, and fatigue and enhance self-efficacy in neurological disorders. Step 2 identified key determinants, objectives, and strategies for self-management in iSMART, including knowledge, behavioral regulation, skills, self-efficacy, motivation, negative and positive affect, and social and environmental support. In step 3, we generated the intervention components underpinned by appropriate BCTs. In step 4, we developed iSMART with the planning group members. Especially, iSMART simplified the original psychoeducation program and added 2 new components: SMS text messaging and behavioral coaching, intending to increase the uptake by people after stroke. iSMART was found to be acceptable (mean score 4.63, SD 0.38 out of 5), appropriate (mean score 4.63, SD 0.38 out of 5), and feasible (mean score 4.58, SD 0.34 out of 5). Conclusions: We describe a detailed example of using IM and the taxonomy of BCTs for designing and developing a digital intervention to support people after stroke in managing chronic symptoms and maintaining active participation in daily life.

Original languageEnglish (US)
Article numbere45099
JournalJMIR Human Factors
Volume10
DOIs
StatePublished - 2023

Funding

GEN has received research support from the National Institutes of Health (NIH), the Health Resources and Services Administration, the Barnes Jewish Hospital Foundation, the Washington University McDonnell Center for Systems Neuroscience and Mallinckrodt Institute of Radiology, and Usona Institute (drug only). She has served as a consultant for Alkermes plc; CarelonRx; Otsuka Pharmaceutical Co., Ltd; and Sunovion Pharmaceutical Co., Ltd. DCM reports research support from the NIH. He has served as a consultant for Otsuka Pharmaceutical Co., Ltd; Optum Behavioral Health; Centerstone Research Institute; and OneMind Foundation. He receives royalties from Oxford Press and has an ownership interest in Adaptive Health. SIL reports research support from the NIH. MWMF has served as an independent contractor for Isaac Ray Forensic Group and Michigan Avenue Neuropsychologists. CLM has an ownership interest in Infinite Arms. He reports subcontracts from the NIH and VA Headache Centers of Excellence. AWKW reports research support from the NIH; the National Institute on Disability, Independent living, and Rehabilitation Research; and the Craig H. Neilsen Foundation. All other authors declare no other conflicts of interest. The authors would like to thank the planning group members for their time and effort in providing feedback related to the intervention development. The authors would also like to thank graduate students, staff, and faculty members at Washington University for their research assistantship, in-kind resource sharing, mentorship, and involvement in different aspects of the research. The contents of this publication and the writing effort of the first author were supported by grants from the American Occupational Therapy Foundation (AOTFIRG20Wong) and the National Center for Medical Rehabilitation Research under the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K01HD095388). Research reported in this publication was also supported by the National Institute of Mental Health (R34 MH118395) and the Washington University Mobile Health Research Core, part of the Institute of Clinical and Translational Sciences, funded by the National Center for Advancing Translational Sciences (UL1TR002345). The content is solely the responsibility of the authors and does not necessarily represent the official view of the funding agencies.

Keywords

  • SMS text messaging
  • behavior change
  • digital intervention
  • intervention mapping
  • mobile health
  • mobile phone
  • rehabilitation
  • self-management
  • stroke
  • technology

ASJC Scopus subject areas

  • Human Factors and Ergonomics
  • Health Informatics

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