Process evaluation of F@ce 2.0, a team-based, person-centred intervention for rehabilitation after stroke supported by ICT

Abstract Background Rehabilitation after stroke is a complex process, and innovative solutions, including digital tools, have been suggested as way of meeting the challenge of limited access to services. F@ce 2.0 is a person-centred intervention for rehabilitation after stroke where goal achievement is supported by information and communication technology. Guidance for evaluation of complex interventions, such as that from the UK Medical Research Council (MRC), underlines the importance of evaluating not only the effects of an intervention but also process, such as its implementation in a clinical setting. The objective was therefore to study the implementation process of the F@ce 2.0 intervention for stroke survivors living at home as well as the interaction between the intervention and the implementation context. Methods A process evaluation of the implementation of F@ce 2.0 was conducted, informed by the MRC guidance for process evaluations, utilising a convergent mixed methods design. Participants included stroke survivors ( n = 39), rehabilitation team members ( n = 53) and managers ( n = 6). Data were collected through a web server, surveys and interviews. Descriptive statistics were used for quantitative analysis. Qualitative data were analysed using a deductive thematic approach based on the Consolidated Framework for Implementation Research. Results Analysis revealed challenges in conducting research during the COVID-19 pandemic as well as limitations related to implementation planning in relation to the specific context. The reach of the intervention among stroke survivors was low, and fidelity issues were identified related to the teams’ lack of readiness to deliver the intervention. Analysis of teams’ perception of delivering the intervention revealed that they saw potential in using a structured instrument for person-centred goal setting and in goal reminders, but also a hesitation regarding the usability of the intervention for stroke survivors. Teams also expressed a need of further education in delivering the intervention. Conclusions The process evaluation showed that although rehabilitation teams recognized the potential of F@ce 2.0, implementation and reach were limited, largely due to insufficient contact with the teams for both support and monitoring. Earlier involvement of the rehabilitation teams would likely have helped identify educational needs and organizational conditions necessary for successful implementation. Trial registration ClinicalTrials.gov NCT04351178. Firs posted 2020-04-17. https://clinicaltrials.gov/study/NCT04351178 .