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- Mälstam, Emelie, et al.
(författare)
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Incorporating new ways of doing by learning from everyday experiences and interactions using a multifactorial mHealth app
- 2023
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Ingår i: Digital Health. - : SAGE. - 2055-2076. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Background: Digital health innovations can support the prevention and management of risk factors for cardiovascular diseases, such as stroke. However, little is known about people's everyday experiences of digitally augmented stroke-prevention programmes combining onsite group sessions including peers and healthcare professionals with interaction and support from a multifactorial mHealth app. Objective: The aim of this study was to explore how people with stroke risk experienced interaction with a multifactorial mHealth app as support in the make my day stroke-prevention programme. Methods: Repeated interviews and observations with 12 adults with moderate to high stroke risk were analysed using a constant comparative method informed by constructive grounded theory. Results: Incorporating new ways of doing into everyday life involves a process through which participants learn from both being and doing in different environments (e.g., digital, physical and social). Digital self-monitoring combined with seemingly trivial everyday experiences played central roles in the process of increasing awareness of health and stroke risks, and providing tools to support increased self-reflection on everyday behaviours. Adoption of positive health behaviours in everyday life was supported or hindered by how easy to use and personally relevant the mHealth app was perceived to be. Conclusions: An experience-based group programme together with a personally relevant multifactorial mHealth app can be supportive in stroke prevention to increase general health literacy and stroke risk literacy, and promote the incorporation of new ways of doing in everyday life. Routines of doing digital self-monitoring and health-promoting activities were however strongly influenced by different environments in which choices are presented. It is therefore important to explore how both self-monitoring and health-promoting activities can be incorporated into everyday routines for different individuals. Research should also explore how personally relevant mHealth can be developed and integrated into prevention practices in primary healthcare.
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| 2. |
- Mälstam, Emelie
(författare)
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Make My Day : exploring engaging occupations in stroke prevention and promotion of health
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Stroke is one of the major causes of disease burden worldwide. Most stroke cases are attributed to modifiable risk factors, such as high blood pressure, overweight, smoking, physical inactivity, and poor diet, making promoting an overall healthy lifestyle an essential strategy for stroke prevention. While multifactorial lifestyle interventions in a primary healthcare setting have been useful in addressing risk factors to prevent cardiovascular diseases (CVDs), such approaches specifically designed for primary stroke prevention are scarce in a Swedish setting. Applying an occupational perspective, incorporating and sustaining engaging occupations in everyday life has not previously been explored, and such an approach's feasibility has not been evaluated. Engaging occupations have been characterized by their high meaningfulness, intense participation, and importance for a person’s well-being. They are therefore important to explore in the context of addressing and improving risk factors for stroke and as part of a model for stroke prevention in primary healthcare. Aim: To generate knowledge about engaging occupations in stroke prevention and promoting health among people at risk for stroke. To explore and evaluate the feasibility and implementation process of Make My Day (MMD), a digitally augmented stroke prevention intervention in primary healthcare. Methods: The Medical Research Council’s (MRC) guidance for developing and evaluating complex interventions has been used in this thesis. In the exploration and development of MMD, key theoretical underpinnings were studied. In Study I, interviews were conducted with persons at risk for stroke who also had been diagnosed with a transient ischemic attack (TIA) (n=6). Study II built on data from observations and interviews with persons at moderate to high risk for stroke (n=6) participating in Study III. In addition, data on the same topic from Study I was extracted and used to answer the aim of Study II. Data in both Studies I and II was analyzed using a constant comparative method. Study III was a pilot randomized controlled trial (RCT) evaluating the feasibility of MMD among persons at risk for stroke (n=29). Both descriptive and inferential statistics were used to analyze the data. Study IV was a process evaluation conducted alongside the pilot RCT evaluating the intervention's reach, fidelity, dose, and contextual factors derived from logbooks and reflective field notes. Descriptive statistics was applied. To analyze data on acceptability derived from interviews and reflective field notes, a constant comparative method was used. Results: Studies I-IV illustrate that the utilization of engaging occupations in stroke prevention is feasible. Engaging occupations as means and goals was supportive in promoting healthy lifestyle changes in everyday life among persons at risk for stroke. This was partly because of the motivational element of engaging occupations (Study I). Changing lifestyle habits was, however complex and imbued with barriers ranging from the individual to societal level. New ways of doing in everyday life could be facilitated by developing a self-monitoring routine in tandem with engaging in and reflecting on one’s occupations in everyday life (Study II). In learning and changing ways of doing, engaging in a personally relevant mHealth app was supportive. When the digital environment corresponds with literacy levels, previous experiences, and needs in terms of automatizations, self-monitoring became enjoyable and more accessible to integrate into everyday life for persons at risk for stroke. Moreover, Study III showed that the MMD intervention was feasible through its timely recruitment of participants, overall high response rates and study completion, and sensitivity to change in key outcomes, such as stroke risk reduction and occupational performance. In addition, Study IV illustrated the acceptability of MMD among persons at risk for stroke and health professionals. Key mediators were the high willingness to and belief in working with the framework of MMD. Key challenges were time management, heterogeneity in group compositions, and the reimbursement system. Conclusions: This thesis demonstrates the feasibility of a digitally augmented stroke prevention intervention and the usefulness of engaging occupations when promoting healthy lifestyle changes. The knowledge gained may be transferable to interventions addressing the prevention of other CVDs, also caused by modifiable risk factors. However, sustainable implementation of prevention like MMD relies on personally relevant approaches and on addressing aspects on the organizational and socio-political level so that preventative interventions such as MMD are reimbursed.
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| 3. |
- Mälstam, Emelie, et al.
(författare)
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The Feasibility of Make My Day—A Randomized Controlled Pilot Trial of a Stroke Prevention Program in Primary Healthcare
- 2023
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 20:19
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Tidskriftsartikel (refereegranskat)abstract
- Incorporating and sustaining engaging everyday activities (EEAs) in everyday life holds potential for improving health and wellbeing; thus, there is reason to explore EEAs as a behavioral change technique in stroke prevention. The aim of this study was to evaluate the feasibility of the stroke prevention program Make My Day (MMD) for people with moderate-to-high risk for stroke in a primary healthcare setting, where EEAs are utilized to promote healthy activity patterns. A randomized controlled pilot trial was designed to evaluate the feasibility of MMD. Twenty-nine persons at risk for stroke were recruited and randomized into either an intervention group (n = 14) receiving MMD or a control group (n = 15) receiving brief health advice and support with goal setting. The results suggest that MMD is feasible, with timely recruitment, overall high response rates and study completion, and sensitivity to change in key outcome measures. Moreover, the results demonstrate that the application of EEAs can be useful for promoting behavioral change in stroke prevention. Recommendations for improvements for a full-scale trial include recruiting a relevant sample, using reliability- and validity-tested outcome measures, and implementing strategies to limit missing data.
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