{
  "abstract": "Background\n\nSocial participation is a key goal of stroke rehabilitation, yet effective interventions remain limited. Existing approaches focus largely on functional training or general psychological support, rarely targeting resilience as a modifiable mechanism for enhancing social participation. Most interventions are delivered face-to-face, limiting accessibility and scalability. A theory-driven digital intervention that integrates resilience training with contextualized practice may offer a promising pathway to support social reintegration in stroke survivors.Objective\n\nThis study aimed to develop a theory-driven, digital resilience-based course-game sequential intervention for improving social participation in stroke survivors and to evaluate its usability among the target population.Methods\n\nThis was an intervention development and usability study. Following the first 4 steps of intervention mapping, we completed the following steps: (1) conducted a needs assessment based on prior empirical evidence identifying psychological resilience as a key determinant of social participation; (2) defined performance and change objectives grounded in the Kumpfer resilience framework, which delineates 5 protective factors (cognitive, emotional, spiritual, behavioral, and physical); (3) selected theory-based methods and practical applications; and (4) developed an intervention prototype through 4 phases: initial design integrating course learning and gamified experiential modules, expert review and refinement by an 8-member panel, development of the digital system via a WeChat mini-program, and finalization of comprehensive intervention scripts. Participants were recruited using convenience sampling from a rehabilitation hospital in Shanghai, China. Usability was evaluated with 14 stroke survivors through 5 representative tasks, the System Usability Scale (SUS), and semistructured qualitative interviews. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using conventional content analysis.Results\n\nThe intervention comprised 2 sequential modules: a 7-session course learning module targeting 5 resilience factors, delivered weekly via narrative audio and multimodal content, and a gamified experiential module featuring a supermarket shopping scenario that enabled contextualized skill application. Each weekly course session was designed to last approximately 60 minutes. The duration of a single game session was 20 minutes. Participants had a mean age of 65.4 (SD 9.75) years, and 78.6% (11/14) had experienced an ischemic stroke. All participants completed the usability tasks successfully. The mean SUS score was 73.6 (SD 12.2, 95% CI 66.5-80.6; median 77.5, IQR 61.3-80.6), indicating good usability. Qualitative feedback revealed 3 themes: perceived ease of use and accessibility, perceived usefulness and engagement, and suggestions for improvement.Conclusions\n\nThis study systematically developed a theory-driven, digital course-game sequential intervention that is innovative in targeting psychological resilience as a core mechanism for social participation, distinguishing it from conventional function-focused or generic resilience approaches. By integrating systematic course learning with contextualized gamified practice, it offers a scalable, low-burden tool that addresses key gaps in stroke rehabilitation. These findings support progression to feasibility and efficacy testing through randomized controlled trials in real-world settings.",
  "abstract_shown": true,
  "affiliations": [
    "School of Nursing, Naval Medical University, 800 Xiangyin Road, Yangpu District, Shanghai, 200433, China, 1 13761801446.",
    "Department of Hematology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Xuan Zhou",
      "orcid": "0000-0002-6827-8960"
    },
    {
      "affs": [
        1
      ],
      "name": "You Lv"
    },
    {
      "affs": [
        0
      ],
      "name": "Runlin Liu"
    },
    {
      "affs": [
        0
      ],
      "name": "Wenjun Gao",
      "orcid": "0000-0002-5767-1396"
    },
    {
      "affs": [
        0
      ],
      "name": "Lanshu Zhou",
      "orcid": "0000-0001-8792-3972"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/557x8egysmbgn.bib",
  "cited_by": 0,
  "doi": "10.2196/96250",
  "fulltext_url": "https://europepmc.org/articles/PMC13727025",
  "id": "557x8egysmbgn",
  "issns": [
    "2291-9279"
  ],
  "landing_url": "https://europepmc.org/article/MED/42970759",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Games and Gamification for Health"
    ],
    [
      "heading",
      "Gamification"
    ],
    [
      "heading",
      "Methods and Feasibility Studies"
    ],
    [
      "heading",
      "Original Paper"
    ],
    [
      "heading",
      "Serious Games for Health and Medicine"
    ],
    [
      "heading",
      "Usability of Games and Gamification"
    ],
    [
      "openalex",
      "2742|Stroke Rehabilitation and Recovery"
    ]
  ],
  "openalex": "W7225123799",
  "pdf_url": "https://europepmc.org/articles/PMC13727025?pdf=render",
  "pmcid": "PMC13727025",
  "pmid": "42970759",
  "published": "2026-11-02",
  "publisher": "JMIR Publications Inc.",
  "ris": "https://research.draconitic.com/paper/557x8egysmbgn.ris",
  "sources": [
    {
      "first_seen": "2026-11-04T15:20:43Z",
      "native_id": "MED:42970759",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42970759"
    },
    {
      "first_seen": "2026-11-05T12:23:14Z",
      "native_id": "PMC13727025",
      "source": "pmc",
      "url": "https://doi.org/10.2196/96250"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2742|Stroke Rehabilitation and Recovery",
      "subfield": "general"
    }
  ],
  "title": "Digital Resilience-Based Course-Game Sequential Intervention for Social Participation in Stroke Survivors: Development and Usability Study.",
  "title_text": "Digital Resilience-Based Course-Game Sequential Intervention for Social Participation in Stroke Survivors: Development and Usability Study.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-06T12:22:50Z",
  "url": "https://research.draconitic.com/paper/557x8egysmbgn",
  "venue": "JMIR serious games",
  "versions": []
}