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Peer-reviewedCC BY 4.0BMJ Open

Performing lifestyle changes and reducing stroke risk: a process evaluation of a stroke prevention intervention

  • Cecilia Johnsson1
  • Eric Asaba1,2
  • Susanne Guidetti1,3
  • Maria Hagströmer4,5
  • Ann-Helen Patomella1,5
5 affiliations
  1. 1Department of Neurobiology, Care Sciences and Society (NVS), Division of Occupational Therapy, Karolinska Institute, Stockholm, Sweden
  2. 2Department of Health and Rehabilitation, Sahlgrenska Academy, Gothenburg, Sweden
  3. 3Medical Unit Allied Health Professionals, Womens Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
  4. 4Department of Neurobiology Care Sciences and Society (NVS), Division of Physiotherapy, Karolinska Institute, Stockholm, Sweden
  5. 5Academic Primary Care Health Centre, Region Stockholm, Stockholm, Sweden
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Abstract

Objective: To examine the implementation process, mechanisms of change and contextual influences of a stroke prevention intervention.

Design: A process evaluation following the UK Medical Research Council’s process evaluation framework was conducted alongside a randomised controlled trial (RCT).

Setting: The intervention was conducted in Swedish primary healthcare.

Participants: Persons at high risk of stroke participating in the Make My Day, a 10-week group-based intervention (n=122) and healthcare professionals delivering the intervention (n=10).

Methods: Quantitative data from logbooks, surveys and app registrations, and qualitative data from interviews, logbooks and reflexive fieldnotes were collected across five cohorts. Data were analysed separately and integrated using a convergent mixed-methods approach.

Results: Fidelity varied; overall adherence to the study manual and programme content was good, while fidelity to specific session activities and session attendance varied, with a mean of 3.6 (SD 2.2) out of 6. Recruitment successfully reached individuals at high risk of stroke, but reaching a vulnerable population was challenging. Realistic, activity-focused goal setting emerged as the most perceived valued mechanism of change. Engaging everyday activities supported sustainable change when a sense of belonging was established. The group served as both a facilitator and a barrier to lifestyle change. The mobile app offered opportunities but faced usability challenges. Healthcare professionals’ delivery of the intervention was expressed as central for the change.

Conclusions: This study demonstrates how fidelity, facilitation and contextual conditions shape the functioning of a complex lifestyle intervention. Supporting healthcare professionals with adequate preparation and pedagogical skills is critical to optimising the delivery and outcomes of stroke prevention interventions in primary healthcare.

Trial registration number: NCT05279508 .

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Cite

BibTeXRIS
BibTeX
@article{johnsson2026performing,
  title = {{Performing lifestyle changes and reducing stroke risk: a process evaluation of a stroke prevention intervention}},
  author = {Cecilia Johnsson and Eric Asaba and Susanne Guidetti and Maria Hagströmer and Ann-Helen Patomella},
  journal = {BMJ Open},
  year = {2026},
  month = sep,
  doi = {10.1136/bmjopen-2026-123012},
  url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-123012},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Performing lifestyle changes and reducing stroke risk: a process evaluation of a stroke prevention intervention
AU  - Cecilia Johnsson
AU  - Eric Asaba
AU  - Susanne Guidetti
AU  - Maria Hagströmer
AU  - Ann-Helen Patomella
PY  - 2026
DA  - 2026/09/30
JO  - BMJ Open
DO  - 10.1136/bmjopen-2026-123012
UR  - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-123012
AB  - Objective: To examine the implementation process, mechanisms of change and contextual influences of a stroke prevention intervention.  Design: A process evaluation following the UK Medical Research Council’s process evaluation framework was conducted alongside a randomised controlled trial (RCT).  Setting: The intervention was conducted in Swedish primary healthcare.  Participants: Persons at high risk of stroke participating in the Make My Day, a 10-week group-based intervention (n=122) and healthcare professionals delivering the intervention (n=10).  Methods: Quantitative data from logbooks, surveys and app registrations, and qualitative data from interviews, logbooks and reflexive fieldnotes were collected across five cohorts. Data were analysed separately and integrated using a convergent mixed-methods approach.  Results: Fidelity varied; overall adherence to the study manual and programme content was good, while fidelity to specific session activities and session attendance varied, with a mean of 3.6 (SD 2.2) out of 6. Recruitment successfully reached individuals at high risk of stroke, but reaching a vulnerable population was challenging. Realistic, activity-focused goal setting emerged as the most perceived valued mechanism of change. Engaging everyday activities supported sustainable change when a sense of belonging was established. The group served as both a facilitator and a barrier to lifestyle change. The mobile app offered opportunities but faced usability challenges. Healthcare professionals’ delivery of the intervention was expressed as central for the change.  Conclusions: This study demonstrates how fidelity, facilitation and contextual conditions shape the functioning of a complex lifestyle intervention. Supporting healthcare professionals with adequate preparation and pedagogical skills is critical to optimising the delivery and outcomes of stroke prevention interventions in primary healthcare.  Trial registration number: NCT05279508 .
SN  - 2044-6055
SN  - 2044-6055
ER  -