Background: Evidence indicates inadequate access to secondary stroke prevention (SSP) in rural and poor urban areas. While self-management support (SMS) soon after stroke results in improvements, the best mode of delivery and its use in underserved populations is understudied.
Methods: A pre/post repeated measures design was applied to determine feasibility and effectiveness of mHealth to deliver SMS to stroke survivors in community based urban clinics and in rural South Texas. Adults with stroke and two or more uncontrolled stroke risk factors were eligible. The telehealth SMS program, Video-teleconference - Self-management TO Prevent stroke (V-STOP) was delivered by trained staff on a video teleconferencing mobile application (see Table 1). Participants received up to 3 stroke follow-up clinic visits and 3 group SMS sessions at home on their mobile device. Primary outcomes were feasibility (attendance and satisfaction); blood pressure, disability, psychosocial measures, and stroke knowledge. Paired t-test was used to determine improvement in outcomes at baseline, 6, 12, 18 weeks.
Results: V-STOP was delivered using mHealth to 66 participants over 1 year. Mean age: 57, 42% female, 17% Black and 62% Hispanic: annual income of less than $25,000 (54%) and no health insurance (63%). Attendance rate was 40% for all 6 sessions. Satisfaction with the program and mHealth delivery was high, mean score of 4.88 out of 5. Improvements from baseline to 18 weeks were observed in systolic blood pressure, mean reduction 19 mmHg, ( p =0.015); stroke knowledge, ( p = 0.001); self-efficacy, ( p =0.004); exercise ( p =0.03); activity limitations ( p =0.001); anxiety ( p =0.025); disability ( p =0.024).
Conclusions: Implementation of SMS using mHealth is feasible for SSP among medically underserved stroke survivors. mHealth increases post stroke follow-up and helps stroke survivors improve risk factors.