Performing lifestyle changes and reducing stroke risk: a process evaluation of a stroke prevention intervention
In brief
Practical goal-setting stood out in a 10-week stroke prevention program
In a process evaluation of a 10-week group program involving 122 people at high risk of stroke, participants valued realistic goals tied to everyday activity, especially when the group fostered belonging. Delivery was broadly faithful to the manual, but attendance averaged 3.6 of six sessions and group dynamics and app usability brought challenges; staff preparation may be key to consistent delivery.
- Journal
- BMJ open (Q1)
- Published
- 30 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Cecilia Johnsson, Eric Asaba, Susanne Guidetti, Maria Hagströmer, Ann-Helen Patomella
- PMID
- 42816085
- DOI
- 10.1136/bmjopen-2026-123012
Why clinicians should know about it
- Picked for Neurology (clinical) (top studies of the week, 4 October 2026): Process evaluation of stroke prevention lifestyle intervention
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.