The development, feasibility, and acceptability of a breakfast group intervention for stroke rehabilitation

Background: There are 1.2 million stroke survivors in the UK and the number is projected to increase significantly over the next decade. Research suggests that between 50% and 80% of hospitalised stroke survivors experience difficulties with eating and drinking. Presently, rehabilitation approaches to address these difficulties involve individual rehabilitation sessions led by uni-professionals. Recent national stroke guidance recommends that stroke survivors receive three hours of daily rehabilitation and emphasises the importance of addressing the psychosocial aspects of recovery. Implementing these recommendations presents a challenge to healthcare professionals, who must explore innovative methods to provide the necessary rehabilitation intensity. This study aimed to address these challenges by codesigning a multi-disciplinary breakfast group intervention and implementation toolkit to improve psychosocial outcomes.
Methods: The Hawkins 3-step framework for intervention design was used to develop a multidisciplinary breakfast group intervention and to understand if it was acceptable and feasible for patients and healthcare professionals in an acute stroke ward. The Hawkins 3- steps were 1) evidence review and consultations 2) coproduction 3) prototyping. In collaboration with fifteen stakeholders, a prototype breakfast group intervention and implementation toolkit were codesigned over four months. Experience-based Codesign was used to engage stakeholders.
Results: The literature review is the first to investigate the psychosocial impact of eating and drinking difficulties post stroke. The key finding was the presence of psychological and social impacts which included, the experience of loss, fear, embarrassment shame and humiliation as well as social isolation. Stroke survivors were striving to get back to normality and this included the desire to socially dine with others. Two prototype iterations of the intervention were tested with 16 stroke survivors across three hospital sites. The multidisciplinary breakfast group intervention was designed to offer intensive rehabilitation in a social group context. The codesigned implementation toolkit guided a personalised and tailored approach. A perceived benefit of the intervention was the opportunity to address the psychosocial aspects of eating and drinking rehabilitation as well as providing physical rehabilitation. Stroke survivors highly value the opportunity to socialise and receive support from their peers. The intervention was acceptable to both patients and healthcare professionals, and the workforce model proved practical and feasible to deliver using a collaborative approach in the context of resource-limited healthcare.
Conclusions: The breakfast group interventions, developed through codesign, were positively received by patients and staff and feasible to deliver. They introduce an innovative and novel approach to stroke rehabilitation, personalised to each individual's needs, and offer a comprehensive intervention which addresses both physical and psychosocial aspects which target challenges related to eating and drinking. Unique contributions of this study include a theoretical model for breakfast group interventions, a programme theory and practical tool kit for clinicians to support the translation of research findings and implement breakfast groups in clinical practice.