L.K. Kwah1, K. Doshi2, D.A. De Silva3, W.M. Ng4, S. Thilarajah5
1Singapore Institute of Technology, Health and Social Sciences Cluster, Singapore, Singapore, 2National University of Singapore, Department of Psychology, Singapore, Singapore, 3National Neuroscience Institute, Singapore General Hospital Campus, Singapore, Singapore, 4National Neuroscience Institute, Department of Nursing, Singapore, Singapore, 5Singapore General Hospital, Physiotherapy Department, Singapore, Singapore

Background: The benefits of regular physical activity (PA) after stroke are well known.
Although recommended PA levels after stroke are clear (i.e., 150-300 minutes of moderate intensity PA per week), stroke survivors are not achieving these PA levels. To date, barriers and facilitators to PA after stroke have not been explored in Singapore. While factors such as physical ability, environmental issues (e.g., access, transport, cost), social networks and participation in meaningful activities have been reported to influence PA after stroke in the United States, United Kingdom, Canada and Australia, these determinants might differ in Singapore due to differences in culture, clinical practices and health care systems.

Purpose: As a precursor to an intervention development study, we aimed to use the Theoretical Domains Framework (TDF) to identify factors influencing PA after stroke in Singapore.

Methods: Between November 2021 and January 2022, we conducted interviews with 19 community-dwelling stroke survivors with a weak arm and/or leg. An interview guide based on the TDF was developed. We conducted content analysis and coding of stroke survivors’ statements into the 14 TDF domains. From each TDF domain, we generated belief statements and themes. We prioritised the domains based on the frequencies of the belief statements, presence of conflicting belief statements and evidence of strong belief statements.

Results: Nine of the 14 domains were identified as relevant (i.e., likely to improve PA levels if targeted in interventions). These domains were environmental context and resources, knowledge, social influences, emotion, reinforcement, behavioral regulation, beliefs about consequences, skills and beliefs about capabilities. It was evident that many factors influenced stroke survivors’ participation in regular PA. For example, the lack of access, suitable equipment and skilled help often made a difference as to whether one engaged in regular PA at public fitness spaces such as parks, gyms and swimming pools (environmental context and resources). While a few stroke survivors felt they had the skills to engage in regular PA, most expressed not knowing how much and how hard to work, which exercises to do, which equipment to use and how to adapt exercises and equipment (knowledge and skills). This often left them feeling afraid to try new activities or venture out to new places for fear of the unknown or adverse events (e.g., falls) (emotion). In some cases, doing the activities in a group encourage them to get out and engage in PA (social influences).

Conclusions: Relevant barriers and facilitators to PA after stroke in Singapore were identified. These results highlight potential personal, organizational and community factors to target to improve PA levels after stroke in Singapore.

Implications: Results are used to inform the next stage of the research project which consists of two co-design workshops held with stroke survivors and caregivers to identify and refine elements of a complex intervention targeted at improving PA after stroke.

Funding acknowledgements: The research work is funded by an Ignition grant.

Physical activity

Neurology: stroke
Research methodology, knowledge translation & implementation science
Health promotion & wellbeing/healthy ageing/physical activity

Did this work require ethics approval? Yes
Institution: Singapore Institute of Technology
Committee: Singapore Institute of Technology Institutional Review Board
Ethics number: 2021104

All authors, affiliations and abstracts have been published as submitted.

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