Barriers and Facilitators to Maintaining Physical Activity After an mHealth Intervention for People Poststroke or Transient Ischemic Attack: Reflexive Thematic Analysis

Clinical Snapshot

Key Findings

• P Value: Not applicable for qualitative research

• Effect Size: Not applicable for qualitative research

• Primary Outcome: Three main themes: building experience and knowledge, staying active in complex life situations, and contextual meaning for activity maintenance

• Nnt Or Sensitivity: Conceptual model: 'soap bubble' metaphor representing fragility and need for supportive environment

• Confidence Interval: Not applicable for qualitative research

Clinical Application

Findings suggest need for extended support and environmental considerations in mHealth program design Relevant to Australian stroke rehabilitation services, community health programs, and telehealth initiatives supported by Medicare Benefits Schedule Adults with stroke or TIA participating in mHealth interventions, particularly in rehabilitation and community settings

Abstract

BACKGROUND: Regular physical activity is critical for preventing secondary stroke following a stroke or transient ischemic attack (TIA). Although mobile health (mHealth) interventions have shown promise for promoting short-term increases in physical activity, evidence on their long-term effects and the mechanisms that support sustained behavior change remains limited. In particular, little is known about how people poststroke or TIA integrate the skills, knowledge, and habits gained through mHealth interventions into their daily lives once structured intervention support ends. OBJECTIVE: This study aimed to explore the perceived barriers and facilitators of maintaining physical activity among individuals poststroke or TIA after completing an mHealth intervention. METHODS: A qualitative approach was used, involving a strategic sample of 12 participants recruited after they had completed a 6-month mHealth intervention for people poststroke or TIA. The intervention included supervised physical therapy with mHealth support for physical exercises and behavior change (eg, counseling, goal-setting, and self-monitoring), followed by a 6-month postintervention period with access to self-managed mHealth support. To enable richness and depth in participants' accounts, the dataset consisted of 2 semistructured interviews conducted 3 months and 6 months after completing the intervention, along with participant-generated photographs. Between the interviews, participants took photos to reflect their experiences of maintaining physical activity after the intervention. These images served as prompts for dialog and reflection during the second interview. Data were analyzed using reflexive thematic analysis. RESULTS: We generated 3 themes: building experience and knowledge to maintain physical activity, staying physically active in a complex life situation, and the meaning of context for maintaining physical activity after the intervention. Barriers and facilitators were conceptually integrated into a comprehensive understanding of maintaining physical activity, symbolized by the metaphor of a soap bubble, which requires persistence and a supportive environment to stay afloat. The complexity of participants' health and life situations created barriers to maintaining physical activity. To overcome these barriers, developing personal strategies within a supportive social and physical context was crucial. This development was facilitated by the mHealth intervention, which enabled knowledge acquisition of the principles of physical activity after stroke or TIA, along with increased awareness of its health benefits. CONCLUSIONS: mHealth interventions for people poststroke and TIA can serve as a catalyst for physical activity engagement and an enhancer of the knowledge and experience necessary to maintain physical activity after the intervention. Despite health-related and contextual barriers, participants may use personalized strategies, supported by their social and environmental context, to navigate these challenges. These insights highlight opportunities for future mHealth interventions to strengthen the interaction between individuals and their environment and empower tailored strategies for behavior change and long-term physical activity maintenance.

References

1. 1.Lagerlund, H., Moulaee Conradsson, D., Häger, C. K., Kwak, L., & Holmlund, L. (2026). Barriers and facilitators to maintaining physical activity after an mHealth intervention for people poststroke or transient ischemic attack: Reflexive thematic analysis. JMIR Cardio. https://doi.org/10.1161/STROKEAHA.124.049474