Abstract Body: Background and aims: The burden of stroke and stroke-related disability in Peru – a low- to middle-income country – is nearly 50% higher than the global average. Gaps in post-stroke care in Peru include insufficient rehabilitation and post-acute care, limited caregiver training, and lack of a national palliative care program. To address these gaps, we designed and piloted a hospital-based training intervention to support patients discharging home after severe stroke.
Methods: Between June 1st, and November 30th, 2023, we randomized caregivers to two intervention arms (online vs in-person), which both included training in nasogastric and Foley tube management, bathing and cleaning, and mobilization. Using a convergent mixed-methods design, we simultaneously collected quantitative and qualitative data from caregivers and stroke nursing staff one-month after discharge). Outcomes informed by Proctor et al and RE-AIM frameworks we used to describe and assess feasibility and acceptability of implementation.
Results: We recruited 38 caregivers of patients with severe stroke (patient median modified Rankin Score of 5) and randomly assigned 19 to each arm. Feasibility and acceptability, as the percentage greater than 75% to administering two caregivers’ scales and the percentage greater than 50% reporting acceptability to the intervention, respectively, were over 80% for both groups; adoption, as the percentage of caregivers who completed training was 100% for in-person versus 57.9% for virtual arm (p=0.001). Willingness to participate in the training was a facilitating factor; barriers included caregiver burden, stressful family dynamics and limited internet skills (for older caregivers).
Conclusions: While both in-person and online caregiver trainings were feasible and acceptable, in-person training was both preferred and achieved superior results. More interventions to improve support for caregivers of patients with severe stroke with clear implementation guidance strategies are needed to ensure their effectiveness, impact, and sustainability.