Abstract Body: Introduction: Stroke imposes a significant burden on individuals, families, and healthcare systems, with high readmission rates and healthcare utilization. It disproportionately affects racial/ethnic minorities, exacerbating healthcare disparities. There is a critical need for tailored, patient-centered interventions, particularly for minority populations.
Objectives: This research identifies key themes in stroke survivors' and care partners' perspectives post-stroke, and examines the demographic and social determinants of health impacting outcomes. The study focuses on how these factors influence survivors' experiences with a digital health platform offering personalized support through remote clinical guidance and curated educational content.
Methods: A mixed-methods, exploratory design was employed with 50 participants, including 36 unique stroke survivors (52.7% female, 47.2% male) and 13 care partners (84.6% female, 15.3% male), followed for 90 days for comprehensive post-stroke care via Principal Illness Navigation (PIN). The average age of participants was 59 years, with close to 60% being non-white. Participants provided feedback through focus groups conducted via video-conferencing between December 2022 and March 2024. These sessions included up to 3 participants, a facilitator, a Kandu representative, and lasted no more than 60 minutes.
Results: Participants were highly engaged, with an average of 12 navigator touchpoints over 12 weeks, totaling 7.65 hours of one-on-one navigator time. The cohort identified an average of 3.1 social determinants of health (SDOH) needs, with mental health (43.9%), financial strain (34.1%), and family/community support (31.7%) being the most common. Focus group themes included: (1) Multi-faceted Therapeutic Support, (2) Educational Content & Services, (3) Triaging/Clinical Care Guidance, (4) Behavioral Health Support, (5) Connectivity/Community, (6) Programmatic Value, and (7) Constructive Feedback/Future Opportunities.
Conclusion: This study offers insights into the effectiveness of a digital health and clinical navigation platform in enhancing stroke recovery and person-centered care. The program addressed core themes impacting patient and care partner experiences, such as access to educational resources, real-time clinical guidance, intervention compliance, and behavioral health needs. These findings can inform future interventions aimed at providing post-acute stroke navigation and reducing healthcare disparities.