Abstract Background: Stroke patients discharged home often experience emotional and cognitive problems, resulting in participation restrictions. The ECO-stroke intervention was designed to reduce...Show moreAbstract Background: Stroke patients discharged home often experience emotional and cognitive problems, resulting in participation restrictions. The ECO-stroke intervention was designed to reduce these restrictions. Effectiveness will be examined in a separate randomized controlled trial (RCT). The current process evaluation assesses the feasibility of the ECO-stroke intervention, examining implementation, mechanisms of impact and contextual factors. Implementation involves assessing who received the intervention (reach), the intervention quantity (dose), and adherence to the protocol (fidelity). Additionally, mechanisms of impact examined the relationship between intervention components and changes in participation restrictions. Contextual factors examined external barriers and facilitators affecting implementation. Methods: Data from 264 patients allocated to the intervention group of the RCT were used. Nurses collected data in electronic case reports at six weeks after stroke. Measures included timing of the intervention, intervention duration, whether questionnaires were completed, shared decision-making was used, and whether a companion was present. Participation restrictions was measured using the USER-P-R questionnaire at 6 and 12 weeks after stroke. These measures were used to assess the fidelity and to conduct a multiple regression analysis examining their predictive properties on change in participation restrictions. Additionally, qualitative data was collected through focus group interviews with nurses, which were transcribed and analysed using a thematic analysis to further analyse implementation, mechanisms of impact and contextual factors. Results: The intervention reached 262 of the patients (99.2%), and five of the nurses (83.3%). The median intervention duration was 60 minutes. Components of the intervention were performed according to protocol > 80% of the time, except for duration of the intervention (50.4%). Individual components of the intervention did not predict change in participation restrictions. The intervention duration was a barrier for implementation, as patients become fatigued during the intervention, and the workload for nurses is increased. Conclusions: The intervention was implemented successfully. Nurses were positive about the intervention. Due to methodological issues no firm conclusion can be drawn on the mechanisms of impact. If the intervention turns out to be (cost-) effective, there are no major barriers for implementation in clinical practice.Show less
