Co-designing the “Adherence Counselling Toolkit (ACT now)” to promote exercise adherence of survivors of stroke

Exercise post-stroke is important; however, adherence has been shown to decrease over time. This study was designed to explore health behaviours in survivors of stroke and exercise prescription in health professionals to inform the development of an “Adherence Counselling Toolkit”, supporting health professionals working with survivors of stroke. Mixed-methods co-design was conducted in two stages, guided by an Integrated Knowledge Translation approach. The toolkit was based on the Capability, Opportunity, and Motivation-Behaviour model. Stage 1 involved exploring exercise behaviours of survivors of stroke and exercise prescription in health professionals through surveys. Stage 2 involved co-designing the toolkit through focus groups and engagement of a stakeholder working group. One hundred and sixty-four survey responses were included. Survey findings informed the focus groups (n = 29 participants), where five key themes were identified; key issues impacting adherence, barriers to adherence, what could promote adherence, skills and knowledge required by the health professionals and toolkit content. The stakeholder working group worked with the research team and a designer, providing recommendations regarding the toolkit content, format, and design. Development of the “Adherence Counselling Toolkit” was guided by a rigorous co-design process to support health professionals with improving exercise adherence in survivors of stroke. Health outcomes for survivors of stroke may be improved with better adherence to exercise.Resources to support adherence to exercise are needed.A co-design process, incorporating the needs and preferences of all key stakeholders has guided the development of the Adherence Counselling Toolkit.The Adherence Counselling Toolkit needs to be evaluated to ensure its feasibility and benefit for health professionals working with survivors of stroke. Health outcomes for survivors of stroke may be improved with better adherence to exercise. Resources to support adherence to exercise are needed. A co-design process, incorporating the needs and preferences of all key stakeholders has guided the development of the Adherence Counselling Toolkit. The Adherence Counselling Toolkit needs to be evaluated to ensure its feasibility and benefit for health professionals working with survivors of stroke.