Development of a digital, self-guided return-to-work toolkit for stroke survivors and employers using intervention mapping.

Abstract

Stroke incidence is rising among working-age adults in high-income countries. Employers often lack knowledge and skills to support return-to-work post-stroke. In the United Kingdom, nearly 40% of stroke survivors stop working. Vocational rehabilitation is rarely accessible, and self-guided resources often lack tools to support practical application. This study developed a self-guided return-to-work toolkit for stroke survivors and employers. Steps 1-4 of the six-step Intervention Mapping approach were followed. Intervention goal, content, and design were informed by three online workshops with employers (n = 12) and meetings with an advisory group (n = 20), including stroke charity and trade union representatives, stroke survivors, healthcare professionals, and experts in human resources and vocational rehabilitation. Theory-based pretesting (task-based usability review, advisory group discussions) was shaped by prototype review with advisory group members, including employers (n = 4), stroke survivors (n = 7), and healthcare professionals (n = 4). Framework analysis was used to structure feedback related to acceptability, ease of use/learnability, accessibility, inclusivity, perceived usefulness, and technical or environmental issues. No personal data were analysed. The toolkit aims to empower stroke survivors and employers to plan and manage a sustainable return-to-work post-stroke. It exists as two Xerte eLearning packages, with accessibility features such as screen reader compatibility and keyboard navigation. The toolkit contains theory- and evidence-based content for a) stroke survivors and b) employers, and includes downloadable PDF tools. Stroke survivor-focused content provides guidance on identifying and disclosing support needs to employers. Employer-focused content guides employers in increasing and maintaining understanding of stroke survivors' work abilities, and implementing and monitoring tailored reasonable adjustments. Pretesting indicated the toolkit is comprehensive, empowering, and fosters open communication, offering key information and practical tools. Minor refinements and technical improvements were suggested. This toolkit addresses a gap in return-to-work guidance in the United Kingdom. Refinement, testing, and evaluation in real-world settings are needed.