{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T14:01:18Z","timestamp":1790776878970,"version":"4.1.0"},"reference-count":47,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Swedish Research Council for Health, Working Life, and Welfare","award":["2020-00175"],"award-info":[{"award-number":["2020-00175"]}]},{"name":"Research School in Health Sciences at Karolinska Institutet","id":[{"id":"https:\/\/ror.org\/056d84691","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,9,11]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"\n Objective<\/jats:title>\n To examine the implementation process, mechanisms of change and contextual influences of a stroke prevention intervention.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n A process evaluation following the UK Medical Research Council\u2019s process evaluation framework was conducted alongside a randomised controlled trial (RCT).<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n The intervention was conducted in Swedish primary healthcare.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n Persons at high risk of stroke participating in the Make My Day, a 10-week group-based intervention (n=122) and healthcare professionals delivering the intervention (n=10).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Quantitative data from logbooks, surveys and app registrations, and qualitative data from interviews, logbooks and reflexive fieldnotes were collected across five cohorts. Data were analysed separately and integrated using a convergent mixed-methods approach.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Fidelity varied; overall adherence to the study manual and programme content was good, while fidelity to specific session activities and session attendance varied, with a mean of 3.6 (SD 2.2) out of 6. Recruitment successfully reached individuals at high risk of stroke, but reaching a vulnerable population was challenging. Realistic, activity-focused goal setting emerged as the most perceived valued mechanism of change. Engaging everyday activities supported sustainable change when a sense of belonging was established. The group served as both a facilitator and a barrier to lifestyle change. The mobile app offered opportunities but faced usability challenges. Healthcare professionals\u2019 delivery of the intervention was expressed as central for the change.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This study demonstrates how fidelity, facilitation and contextual conditions shape the functioning of a complex lifestyle intervention. Supporting healthcare professionals with adequate preparation and pedagogical skills is critical to optimising the delivery and outcomes of stroke prevention interventions in primary healthcare.<\/jats:p>\n <\/jats:sec>\n \n Trial registration number<\/jats:title>\n \n NCT05279508<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-123012","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:35:34Z","timestamp":1790775334000},"page":"e123012","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Performing lifestyle changes and reducing stroke risk: a process evaluation of a stroke prevention intervention"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct05279508","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3521-428X","authenticated-orcid":false,"given":"Cecilia","family":"Johnsson","sequence":"first","affiliation":[{"name":"Department of Neurobiology, Care Sciences and Society (NVS), Division of Occupational Therapy, Karolinska Institute, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Asaba","sequence":"additional","affiliation":[{"name":"Department of Neurobiology, Care Sciences and Society (NVS), Division of Occupational Therapy, Karolinska Institute, Stockholm, Sweden"},{"name":"Department of Health and Rehabilitation, Sahlgrenska Academy, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6878-6394","authenticated-orcid":false,"given":"Susanne","family":"Guidetti","sequence":"additional","affiliation":[{"name":"Department of Neurobiology, Care Sciences and Society (NVS), Division of Occupational Therapy, Karolinska Institute, Stockholm, Sweden"},{"name":"Medical Unit Allied Health Professionals, Womens Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Hagstr\u00f6mer","sequence":"additional","affiliation":[{"name":"Department of Neurobiology Care Sciences and Society (NVS), Division of Physiotherapy, Karolinska Institute, Stockholm, Sweden"},{"name":"Academic Primary Care Health Centre, Region Stockholm, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2667-4073","authenticated-orcid":false,"given":"Ann-Helen","family":"Patomella","sequence":"additional","affiliation":[{"name":"Department of Neurobiology, Care Sciences and Society (NVS), Division of Occupational Therapy, Karolinska Institute, Stockholm, Sweden"},{"name":"Academic Primary Care Health Centre, Region Stockholm, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"2026093006351218000_16.9.e123012.1","unstructured":"World Health Organization . 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