Implementation of Stroke Prevention Intervention Make My Day in Swedish Primary Healthcare.
Emelie Mälstam, Eric Asaba, Elisabet Åkesson and 2 others
The programme was feasible and well-received, with engaging occupations the most valued mechanism and high app use.
But only two of five planned sites could run it, attendance fell short, and Swedish reimbursement rules do not cover this type of prevention work.
Key findings
1Engaging occupations (meaningful, purposeful daily activities) were the most consistently valued mechanism for promoting lifestyle change, described by both health professionals and participants as a unifying thread that reinforced the other components of the programme.
2Only two of the five planned primary healthcare sites could deliver the intervention because of a shortage of occupational therapists in rural areas; the intervention group ended up with 15 participants instead of the 30 planned, and the median number of group sessions attended was 4.5 out of 6.
3The Swedish primary healthcare reimbursement system does not pay for addressing modifiable stroke risk factors through primary prevention, which health professionals identified as a major barrier to sustaining this type of work in routine practice.
Still to come
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
Only two of the five planned sites actually delivered the intervention, and both were in the Stockholm area; the rural sites could not participate because of occupational therapist shortages, so the findings do not represent rural Swedish primary care. The intervention group had 15 participants (14 in the demographics table) instead of the 30 planned, which limits the range of experiences captured. Participants were predominantly women, Swedish-born, and from moderate-to-high socioeconomic neighbourhoods; people with lower income, immigrant backgrounds, or lower education were underrepresented, so the findings may not apply to those groups. Session attendance was below plan (median 4.5 of 6), and the paper does not report whether the missed sessions affected the qualitative findings. The intervention was delivered in close collaboration with the research team, which may have inflated fidelity and participant engagement compared with routine delivery. Some evaluations were conducted post hoc rather than planned in advance, and specific quality criteria for the process evaluation were not fully developed in the pilot protocol. This is a process evaluation, not an efficacy trial. It tells you whether and how the programme can be delivered, not whether it reduces stroke risk. The outcome data are in a separate pilot trial paper.
Declared interests
The authors declared no conflicts of interest. Funding came from the Research School of Caring Science at Karolinska Institutet, the University of Gävle Faculty of Health and Occupational Studies, and the Swedish Association of Occupational Therapists. No industry or device manufacturer was involved.
The easy way to misread this
Do not read this paper as evidence that the Make My Day programme prevents strokes or reduces stroke risk. It is a process evaluation: it reports on whether the programme could be delivered, how it was experienced, and what got in the way. The outcome data (stroke risk scores) are in a separate pilot trial paper. Additionally, with only two delivery sites, 15 intervention participants, and a sample skewed toward women from higher-income Swedish neighbourhoods, the implementation findings cannot be assumed to hold in your setting, your population, or your funding environment.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →