Developing a rehabilitation intervention for eating and drinking difficulties following stroke through co-design...

Eating and drinking difficulties are common after stroke and have profound physical, psychological, and social consequences. Although mealtime group activities are commonly used in rehabilitation settings to support recovery, these approaches are rarely standardised, systematically developed, or evidence-informed, and there is limited research evaluating structured group-based mealtime interventions in stroke care. Co-produced, contextually grounded interventions may improve engagement and clinical relevance. This study aimed to co-design a breakfast group intervention to address eating and drinking difficulties for people after stroke in hospital settings.

This intervention development study was conducted across three secondary care hospital stroke wards. Ten online workshops were held with a 15-member Stakeholder Intervention Development Group comprising stroke survivors, informal carers, and multidisciplinary healthcare professionals. An iterative co-design process was used, informed by prior systematic review findings, observational work, interviews, and trigger films exploring lived experiences. Intervention development combined Hawkins' framework with Experience-Based Co-Design. Workshops involved structured co-design activities, group discussion, and reflection on personal experiences. Data from workshops were synthesised collaboratively to refine intervention content and delivery.

Stakeholders co-produced the Breakfast Group Intervention for Stroke Rehabilitation (BISTRo) and an accompanying implementation toolkit. Five core components were identified: (1) multidisciplinary participation, (2) physical rehabilitation, (3) food preparation and choice, (4) peer support, and (5) psychological well-being. The intervention was tailored for delivery on hospital stroke wards, with adaptations for infection control procedures and local contextual variation. Online participatory methods enabled sustained engagement and inclusive contribution from diverse stakeholders.

Using Experience-Based Co-Design within Hawkins' framework supported the inclusive and iterative development of a complex rehabilitation intervention. This co-produced approach generated a contextually grounded breakfast group model suitable for feasibility testing and future evaluation. The findings highlight the value of stakeholder partnership in designing health service interventions addressing post-stroke eating and drinking difficulties.

The study was registered on Clinical Trials.gov ID NCT05102812 on the 17th of February 2022.