Digital Resilience-Based Course-Game Sequential Intervention for Social Participation in Stroke Survivors: Development and Usability Study

Social participation is a key goal of stroke rehabilitation, yet effective interventions remain limited. Existing approaches focus largely on functional training or general psychological support, rarely targeting resilience as a modifiable mechanism for enhancing social participation. Most interventions are delivered face-to-face, limiting accessibility and scalability. A theory-driven digital intervention that integrates resilience training with contextualized practice may offer a promising pathway to support social reintegration in stroke survivors.

This study aimed to develop a theory-driven, digital resilience-based course-game sequential intervention for improving social participation in stroke survivors and to evaluate its usability among the target population.

This was an intervention development and usability study. Following the first 4 steps of intervention mapping, we completed the following steps: (1) conducted a needs assessment based on prior empirical evidence identifying psychological resilience as a key determinant of social participation; (2) defined performance and change objectives grounded in the Kumpfer resilience framework, which delineates 5 protective factors (cognitive, emotional, spiritual, behavioral, and physical); (3) selected theory-based methods and practical applications; and (4) developed an intervention prototype through 4 phases: initial design integrating course learning and gamified experiential modules, expert review and refinement by an 8-member panel, development of the digital system via a WeChat mini-program, and finalization of comprehensive intervention scripts. Participants were recruited using convenience sampling from a rehabilitation hospital in Shanghai, China. Usability was evaluated with 14 stroke survivors through 5 representative tasks, the System Usability Scale (SUS), and semistructured qualitative interviews. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using conventional content analysis.

The intervention comprised 2 sequential modules: a 7-session course learning module targeting 5 resilience factors, delivered weekly via narrative audio and multimodal content, and a gamified experiential module featuring a supermarket shopping scenario that enabled contextualized skill application. Each weekly course session was designed to last approximately 60 minutes. The duration of a single game session was 20 minutes. Participants had a mean age of 65.4 (SD 9.75) years, and 78.6% (11/14) had experienced an ischemic stroke. All participants completed the usability tasks successfully. The mean SUS score was 73.6 (SD 12.2, 95% CI 66.5-80.6; median 77.5, IQR 61.3-80.6), indicating good usability. Qualitative feedback revealed 3 themes: perceived ease of use and accessibility, perceived usefulness and engagement, and suggestions for improvement.

This study systematically developed a theory-driven, digital course-game sequential intervention that is innovative in targeting psychological resilience as a core mechanism for social participation, distinguishing it from conventional function-focused or generic resilience approaches. By integrating systematic course learning with contextualized gamified practice, it offers a scalable, low-burden tool that addresses key gaps in stroke rehabilitation. These findings support progression to feasibility and efficacy testing through randomized controlled trials in real-world settings.