How to build home based stroke rehabilitation using participatory action research: lessons learned from developing regional stroke networks

This study aims to identify lessons learned regarding: 1) regional factors influencing the development and implementation of home-based stroke rehabilitation (HBSR) networks, during participatory action research (PAR) and 2) the role of the PAR-facilitator in this process. By developing a roadmap based on the lessons learned, we aim to support PAR-facilitators in developing HBSR using regional networks. In each region, data were collected through individual communication, group discussions, process and outcome evaluations, public consultations, and the PAR-facilitator’s logbook. Ending each project, regional evaluations and logbooks were synthesized into a process narrative. Key lessons were drawn through critical reflection sessions and translated into a revised process description (roadmap). The study showed that motivated professionals, available preconditions for stroke care coordination, and interprofessional collaboration, influenced HBSR implementation. Participants reported the PAR-facilitator playing a crucial role in process monitoring and facilitating information, collaboration and motivation. Also, PAR-methods were considered valuable. The lessons learned resulted in a roadmap describing recommended actions, methods, key considerations, and questions to support reflexivity. PAR is a promising approach for developing and implementing HBSR networks. Project success depends on prerequisites in context, professionals’ motivation and collaboration and guidance by a competent PAR facilitator. Home‑based stroke rehabilitation has strong potential and is increasingly encouraged in the Durch context, but the essential conditions required to deliver it effectively are not always in place.Rehabilitation professionals should recognize how regional conditions, such as follow-up coordination after discharge, stakeholder motivation, and collaborative structures, shape the successful delivery of home-based stroke rehabilitation.Rehabilitation professionals should tailor the development and implementation of home-based stroke rehabilitation to their local context and actively contribute to strengthening regional conditions that support collaboration.Rehabilitation professionals who aim to implement complex innovations can benefit greatly from the support of a participatory action research-facilitator with strong communication, social, scientific, and organizational skills to clarify problems, support shared decision-making, and stimulate collective ownership of solutions.Rehabilitation professionals who work with a participatory action research facilitator to develop a regional collaborative network can benefit from the structured roadmap presented in this study to navigate the complexity of developing and implementing home‑based stroke rehabilitation. Home‑based stroke rehabilitation has strong potential and is increasingly encouraged in the Durch context, but the essential conditions required to deliver it effectively are not always in place. Rehabilitation professionals should recognize how regional conditions, such as follow-up coordination after discharge, stakeholder motivation, and collaborative structures, shape the successful delivery of home-based stroke rehabilitation. Rehabilitation professionals should tailor the development and implementation of home-based stroke rehabilitation to their local context and actively contribute to strengthening regional conditions that support collaboration. Rehabilitation professionals who aim to implement complex innovations can benefit greatly from the support of a participatory action research-facilitator with strong communication, social, scientific, and organizational skills to clarify problems, support shared decision-making, and stimulate collective ownership of solutions. Rehabilitation professionals who work with a participatory action research facilitator to develop a regional collaborative network can benefit from the structured roadmap presented in this study to navigate the complexity of developing and implementing home‑based stroke rehabilitation.