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International Journal of Stroke 19(1)
Figure 1. Study flowchart.
the survey, and out of these, 59 completed the first phase of
the survey (response rate 86%). Consented HCPs were
asked to complete an anonymised online survey with predetermined
and open-ended questions, including the validated
System Usability Scale (SUS)31 for determining
usability of PreventS-MD. Specifically, HCPs were asked
to answer three sets of questions (A, B, and C; Supplemental
Appendix Tables 1 and 2). In section A, they were asked
their opinion about the need for innovative primary stroke
prevention. In section B, they were asked about how much
they think they might use PreventS-MD with their patients
and how they think they would use it, and in section C, they
were asked their opinion about different features they
would prefer to see in the software.
In the second phase of the study, 69 HCPs who consented
to participate in the first phase of the survey were
invited to participate in the second phase, and 58 (84%) of
them completed the second phase of the survey. At this
stage of the survey, individuals at increased risk of stroke
and/or CVD (including people who had experienced stroke
or TIA) were invited to participate in the study. They were
evaluated at the outpatient clinic for stroke risk and risk
factors management by 2 HCPs using PreventS-MD to
determine their satisfaction/acceptability with the app and
1 month self-reported adherence to the preventative recommendations.
Inclusion criteria were (1) presence of at least
one lifestyle risk factor (e.g. smoking, overweight, sedentary
lifestyle, etc.) or metabolic risk factor (e.g. elevated
blood pressure, diabetes mellitus, etc.) for stroke; (2) age
20+ years; (3) fluency in English; and (4) informed consent
to participate in the study. We enrolled four individuals
with and six individuals without a history of stroke or TIA.
International Journal of Stroke, 19(1)
Individuals with a history of acute coronary syndrome,
alcoholism, major psychiatric disorder, malignancy, and/or
life expectancy less than 5 years (as judged by the study
clinician) were excluded from the study.
Measures
In the first phase of the study, evaluation of PreventS
comprised utilization of the commonly used SUS31 and
an additional study questionnaire (Supplemental
Appendix pp. 3-17). We reviewed the results of the
online survey, including recommendations for improving
the functionality, interface, and usability of the prototype
of PreventS-MD called PreventS web app. Using
the feedback collected, we updated PreventS by improving
the layout and reporting sections of the web app and
upgraded it to the final version, PreventS-MD, which
was tested during the second phase of the study. In both
phases of the study, we tested usability of PreventS and
PreventS-MD using hypothetical data. In addition, in
Phase 2 of the study, two physicians in New Zealand
tested PreventS-MD by assessing 10 real patients in clinical
settings. The HCPs who conducted the assessments
and individuals who underwent the assessment were
then contacted by a qualitative study researcher for a
semi-structured telephone interview about their experience
of using PreventS-MD.
Statistical considerations
Data collected from both phases were analyzed using
quantitative and qualitative methods. Quantitative data
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