teleABLE: Adapting a Behavioral Activation-Based Intervention to Reduce Post-Stroke Sedentary Behavior Using Telehealth

PROJECT SUMMARY/ABSTRACT This K23 application proposes a career development plan to help Dr. Emily Kringle establish an independent research program that focuses on optimizing health among adults with stroke-related disability and other neurological disabilities. She will train under the mentorship of a transdisciplinary group of senior scientists with research expertise in behavioral clinical trials, stakeholder-engaged intervention development, qualitative research methods, and interpersonal theories and methods. She will continue working with her current T32 mentors, Drs. Jun Ma and Megan Lewis, both of whom have extensive experience mentoring trainees. This will be complemented by content and mentoring expertise from Drs. Bethany Barone Gibbs, Elizabeth Skidmore, and Dilip Pandey. Collectively, this team will provide an outstanding training environment that will allow Dr. Kringle to fill critical gaps in her knowledge and skill set relating to the study of lifestyles interventions and interpersonal social dynamics that influence post-stroke sedentary behavior and quality of life. Her training goals are to develop skills in (1) design and analyses of conventional and contemporary behavioral clinical trials, (2) qualitative analyses of stakeholder engagement data, (3) theory, measurement, and analyses of interpersonal (dyadic) influences on post-stroke health behaviors, and (4) professional skills in interdisciplinary team science and scientific leadership. Achieving these goals will strengthen her scholarly activities, establish important collaborations, and acquire critical data that will ensure her successful transition to independence. To this end, Dr. Kringle’s proposed research plan that builds directly on her prior work developing the Activating Behavior for Lasting Engagement (ABLE) intervention. ABLE uses behavioral activation to reduce post-stroke sedentary behavior. Reducing sedentary behavior is particularly important for promoting health in the context of stroke-related disability. Even if impairments (motor, cognitive, sensory) fully resolve, stroke survivors do not automatically re-engage in non-sedentary activities as impairments diminish. Further, residual impairments, social influences (protective care providers), and environmental factors (transportation, accessibility) create barriers to engagement in personally meaningful non-sedentary daily activities. The purpose of this proposal is to adapt ABLE to telehealth (teleABLE), targeting the first year post-stroke, and evaluate its acceptability, fidelity, and potential effects in a pilot randomized clinical trial. We will also explore factors that are potential moderators or theoretically driven mediators of intervention outcomes. Embedded within this trial is data collection from stroke survivors’ social support person to explore interpersonal (dyadic) influences on post- stroke sedentary behavior. Findings from this study, in combination with the career development plan, will enable Dr. Kringle to launch an independent program of research that aims to 1) develop interventions that reduce post-stroke sedentary behavior to enhance health and quality of life, and 2) elucidate the role of interpersonal social dynamics in health behaviors and quality of life among adults with stroke-related disability.