Oral Presentation Smart Strokes Annual Scientific Meeting 2025

Community-Based Stroke Service and Support Program for Indonesia: a Co-design Study (127723)

Yudi Hardianto 1 2 , Tara Purvis 1 , Elizabeth Lynch 3 , Michele L Callisaya 4 5 , Richard I Lindley 6 7 , Noor Azah A Aziz 8 , Andi M Irwan 9 , Dominique A Cadilhac 1 10
  1. Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
  2. Department of Physiotherapy, Faculty of Nursing, Hasanuddin University, Makassar, South Sulawesi, Indonesia
  3. College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
  4. Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC, Australia
  5. Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
  6. Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
  7. The George Institute for Global Health, Barangaroo, NSW, Australia
  8. Department of Family Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
  9. Department of Gerontological Nursing, Faculty of Nursing, Hasanuddin University, Makassar, South Sulawesi, Indonesia
  10. Stroke Theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia

Introduction: Stroke is a leading cause of disability in Indonesia, and there is limited access to hospital-based rehabilitation for survivors of stroke. Delivering community-based physical rehabilitation programs could reduce disability after stroke and improve access to much-needed support after hospitalisation. In this study, we aimed to co-design a stroke rehabilitation and support program to be delivered in Indonesian community health centres (Puskesmas).

Methods: Three co-design workshops were held between August and October 2023, involving 30 stakeholders (stroke experts/academics, neurologists, general practitioners, nurses, physiotherapists, survivors of stroke and caregivers, policymakers, and representatives from the Indonesian National Health Insurance). These included one virtual session (two hours) and two in-person sessions (six hours each) in Makassar, Indonesia. Summaries of essential needs, challenges and important inclusion in a stroke support program were created from the analysis of meeting notes, stakeholders’ discussions, and reflections from the research team.

Results: Several challenges in providing community-based stroke care were described by stakeholders. These included workforce shortages of healthcare professionals trained in stroke care, and low health literacy regarding stroke among survivors of stroke and caregivers. Other barriers included low referrals from hospitals to Puskesmas and limited policy and funding pathways to support stroke care in Puskesmas. The co-designed program included elements of stroke education, prevention, rehabilitation therapies, and long-term support for survivors of stroke and caregivers living in the community. Education and training for the health professionals were required for the program implementation Puskesmas.

Conclusion: The evidence we have generated from the iterative co-design workshops has informed the design of a community-based stroke service and support program to be tested in a pilot study.

Relevance to clinical practice or patient experience: Situated in one Puskesmas, the co-designed program will provide a holistic community stroke service and support program delivered by general practitioners, nurses and physiotherapists (the latter employed for the program).