Factors influencing sedentary behaviours after stroke: findings from qualitative observations and interviews with stroke survivors and their caregivers

Abstract Background: Stroke survivors are more sedentary than healthy, age-matched controls, independent of functional capacity. Interventions are needed to encourage a reduction in overall sedentary time, and regular breaks in prolonged periods of sedentary behaviour. This study captured the views and experiences of stroke survivors and their caregivers related to sedentary behaviour after stroke, to inform the development of an intervention to reduce sedentary behaviour.Methods: Mixed-methods qualitative study. Non-participant observations were completed in two stroke services, inclusive of inpatient and community settings in the United Kingdom. Semi-structured interviews were conducted with stroke survivors and their caregivers (if available) at six- or nine-months post-stroke. Underpinned by the capability, opportunity and motivation (COM-B) model of behaviour change, observational data (132 hours) were analysed thematically and interview data (n=31 stroke survivors, n=12 caregivers) were analysed using the Framework approach.Findings: Observation participants differed in functional ability whereas stroke survivor interviewees were all ambulant. Six themes related to sedentary behaviour after stroke were generated: (1) sedentary behaviour levels and patterns after stroke; (2) the physical and social environment in the stroke service and in the home; (3) standing and movement capability after stroke; (4) emotion and motivation after stroke; (5) caregivers’ influence on, and role in influencing stroke survivors’ sedentary behaviour; and (6) intervening to reduce sedentary behaviour after stroke. Capability, opportunity and motivation were influenced by the impact of the stroke and caregivers’ inclination to support sedentary behaviour reduction. Stroke survivors reported being more sedentary than they were pre-stroke due to impaired balance and co-ordination, increased fatigue, and reduced confidence in mobilising. Caregivers inclination to support stroke survivors to reduce sedentary behaviour depended on factors including their willingness to withdraw from the caregiver role, and their perception of whether the stroke survivor would act on their encouragement. Conclusions: Many stroke survivors indicate being open to reducing sedentary behaviour, with appropriate support from stroke service staff and caregivers. The findings from this study have contributed to an intervention development process using the Behaviour Change Wheel (BCW) approach to develop strategies to reduce sedentary behaviour after stroke.

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Factors influencing sedentary behaviours after stroke: findings from qualitative observations and interviews with stroke survivors and their caregivers

10.21203/rs.2.17808/v1 ◽

2019 ◽

Author(s):

Jennifer Hall ◽

Sarah Morton ◽

Claire F Fitzsimons ◽

Jessica Faye Hall ◽

Rekesh Corepal ◽

...

Keyword(s):

Sedentary Behaviour ◽

Behaviour Change ◽

Intervention Development ◽

Stroke Survivor ◽

Stroke Survivors ◽

Structured Interviews ◽

Stroke Service ◽

Service Staff ◽

Framework Approach ◽

The Impact

Abstract Background: Stroke survivors are highly sedentary. Interventions are needed to encourage a reduction in overall sedentary time, and regular breaks in prolonged periods of sedentary behaviour. This study captured the views and experiences of stroke survivors and their caregivers related to sedentary behaviour after stroke, to inform the development of an intervention to reduce sedentary behaviour. Methods: Mixed-methods qualitative study. Non-participant observations were completed in two stroke services, inclusive of inpatient and community settings in the United Kingdom. Semi-structured interviews were conducted with stroke survivors and their caregivers (if available) at six- or nine-months post-stroke. Underpinned by the capability, opportunity and motivation (COM-B) model of behaviour change, observational data (132 hours) were analysed thematically and interview data (n=31 stroke survivors, n=12 caregivers) were analysed using the Framework approach. Findings: Six themes related to sedentary behaviour after stroke were generated: (1) sedentary behaviour levels and patterns after stroke; (2) the physical and social environment in the stroke service and in the home; (3) standing and movement capability after stroke; (4) emotion and motivation after stroke; (5) caregivers’ influence on, and role in influencing stroke survivors’ sedentary behaviour; and (6) intervening to reduce sedentary behaviour after stroke. Capability, opportunity and motivation were influenced by the impact of the stroke and caregivers’ inclination to support sedentary behaviour reduction. Stroke survivors reported being more sedentary than they were pre-stroke due to impaired balance and co-ordination, increased fatigue, and reduced confidence in mobilising. Caregivers inclination to support stroke survivors to reduce sedentary behaviour depended on factors including their willingness to withdraw from the caregiver role, and their perception of whether the stroke survivor would act on their encouragement. Conclusions: Many stroke survivors indicate being open to reducing sedentary behaviour, with appropriate support from stroke service staff and caregivers. The findings from this study have contributed to an intervention development process using the Behaviour Change Wheel (BCW) approach [1] to develop strategies to reduce sedentary behaviour after stroke.

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A co-production approach guided by the Behaviour Change Wheel to develop an intervention for reducing sedentary behaviour after stroke

10.21203/rs.3.rs-17919/v2 ◽

2020 ◽

Author(s):

Jennifer Hall ◽

Sarah Morton ◽

Jessica Hall ◽

David J Clarke ◽

Claire F Fitzsimons ◽

...

Keyword(s):

Sedentary Behaviour ◽

Behaviour Change ◽

Intervention Development ◽

Inpatient Setting ◽

Stroke Survivors ◽

Behaviour Change Wheel ◽

Target Behaviour ◽

Service Staff ◽

Stroke Services ◽

Production Approach

Abstract Background: Stroke survivors are highly sedentary; thus, breaking up long uninterrupted bouts of sedentary behaviour could have substantial health benefit. However, there are no intervention strategies specifically aimed at reducing sedentary behaviour tailored for stroke survivors. The purpose of this study was to use co-production approaches to develop an intervention to reduce sedentary behaviour after stroke.Methods: A series of five co-production workshops with stroke survivors, their caregivers, stroke service staff, exercise professionals, and researchers were conducted in parallel in two stroke services (England and Scotland). Workshop format was informed by the Behaviour Change Wheel (BCW) framework for developing interventions and incorporated systematic review and empirical evidence. Taking an iterative approach, data from activities and audio recordings were analysed following each workshop and findings used to inform subsequent workshops, to inform both the activities of the next workshop and ongoing intervention development.Findings: Co-production workshop participants (n = 43) included 17 staff, 14 stroke survivors, six caregivers, and six researchers. The target behaviour for stroke survivors is to increase standing and moving, and the target behaviour for caregivers and staff is to support and encourage stroke survivors to increase standing and moving. The developed intervention is primarily based on co-produced solutions to barriers to achieving the target behaviour. The developed intervention includes 34 behaviour change techniques. The intervention is to be delivered through stroke services, commencing in the inpatient setting and following through discharge into the community. Participants reported that taking part in intervention development was a positive experience. Conclusions: To our knowledge, this is the first study that has combined the use of co-production and the BCW to develop an intervention for use in stroke care. In-depth reporting of how a co-production approach was combined with the BCW framework, including the design of bespoke materials for workshop activities, should prove useful to other researchers and practitioners involved in intervention development in stroke.

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A co-production approach guided by the Behaviour Change Wheel to develop an intervention for reducing sedentary behaviour after stroke

10.21203/rs.3.rs-17919/v1 ◽

2020 ◽

Author(s):

Jennifer Hall ◽

Sarah Morton ◽

Jessica Hall ◽

David J Clarke ◽

Claire F Fitzsimons ◽

...

Keyword(s):

Sedentary Behaviour ◽

Behaviour Change ◽

Intervention Development ◽

Inpatient Setting ◽

Stroke Survivors ◽

Behaviour Change Wheel ◽

Target Behaviour ◽

Service Staff ◽

Stroke Services ◽

Production Approach

Abstract Background: Stroke survivors are highly sedentary; thus, breaking up long uninterrupted bouts of sedentary behaviour could have substantial health benefit. However, there are no intervention strategies specifically aimed at reducing sedentary behaviour tailored for stroke survivors. The purpose of this study was to use co-production approaches to develop an intervention to reduce sedentary behaviour after stroke. Methods: A series of five co-production workshops with stroke survivors, their caregivers, stroke service staff, exercise professionals, and researchers were conducted in parallel in two stroke services (England and Scotland). Workshop format was informed by the Behaviour Change Wheel (BCW) framework for developing interventions and incorporated systematic review and empirical evidence. Taking an iterative approach, data from activities and audio recordings were analysed following each workshop and findings used to inform subsequent workshops, to inform both the activities of the next workshop and ongoing intervention development. Findings: Co-production workshop participants (n = 43) included 17 staff, 14 stroke survivors, six caregivers, and six researchers. The target behaviour for stroke survivors is to increase standing and moving, and the target behaviour for caregivers and staff is to support and encourage stroke survivors to increase standing and moving. The developed intervention is primarily based on co-produced solutions to barriers to achieving the target behaviour. The developed intervention includes 34 behaviour change techniques. The intervention is to be delivered through stroke services, commencing in the inpatient setting and following through discharge into the community. Participants reported that taking part in intervention development was a positive experience. Conclusions: To our knowledge, this is the first study that has combined the use of co-production and the BCW to develop an intervention for use in stroke care. In-depth reporting of how a co-production approach was combined with the BCW framework, including the design of bespoke materials for workshop activities, should prove useful to other researchers and practitioners involved in intervention development in stroke.

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Theory-based electronic learning intervention to support appropriate antibiotic prescribing by nurses and pharmacists: intervention development and feasibility study protocol

BMJ Open ◽

10.1136/bmjopen-2018-028326 ◽

2019 ◽

Vol 9 (8) ◽

pp. e028326 ◽

Cited By ~ 3

Author(s):

Molly Courtenay ◽

Rosemary Lim ◽

Rhian Deslandes ◽

Rebecca Ferriday ◽

David Gillespie ◽

...

Keyword(s):

Behaviour Change ◽

Feasibility Study ◽

Intervention Development ◽

Antibiotic Prescribing ◽

Structured Interviews ◽

Step Method ◽

Ethical Approval ◽

Prescribing Behaviour ◽

Tract Infections ◽

The Impact

IntroductionNurse and pharmacist independent prescribers manage patients with respiratory tract infections and are responsible for around 8% of all primary care antibiotic prescriptions. A range of factors influence the prescribing behaviour of these professionals, however, there are no interventions available specifically to support appropriate antibiotic prescribing behaviour by these groups. The aims of this paper are to describe (1) the development of an intervention to support appropriate antibiotic prescribing by nurse and pharmacist independent prescribers and (2) an acceptability and feasibility study designed to test its implementation with these prescribers.Method and analysisDevelopment of intervention: a three-stage, eight-step method was used to identify relevant determinants of behaviour change and intervention components based on the Behaviour Change Wheel. The intervention is an online resource comprising underpinning knowledge and an interactive animation with a variety of open and closed questions to assess understanding. Acceptability and feasibility of intervention: nurse and pharmacist prescribers (n=12–15) will use the intervention. Evaluation includes semi-structured interviews to capture information about how the user reacts to the design, delivery and content of the intervention and influences on understanding and engagement, and a pre-post survey to assess participants’ perceptions of the impact of the intervention on knowledge, confidence and usefulness in terms of application to practice. Taking an initial inductive approach, data from interview transcripts will be coded and then analysed to derive themes. These themes will then be deductively mapped to the Capability, Opportunity, Motivation-Behaviour model. Descriptive statistics will be used to analyse the survey data, and trends identified.Ethics and disseminationEthical approval for the study has been provided by the School of Healthcare Sciences Research Governance and Ethics Committee, Cardiff University. The findings will be disseminated via publication in peer-reviewed journals and through conference presentations.

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Abstract 28: Effects of Self-Esteem, Optimism, and Perceived Control on Depression: Testing Dyadic Dynamics in Stroke Survivor-Spouse Dyads

Stroke ◽

10.1161/str.44.suppl_1.a28 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Misook L Chung ◽

Tamilyn Bakas ◽

Laurie D Plue ◽

Linda S Williams

Keyword(s):

Perceived Control ◽

Stroke Survivor ◽

Self Esteem ◽

Stroke Survivors ◽

Control Scale ◽

Life Orientation Test ◽

Life Orientation ◽

Actor Partner Interdependence Model ◽

Patient Health ◽

The Impact

Background: Depression is common in stoke survivors and their caregivers. Given the interdependent relationship among the members of dyads in post-stroke management, improving depression in dyads may depend on their partner’s characteristics. Self-esteem, optimism, and perceived control, all known to be associated with depression in an individual, may also contribute to their partner’s depression. The purpose of this study was to examine whether an individual’s self-esteem, optimism and perceived control predict their own, as well as their partner’s depression. Methods: A total of 112 ischemic stroke survivor-spouse dyads completed surveys in which depression, self-esteem, optimism, and perceived control were assessed using the Patient Health Questionnaire, the Rosenberg Self-esteem Scale, the Revised Life Orientation Test, and the Sense of Control Scale. Multilevel modeling, actor-partner interdependence model (APIM) regression with distinguishable dyad was used to determine influences on depression within the dyad. In APIM, actor effect is the impact of a person’s factors on their own depression and partner effect is the impact of a person’s factors on their partner’s depression. Results: As shown in Figure1, individuals with lower self-esteem, optimism, and perceived control had higher level of depression. Spouses who had stroke survivors with low self-esteem had higher levels of depression. Stroke survivors who had spouses with lower self-esteem and optimism had higher levels of depression. Conclusion: Stroke survivor self-esteem and spouse self-esteem and optimism influenced their partner’s depression. These findings suggest that dyadic intervention is needed to improve depression for the dyads and that depressed stroke survivors may benefit from interventions that improve spousal self-esteem and optimism.

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Which behaviour change techniques are effective to promote physical activity and reduce sedentary behaviour in adults: a factorial randomized trial of an e- and m-health intervention

10.21203/rs.3.rs-24803/v1 ◽

2020 ◽

Author(s):

Helene Schroé ◽

Delfien Van Dyck ◽

Annick De Paepe ◽

Louise Poppe ◽

Wen Wei Loh ◽

...

Keyword(s):

Physical Activity ◽

Sedentary Behaviour ◽

Behaviour Change ◽

Action Planning ◽

Health Intervention ◽

Health Interventions ◽

Behaviour Change Techniques ◽

Self Monitoring ◽

Coping Planning ◽

The Impact

Abstract BackgroundE- and m-health interventions are promising to change health behaviour. Many of these interventions use a large variety of behaviour change techniques (BCTs), but it’s not known which BCTs or which combination of BCTs contribute to their efficacy. Therefore, this study investigated the efficacy of three BCTs (i.e. action planning, coping planning and self-monitoring) and their combinations on physical activity (PA) and sedentary behaviour (SB).MethodsIn a 2(action planning: present vs absent) x2(coping planning: present vs absent) x2(self-monitoring: present vs absent) factorial trial, 473 adults from the general population used the self-regulation based e- and m-health intervention ‘MyPlan2.0’ for five weeks. All combinations of BCTs were considered, resulting in eight groups. Participants selected their preferred target behaviour, either PA (n = 335,age = 35.8,28.1% men) or SB (n = 138,age = 37.8,37.7% men), and were then randomly allocated to the experimental groups. Levels of PA (MVPA in minutes/week) or SB (total sedentary time in hours/day) were assessed at baseline and post-intervention using self-reported questionnaires. Linear mixed-effect models were fitted to assess the impact of the different combinations of the BCTs on PA and SB.ResultsFirst, overall efficacy of each BCT was examined. The delivery of self-monitoring increased PA (t = 2.735,p = 0.007) and reduced SB (t=-2.573,p = 0.012) compared with no delivery of self-monitoring. Also, the delivery of coping planning increased PA (t = 2.302,p = 0.022) compared with no delivery of coping planning. Second, we investigated to what extent adding BCTs increased efficacy. Using the combination of the three BCTs was most effective to increase PA (x2 = 8,849,p = 0.003) whereas the combination of action planning and self-monitoring was most effective to decrease SB (x2 = 3.918,p = 0.048). To increase PA, action planning was always more effective in combination with coping planning (x2 = 5.590,p = 0.014;x2 = 17.722,p < 0.001;x2 = 4.552,p = 0.033) compared with using action planning without coping planning. Of note, the use of action planning alone reduced PA compared with using coping planning alone (x2 = 4.389,p = 0.031) and self-monitoring alone (x2 = 8.858,p = 003), respectively.ConclusionsThis study provides indications that different (combinations of) BCTs may be effective to promote PA and reduce SB. More experimental research to investigate the effectiveness of BCTs is needed, which can contribute to improved design and more effective e- and m-health interventions in the future.Trial registrationThis study was preregistered as a clinical trial (ID number: NCT03274271). Release date: 20 October 2017, http://clinicaltrials.gov/ct2/show/NCT03274271

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Lost Productivity in Stroke Survivors: An Econometrics Analysis

Neuroepidemiology ◽

10.1159/000454730 ◽

2016 ◽

Vol 47 (3-4) ◽

pp. 164-170 ◽

Cited By ~ 8

Author(s):

Manav V. Vyas ◽

Daniel G. Hackam ◽

Frank L. Silver ◽

Audrey Laporte ◽

Moira K. Kapral

Keyword(s):

General Population ◽

Logistic Models ◽

Indirect Costs ◽

Stroke Survivor ◽

Canadian Community Health Survey ◽

Stroke Survivors ◽

Hourly Wage ◽

Factors Associated ◽

Lost Productivity ◽

The Impact

Background: Stroke leads to a substantial societal economic burden. Loss of productivity among stroke survivors is a significant contributor to the indirect costs associated with stroke. We aimed to characterize productivity and factors associated with employability in stroke survivors. Methods: We used the Canadian Community Health Survey 2011-2012 to identify stroke survivors and employment status. We used multivariable logistic models to determine the impact of stroke on employment and on factors associated with employability, and used Heckman models to estimate the effect of stroke on productivity (number of hours worked/week and hourly wages). Results: We included data from 91,633 respondents between 18 and 70 years and identified 923 (1%) stroke survivors. Stroke survivors were less likely to be employed (adjusted OR 0.39, 95% CI 0.33-0.46) and had hourly wages 17.5% (95% CI 7.7-23.7) lower compared to the general population, although there was no association between work hours and being a stroke survivor. We found that factors like older age, not being married, and having medical comorbidities were associated with lower odds of employment in stroke survivors in our sample. Conclusions: Stroke survivors are less likely to be employed and they earn a lower hourly wage than the general population. Interventions such as dedicated vocational rehabilitation and policies targeting return to work could be considered to address this lost productivity among stroke survivors.

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Exploring maintenance of physical activity behaviour change among people living with and beyond gastrointestinal cancer: a cross-sectional qualitative study and typology

BMJ Open ◽

10.1136/bmjopen-2020-037136 ◽

2020 ◽

Vol 10 (10) ◽

pp. e037136

Author(s):

Chloe Grimmett ◽

Claire Foster ◽

Katherine Bradbury ◽

Phillippa Lally ◽

Carl R May ◽

...

Keyword(s):

Physical Activity ◽

Qualitative Study ◽

Intervention Development ◽

Well Being ◽

Rapid Expansion ◽

Structured Interviews ◽

Cross Sectional ◽

Gi Cancer ◽

The Impact

ObjectivesIn the last decade, there has been a rapid expansion of physical activity (PA) promotion programmes and interventions targeting people living with and beyond cancer (LWBC). The impact that these initiatives have on long-term maintenance of PA remains under-researched. This study sought to explore the experiences of participants in order to characterise those who have and have not successfully sustained increases in PA following participation in a PA intervention after a diagnosis of gastrointestinal (GI) cancer, and identify barriers and facilitators of this behaviour.DesignCross-sectional qualitative study. Semi-structured interviews with participants who had previously taken part in a PA programme in the UK, explored current and past PA behaviour and factors that promoted or inhibited regular PA participation. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Themes and subthemes were identified. Differences between individuals were recognised and a typology of PA engagement was developed.ParticipantsTwenty-seven individuals (n=15 male, mean age=66.3 years) with a diagnosis of GI cancer who had participated in one of four interventions designed to encourage PA participation.SettingUK.ResultsSeven themes were identified: disease processes, the role of ageing, emotion and psychological well-being, incorporating PA into everyday life, social interaction, support and self-monitoring and competing demands. A typology with three types describing long-term PA engagement was generated: (1) maintained PA, (2) intermittent PA, (3) low activity. Findings indicate that identifying an enjoyable activity that is appropriate to an individual’s level of physical functioning and is highly valued is key to supporting long-term PA engagement.ConclusionThe typology described here can be used to guide stratified and personalised intervention development and support sustained PA engagement by people LWBC.

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Limited Use Only. How Can the Design of an Everyday Object Evoke an Initiation of Use in Chronic Stroke Survivors

10.26686/wgtn.17134127.v1 ◽

2021 ◽

Author(s):

◽

Mailin Lemke

Keyword(s):

Behaviour Change ◽

Physical Restraint ◽

Stroke Survivor ◽

Chronic Stroke ◽

Daily Activities ◽

Stroke Survivors ◽

Design Strategies ◽

Everyday Objects ◽

Everyday Object

<p>Stroke causes significant damage to the brain and affects 15 million people annually worldwide. Symptoms commonly affect one or both limbs on one side of the body, limiting ability to perform daily activities. The preferential use of the less affected limb for performing everyday activities in the form of compensatory movement is a common phenomenon after a stroke and can lead to a “learned nonuse” of the affected arm and hand. This learned behaviour can be overcome by applying a physical restraint on the less affected arm to initiate use of the affected one. Stroke interventions that use physical restraint are criticised for being labour intensive and expensive and having a limited focus on the home environment of the stroke survivor. This study aimed to design everyday objects that restrain movement to initiate the use of the affected arm and hand. It was undertaken from a pragmatist theoretical perspective, using a human-centred design approach to develop an understanding of the users’ needs and create design solutions that addressed the observed problem. A qualitative multimethod approach helped understanding of how the restraining effect needs to be delivered to initiate use of the affected arm, and which everyday objects are key in daily activities post-stroke. The research through design methodology was employed for developing expansive and serial design prototypes to test how the restraint could be incorporated into a design prototype. The prototypes were evaluated with health professionals and chronic stroke survivors to validate the intended initiation of use. Findings of this study indicate that the development of learned nonuse is multifactorial and occurs over time. The current use of restraint in clinical practice focuses on reminding the survivor to use the affected arm and hand rather than physically restraining its use. It was emphasised by the therapists that a behaviour change is a crucial element in overcoming learned nonuse in the long-term. The evaluation of the design prototypes indicated that the design of the object needs to take into consideration the conceptual model the user has of the object and the interaction needs to be feasible to perform for the stroke survivor. Five different design strategies were developed to restrain movement and elicit an initiation of use. The restraining effect that is evoked by the design strategies can vary between the different users. Additionally, the object needs to provide sufficient feedforward to initiate the use of the affected arm and hand, increase self-efficacy beliefs, provide a repetitive and increasingly challenging movement, provide feedback and sensory input to secure engagement in the process. A behaviour change is an essential element to overcome the learned nonuse in the long-term. A behaviour contract was, therefore, incorporated in the form of the design components to facilitate such a change. At this stage it is unclear which strategy offers the greatest potential to evoke an initiation of use and if the behaviour contract contributes to overcoming the learned nonuse. Further studies are needed to increase the restraining effect and usability of the design prototypes and validate the long-term impact.</p>

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A Qualitative Investigation Into What Parents Want From an Online Behavioural Sleep Intervention for Children With Epilepsy

Frontiers in Psychology ◽

10.3389/fpsyg.2021.628605 ◽

2021 ◽

Vol 12 ◽

Author(s):

Georgia Cook ◽

Paul Gringras ◽

Harriet Hiscock ◽

Deb K. Pal ◽

Luci Wiggs

Keyword(s):

Behaviour Change ◽

Sleep Problems ◽

Neurodevelopmental Disorder ◽

Child Anxiety ◽

Real Life ◽

Intervention Development ◽

Parental Engagement ◽

Structured Interviews ◽

Management Options ◽

Sleep Management

Many of the same sleep problems seen in typically developing (TD) children are frequently experienced by children with epilepsy (CWE). Behavioural sleep interventions (BSIs) are commonly and successfully used to treat these sleep problems in TD children and in some neurodevelopmental disorder populations. Therefore, BSIs should be effective in CWE, however, there are special seizure-related considerations for CWE and their parents which may be salient to consider in any future BSI development for this group. The current study sought to identify, from parents, if there were special considerations for the content and delivery of an online BSI for parents of CWE. Semi-structured interviews were conducted with nine mothers of CWE and thematic analysis was conducted on the interview data. Ten themes were apparent which represented what parents wanted from any online BSI for CWE. Parents wanted (i) other parents’ views and real-life experiences to be included, (ii) recognition of how changes over time may influence the appropriateness of using various sleep-management options, (iii) to be presented with a range of sleep management options from which they could select, (iv) personalised information and suggestions for behaviour-change options, (v) help to address child anxiety around sleep, (vi) for the advice and behaviour-change options to be practical, (vii) general educational information about sleep and the relationship between sleep and epilepsy, (viii) for parental worries and concerns to be acknowledged, (ix) to receive help, support, and reassurance around children’s sleep; and (x) to include the child in the intervention. It was clear that any online BSI would require specific adaptations and additions (to content and delivery format) to best meet the needs of parents of CWE. It is hoped that having identified what parents want from on online BSI for CWE will allow these factors to be acknowledged in future intervention development, with the intention to optimise parental engagement and intervention effectiveness. Practical suggestions for how these aspects could be integrated into any online BSI are suggested.

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