DOI: 10.12688/hrbopenres.14470.1 ISSN: 2515-4826

Implementation evaluation of community-based physical activity programmes for secondary prevention following stroke in Ireland: a RE-AIM and CFIR-informed mixed-methods study protocol using ExWell Medical as a case study.

Lisa Kelly, Fiona Skelly, Veronica Segerström, Carlos Bruen, Sara Burke, Noel McCaffrey, Ronán Collins, Susan M Smith, Catherine D Darker,
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Background Stroke is a leading cause of mortality and long-term disability globally and in Ireland, with prevalence rising due to population ageing. Physical activity is a key component of secondary prevention and recovery; however, there is limited evidence on how community-based exercise programmes are implemented, delivered, and sustained in routine practice. Addressing these gaps is essential to inform national policy and service planning, particularly within the context of Sláintecare and the Health Service Executive’s National Stroke Strategy. This implementation evaluation forms part of the broader INsPIRE (Informing National Policy for Physical Activity-based Secondary Prevention of Stroke in Ireland) project, which aims to generate policy-relevant evidence on scalable and sustainable models of community-based physical activity. Methods This protocol outlines a mixed-methods implementation evaluation using ExWell, a community-based exercise programme, as a real-world case study. The study is guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework and the Consolidated Framework for Implementation Research (CFIR 2.0). Quantitative outcomes include referral patterns, programme uptake, retention and engagement with the ExWell programme. Qualitative data will be collected from stroke survivors, programme staff, referring clinicians, and stakeholders through semi-structured interviews and focus groups to explore contextual determinants influencing implementation. Analysis Quantitative data will be analysed using descriptive and inferential statistics, while qualitative data will undergo reflexive thematic analysis. A convergent mixed-methods approach will integrate findings to examine implementation outcomes and contextual influences. Secondary analysis of existing datasets will support benchmarking. Discussion This study will generate implementation-focused evidence on the delivery, uptake, and sustainability of community-based physical activity programmes for stroke survivors in Ireland, informing policy, resource allocation, and equitable service design aligned with national health policy ‘Sláintecare’ objectives.

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