Objectives(1) To identify operational issues encountered by study participants in using the ‘Care for Stroke’ intervention; (2) to evaluate the feasibility and acceptability of the intervention.DesignMixed-methods research design.SettingParticipant's home. Participants were selected from a tertiary hospital in Chennai, South India.ParticipantsSixty stroke survivors treated and discharged from the hospital, and their caregivers.Intervention‘Care for Stroke’ is a smartphone-enabled, educational intervention for management of physical disabilities following stroke. It is delivered through a web-based, smartphone-enabled application. It includes inputs from stroke rehabilitation experts in a digitised format.MethodsEvaluation of the intervention was completed in two phases. In the first phase, the preliminary intervention was field-tested with 30 stroke survivors for 2 weeks. In the second phase, the finalised intervention was provided to a further 30 stroke survivors to be used in their homes with support from their carers for 4 weeks.Primary and secondary outcome measuresPrimary outcomes: (1) operational difficulties in using the intervention; (2) feasibility and acceptability of the intervention in an Indian setting. Disability and dependency were assessed as secondary outcomes.ResultsField-testing identified operational difficulties related to connectivity, video-streaming, picture clarity, quality of videos, and functionality of the application. The intervention was reviewed, revised and finalised before pilot-testing. Findings from the pilot-testing showed that the ‘Care for Stroke’ intervention was feasible and acceptable. Over 90% (n=27) of the study participants felt that the intervention was relevant, comprehensible and useful. Over 96% (n=29) of the stroke survivors and all the caregivers (100%, n=30) rated the intervention as excellent and very useful. These findings were supported by qualitative interviews.ConclusionsEvaluation indicated that the ‘Care for Stroke’ intervention was feasible and acceptable in an Indian context. An assessment of effectiveness is now warranted.

IntroductionStroke rehabilitation is a process targeted towards restoration or maintenance of the physical, mental, intellectual and social abilities of an individual affected by stroke. Unlike high-income countries, the resources for stroke rehabilitation are very limited in many low-income and middle-income countries (LMICs). Provision of cost-effective, post-stroke multidisciplinary rehabilitation services for the stroke survivors therefore becomes crucial to address the unmet needs and growing magnitude of disability experienced by the stroke survivors in LMICs. In order to meet the growing need for post-stroke rehabilitation services in India, we developed a web-based Smartphone-enabled educational intervention for management of physical disabilities following a stroke.MethodsOn the basis of the findings from the rehabilitation needs assessment study, guidance from the expert group and available evidence from systematic reviews, the framework of the intervention content was designed. Web-based application designing and development by Professional application developers were subsequently undertaken.ResultsThe application is called ‘Care for Stroke’. It is a web-based educational intervention for management of physical disabilities following a stroke. This intervention is developed for use by the Stroke survivors who have any kind of rehabilitation needs to independently participate in his/her family and social roles.Discussion‘Care for stroke’ is an innovative intervention which could be tested not just for its feasibility and acceptability but also for its clinical and cost-effectiveness through rigorously designed, randomised clinical trials. It is very important to test this intervention in LMICs where the rehabilitation and information needs of the stroke survivors seem to be substantial and largely unmet.

Background: The need for palliative care is increasing throughout the world. Developing countries are progressively faced with an ageing population, whose changing health needs require urgent action. Insufficient access to care for both cancer and AIDS patients make palliative care the only humane and feasible response in many contexts. Material and Methods: In order to describe the need for palliative care in Kerala and the development of the new palliative care policy, we have collected and reviewed information from government officials, health professionals involved in cancer care, patients and their families, sponsors, and members of palliative care teams across Kerala. We also collected data on the functioning of the newly established palliative care clinics. Results: The Pain and Palliative Care Society developed in a few years a network of 33 palliative care clinics across Kerala, providing care free of charge to patients in need. Outpatient treatment with a supportive home care service was adopted as the main mode of operation. Trained volunteers from the community assisted in providing care, and family members were empowered to the highest degree in order to ensure continuity of treatment. In 2002 the network of clinics saw about 6,000 new patients, about 25% of incident cancer cases. Conclusions: The synergistic effect of motivation and knowledge, coupled with the use of local resources, has made possible the development of a network of palliative care services, available for free to terminally ill patients. The challenge of adapting such a model to other developing countries is discussed.

A new palliative care unit in Kerala, a southern state of India, treated 440 patients' with advanced cancer in the first 15 months of operation. This paper presents an analysis of the problems these patients presented with. Besides the physical problems due to the disease, these patients were found to have a multitude of other concerns peculiar to the region. Lack of financial resources and facilities for follow-up, concerns about the welfare of the family in the absence of proper state-sponsored social security schemes and lack of proper communication between doctors and patients were the major problems that the patients faced. The availability of numerous systems of alternative medicine and a hope for cure even at a late stage of the disease meant that many patients depended on these alternative therapies as their main form of treatment.

A three-year-old palliative care unit in Calicut, in the south Indian state of Kerala, started a home care service in June 1996. This paper reviews the first year of operation of the service; in this period 340 home visits were made. The service aims to deliver palliative care to the patients who are unable to reach the hospital, to empower patients to care for themselves and to empower the family to care for patients. One doctor and a few trained volunteers form the team. In addition to control of physical symptoms and emotional support, the home visits permitted minor procedures including nasogastric intubation, catheterization of bladder, dressing of wounds and intravenous fluid therapy. In some cases, the visits helped to change the attitude of families towards the patients--for example, allaying fear of contagion. In some instances, the visits changed the attitude of the neighbourhood towards the patient for the better. In spite of problems like the distances involved and bad roads, the experience of this team shows that a home care system is possible and essential for delivery of palliative care in India.