Abstract TP178: Employing Best-Worst Scaling to Understand Community Prioritization of Long-Term Stroke Rehabilitation Services Among Patients with Stroke and Caregivers in Zambia

Introduction: Stroke is a leading cause of disability in Zambia, with limited resources towards long-term rehabilitation. Our prior work performing focus group interviews with patients with stroke and their caregivers identified varying types of rehabilitation services sought within community settings in Zambia. Objective: We used best-worst decision-making experiments and qualitative term mapping to evaluate how people with stroke and their caregivers prioritize stroke rehabilitation services. Methodology: Adults with stroke with onset > 3 months and their caregivers participated in co-creation workshops in which seven rehabilitation service types (i.e. physical therapy, occupational therapy (e.g. activities of daily living support), mental health counseling, religious support, speech therapy, employment retraining, and social support services) were introduced. Qualitative term mapping was first performed to identify characteristics associated with each service. Participants then completed a best-worst decision-making experiment where they ranked the best and worst service among four presented services, repeated seven times with varying service combinations. Standardized mean best-minus-worst (B-W) scores and relative rescaled B-W scores were calculated by a count-based analysis (Table 1) to evaluate aggregate preferences of participants. Results: 36 participants (64% female) were enrolled with a mean age of 49 years (range: 18-69). Half were people with stroke and half were caregivers. Service prioritization by relative B-W scores and mean standardized B-W scores were calculated, producing the following service ranking (Table 1): (1) Social support, (2) occupational therapy, (3) physiotherapy, (4) mental health counseling, (5) speech therapy, (6) spiritual support, (7) employment training. Participants associated social support services with provision of wheelchairs and transportation stipends to and from clinic, while associating occupational therapy with in-home mobility, cooking, and bathing retraining. Conclusion: In this cohort of Zambians with stroke and their caregivers, social support services and occupational therapy were the most prioritized rehabilitation services, both of which are currently largely unavailable in Zambia. These data will inform our future pilot study of implementing a structured rehabilitation program within community settings.