ABSTRACT NUMBER: ESOC2026A1100 UPSKILLING DIVERSE WORKFORCES TO DELIVER INCLUSIVE, ONLINE GROUP THERAPY FOR ADJUSTMENT AFTER STROKE IN UK HEALTH SERVICES: WATERS2 MIXED-METHODS STUDY

Abstract Background and aims Stroke survivors frequently experience unmet psychological needs, particularly people with aphasia or from minoritised communities. Wellbeing After Stroke-2(WAterS-2) is an online, group-based, Acceptance and Commitment Therapy (ACT)-informed intervention adapted for UK NHS stroke services. We aimed to evaluated feasibility and acceptability. Methods Clinical psychologists trained and supervised staff from varied professional and lived-experience backgrounds to deliver ACT-informed groups. Clinical teams referred stroke survivors ≥4 months post-stroke. Mixed-methods assessed feasibility of recruitment, inclusion, retention, fidelity and safety. Stakeholder surveys and interviews explored acceptability and perceived impact. Candidate outcomes were collected post-intervention and at 3-months: mood(HADS), wellbeing(ONS4), psychological flexibility(AAQ-ABI) and quality of life(EQ-5D-5L). Results Nineteen stroke survivors participated across four sites (mean 9.6 months post-stroke; n=6(32%) minoritised ethnicities; n=10(52%) aphasia). Retention was high: 17(89%) completed the programme and 14(74%) attended ≥6/8 sessions, with no intervention-related adverse events. Fidelity to the structured protocol was good. Acceptability was high: survivors valued peer connection, grounding and mindfulness practices. ACT metaphors were helpful for some but posed challenges for others, including those with aphasia. Online delivery was suitable but limited informal connection. Staff reported increased capability and confidence, incorporating ACT skills into routine care. Online outcome and cost-data collection proved feasible, with small/no changes across candidate measures. Conclusions WAterS-2 was feasible, safe, acceptable and inclusive. Diverse UK NHS staff can be upskilled to deliver ACT-informed support with light-touch supervision. Findings inform an implementation toolkit and support progression to a pragmatic trial. Conflict of interest Emma Patchwood: nothing to disclose. Kate Woodward-Nutt: nothing to disclose. Verity Longley: nothing to disclose. Sarah Cotterill: nothing to disclose. Niki Chouliara: nothing to disclose. Shirley Thomas: nothing to disclose.Ann Bamford: nothing to disclose.Paul Conroy: nothing to disclose. Research Advisory Panel: nothing to disclose. Audrey Bowen: nothing to disclose.