E-Mental Health International Conference 2018 Presentation Abstracts
Thursday 15th November
Keynote Speech I
Implementation and integration of digital therapies in secondary care mental health services
Dr Sandra Bucci
University of Manchester, United Kingdom
How can digital systems be used with people who experience severe mental health problems?
Psychosis is associated with significant distress for individuals, families and society. Digital tools have a growing evidence-base for their feasibility, acceptability and effectiveness in depression, anxiety, as well as a range of physical health problems. In recent years, our group has been talking to individuals experiencing severe mental health problems and the staff who are involved in their mental health care about the role digital technology plays in their lives. As a result of these discussions, we are developing digital tools to extend the reach of assessment and intervention delivery for people with psychosis into the context of their day-to-day life. We are also building systems for integrating digital technology into routine clinical services. Dr Bucci will showcase latest thinking and research in digital tools for people who experience psychosis, including recent developments in smartphone apps, integrating software systems into patient healthcare records, and virtual world platforms. Dr Bucci will also discuss the challenges to the implementation of digital health tools in clinical practice based on a series of qualitative studies conducted in the field.
Plenary Session I
Technology and stroke rehabilitation
Professor Michael Nilsson
Global Innovation Chair of Rehabilitation Medicine, Faculty of Health and Medicine, University of Newcastle
The health care systems are challenged by increasing demand on all care sectors, an aging population with a growing incidence of chronic and complex conditions and higher expectations by consumers. Meeting this challenge will require envisioning the potential value of home-based health care, creating a pathway for home-based care to maximize its potential, and integrating it fully into the health care systems. An important part in the future landscape of rehabilitation medicine lies in individualised residential rehabilitation, guided by neuroscientific and biomedical principles. Integrating state of the art treatments into a comprehensive interdisciplinary platform will deliver the best residential rehabilitative care, with the goal of allowing patients to recover in their home environments faster and more complete. Clinical decision support tools utilising machine learning have the potential to increase the precision of rehabilitation interventions further. In combination with for example in home neuro-architecture inspired redesign, residential telemedicine, sensor enriched patient engagement, comprehensive rehabilitation team and carer training processes, this could form a base for more sustainable, effective solutions implemented as a part of long-term recovery strategies and add value to the traditional hospitals and practices.”
Leveraging technology to help young people manage mood, anxiety, and alcohol use
Associate Professor Frances Kay-Lambkin
School of Medicine and Public Health; Deputy Director, Priority Research Centre for Brain and Mental Health Research, University of Newcastle
Dr Sally Fitzpatrick
Program Manager/Clinical Psychologist, Everymind
Plenary Session II
E-Mental Health: Innovation to Implementation
Mr. Nicholas Watters
Director of the Knowledge Exchange Centre, Mental Health Commission, Canada
Leveraging eHealth as a national strategic asset demands a more coordinated approach to planning, implementation and evaluation and the recognition that successful investment in eHealth requires far more than just the acquisition of technology. Recognizing these issues and wishing to encourage evidence-based practice, the Mental Health Commission of Canada commissioned an action research project to develop a clinician toolkit to improve implementation of eHealth tools for clinicians. The toolkit synthesizes the diverse recommendations, policies, research guidelines that could be used to inform clinical practice. The aim of using this technology is to increase the accessibility of services and engage patients and families in Canadian in managing their mental health problems and illnesses. The toolkits objectives are to (1) to synthesis existing evidence-based resources for clinicians in Canada; and (2) to collaboratively identify or develop templates, guidelines, checklists and protocols with which to support clinicians interested in using e-mental health.
Link to the Toolkit:
The potential of new technologies for smoking cessation and health behaviour change
Professor Billie Bonevski
Faculty of Medicine and Public Health, University of Newcastle
While smoking rates have decreased substantially in Australia, almost three million Australians continue to smoke. There is mounting urgency to ensure that smoking cessation support is reaching all smokers regardless of geographic location or socioeconomic status. Novel technologies and continued advances in online health care delivery present many opportunities for addressing tobacco use. This presentation aims to provide a background overview of the prevalence and patterns of tobacco use. A number of devices and innovations will be outlined with specific descriptions of how they may be used to aid smoking cessation and change other health risk behaviours. Specifically, innovations such as wearables, smart patches, virtual reality, avatars and chatbot counselling will be outlined and discussed for the use of smoking cessation. Considerations for the use of smart technologies in health research will also be discussion.
Plenary Session III – mHealth in Action
mHealth – Weight Management Wellness program
Weight Management for people living with mental health conditions: an RCT of a new mobile application
Dr Graeme Browne1, Professor Sally Chan1, Ms. Raelene Kenny2
School of Nursing and Midwifery University of Newcastle1, Port Macquarie Base Hospital, Mid North Coast LHD, Australia2
This paper reports on the early findings of the effect, of a weight management smartphone application (app) for people living with chronic illnesses, on participants’ body weight (primary outcome), Body Mass Index (BMI), activity level, mood and quality of life (secondary outcomes).
Being overweight or obese are major risk factors for many chronic diseases, such as diabetes and cardiovascular diseases, and are dramatically on the rise in urban and rural settings. There are weight loss apps available, but few randomised controlled trials (RCTs) have been conducted to evaluate the effectiveness of these apps.
This study may generate reliable evidence using a rigorous RCT design to evaluate an app which contains unique feature – adopting principles of CBT in weight management. This study addresses current gap in knowledge quality and lack of theory underpinning current weight management apps available. The app could reach out to people living with chronic illness with weight management issues, and help reduce the weight- associated comorbidities.
Method: A pilot RCT of an interactive ‘Weight Management Wellness App’. 76 patients who have a diagnosis of chronic illness with BMI greater than or equal to 25 kg/m2 will be randomly allocated to intervention or control groups.
mHealth – Supporting new mums
Supporting new mums “Postnatal Psychoeducational” smartphone application for first-time mothers
Ms Shanna Fealy1,2, Mr Donovan Jones1, Dr Lyn Ebert1, Dr Eileen Dowse1, Dr Olivia Wynne1, Dr Melvyn Zhang3, A/Prof Roger Ho4, Prof Sally Chan1
University of Newcastle, NSW, Australia1, The Port Macquarie Base Hospital, NSW, Australia2, Institute of Mental Health, Singapore3, Yong Loo Lin School of Medicine, National University of Singapore, Singapore4
Background: The transition to motherhood is often described as a stressful and challenging event associated with both short and long term emotional and physical health consequences. Postnatal depression currently affects one in 7 Australia woman and can have detrimental effects on new mothers and impact on the infant’s psychosocial development. There is a need to develop cost-effective and widely accessible interventions to provide postnatal support. The aim of this presentation is to describe the development of a postnatal psychoeducational smartphone application (app) program to improve maternal psychological and social wellbeing in the post-partum period.
Methods: The ‘Support for New Mums’ app has been developed in partnership with mental health, midwifery, child and family Health experts, and new mothers. It is an evidence-based educational program aimed at improving first time mothers’ self-efficacy in newborn care, psychological well-being, and social support. The contents include information on newborn care, maternal self-care, and psychological challenges of the postpartum period such as the baby blues, postnatal depression, and rational and irrational thoughts. The information is presented using a variety of interactive media platforms including expert advice, online information, video, podcasts, journaling and user uploaded content, as well as weekly self-assessments. Randomized controlled trial to test the efficacy of the app is currently in the planning stages with Mid North Coast Local Health District Translational Research Grant funding awarded for the study in June 2016.
Results and conclusion: This study will provide empirical support for the feasibility, effectiveness and cost-effectiveness of an app-based postnatal psychoeducational intervention. The app has the potential to improve maternal and infant health outcomes, such as preventing postnatal depression and anxiety, reducing unnecessary usage of emergency medical infant care services use for infants and mothers, and therefore reducing the associated healthcare and social burdens.
mHealth – Breast cancer e-support
Professor Sally Chan1, Dr Lyn Ebert1, Dr Jiemin Zhu2
School of Nursing and Midwifery, University of Newcastle, Australia1; Nursing Department, Medical College, Xiamen University, China2
Background: Women undergoing chemotherapy for the treatment of breast cancer have frequently reported unmet supportive care needs. Moreover, easily accessible and innovative support is lacking.
Objective: The purpose of this trial was to determine the effectiveness of an app-based breast cancer e-support program to address women’s self-efficacy (primary outcome), social support, symptom distress, quality of life, anxiety, and depression.
Methods: A multicentre, single-blinded, randomized controlled trial was conducted. A total of 114 women with breast cancer, who were commencing chemotherapy and were able to access internet through a mobile phone, were recruited in the clinics from 2 university-affiliated hospitals in China. Women were randomized either to the intervention group (n=57) receiving breast cancer e-support plus care as usual or the control group (n=57) receiving care as usual alone. Bandura’s self-efficacy theory and the social exchange theory guided the development of the breast cancer e-support program, which has 4 components: (1) a Learning forum, (2) a Discussion forum, (3) an Ask-the-Expert forum, and (4) a Personal Stories forum. Moderated by an experienced health care professional, the breast cancer e-support program supported women for 12 weeks covering 4 cycles of chemotherapy. Health outcomes were self-assessed through paper questionnaires in clinics at baseline before randomization (T0), after 3 (T1), and 6 months (T2) of follow-ups.
Results: Fifty-five participants in the intervention group and 49 in the control group completed the follow-up assessments (response rate: 91.2%). Repeated measures multivariate analysis of covariance (intention-to-treat) found that breast cancer e-support + care as usual participants had significant better health outcomes at 3 months regarding self-efficacy (21.05; 95% CI 1.87-40.22; P=.03; d=0.53), symptom interference (−0.73; 95% CI −1.35 to −.11; P=.02; d=−0.51), and quality of life (6.64; 95% CI 0.77-12.50; P=.03, d=0.46) but not regarding social support, symptom severity, anxiety, and depression compared with care as usual participants.
Conclusions: The breast cancer e-support program demonstrated its potential as an effective and easily accessible intervention to promote women’s self-efficacy, symptom interference, and quality of life during chemotherapy.
Plenary Session IV
Attention Bias Modification for Substance Use Disorders: A Feasibility Study
Dr. Melvyn Zhang
Institute of Mental Health, Singapore
Introduction: Substance use disorders are highly prevalent globally. There remain high relapse rates following conventional psychological interventions for substance use disorders. Recent reviews have highlighted attentional and approach/avoidance biases to be responsible for the multiple relapses. Other studies have reported the efficacy of interventions to modify biases. With advances in technologies, there are now mobile versions of conventional bias modification interventions. However, to date, there are no studies that have evaluated bias modification in a substance-using, non-western sample. Existing evaluations of mobile technologies for the delivery of bias interventions are also limited to alcohol or tobacco use disorders. Hence, the current study aims to examine the feasibility of mobile-based attention bias modification intervention amongst treatment-seeking individuals with substance use and alcohol use disorders.
Methods and Analyses: The study is a feasibility study. Inpatients who are in their rehabilitation phase of clinical management will be recruited. On each day that they are in the study, they are required to complete a craving visual analogue scale and undertake both a visual-probe based assessment and intervention visual probe task in a smartphone application. Reaction time data will be collated for the computation of baseline attentional biases and to determine if there is a reduction of attentional bias across the interventions. Feasibility is determined by the number of participants recruited and participants' adherence to the planned interventions up until the completion of their rehabilitation program, and the ability of the application in detecting baseline biases and changes in biases. Acceptability of the intervention is assessed by a short questionnaire of users' perceptions of the intervention. Statistical analyses will be performed using SPSS version 22.0. Qualitative analysis of the perspectives will be performed using NVivo version 10.0.
Results: At least 60% of those invited to participate undertook the study. The adherence rate was 66.7%. The app was able to detect the changes in attentional biases across varied substance disorders. Participants found the app to be easy to use and interactive. Quite a number of participants reported the app to be boring and repetitive.
Conclusions: This initial feasibility study has demonstrated the potential of a smartphone app in the delivery of attention bias modification for highly prevalent addictive disorders. It is of importance to engage patients in the co-design of an app that could address the issues inherent in the current conceptualization.
Application of functional near infrared spectroscopy in diagnosing psychiatric disorders in Singapore
Associate Professor Roger Ho
National University of Singapore
Psychiatry is the only medical specialty without any objective and cost-effective diagnostic tool. For the past two centuries, psychiatrists rely on the clinical interview to establish a diagnosis. Other functional imaging modalities are limited by high costs and lack of diagnostic values. Functional Near Infrared Spectroscopy (fNIRS) offers a break-through as it is cost-effective and able to provide a diagnostic report to patients. This presentation is a continuum of the presentation in e-mental health international conference 2016. A/Prof Roger Ho will discuss his latest research findings and future visions through the tripartite alliance between the university, industry and hospital.
Integrating sensors and wearables into mainstream of healthcare: opportunities, issues, and considerations
Professor Kendall Ho
Faculty of Medicine & Lead, Digital Emergency Medicine, University of British Columbia
This presentation will explore the use of wearables and sensors in health and how they can be judiciously introduced into health system to contribute to patient care. Participants will:
- Understand the principles behind why wearables and sensors are valuable tools to support patient wellness and disease management.
- Study examples in BC of prescribing sensors and wearables to patients to improve patient and health system outcomes.
- See emerging trends in sensors and wearables that will influence how healthcare will be delivered in the future.
Friday, November 16th
Plenary Session V – LifeSpan Newcastle
Evidence base for e-health and how it can contribute to suicide prevention
Professor Helen Christensen
Director and Chief Scientist, Black Dog Institute; Professor of Mental Health, UNSW
Suicide prevention requires the adoption of multi-modal, comprehensive and integrated approaches. Recognising the need for scale and reach, digital technologies, such as websites, apps and sensors have been employed by suicide prevention agencies to assist in suicide prevention. Scientific studies of the effectiveness of these interventions is emerging. In this talk, the potential domains for the use of these technologies are identified: schools; workplaces; public online environments; primary care/healthcare settings; means restriction; and crisis and aftercare. Examples of the effectiveness of these interventions are described, with a focus on clinical treatment applications, using data from recent randomised controlled trials from the Black Dog Institute, and research trials from other leading centres. There is more replication required, and more comprehensive consumer informed research to be undertaken. However, these technologies are rapidly expanding ahead of research effectiveness, but, nevertheless have potential to be used as part of larger integrated suicide prevention approaches.
Social media and suicide prevention
Dr. Jo Robinson
Director and Chief Scientist, Black Dog Institute; Professor of Mental Health, UNSW
Suicide-related behaviour in young people is unacceptably high and evidence is lacking regarding acceptable and effective interventions. Young people are avid consumers of social media and use these platforms to communicate with their peers, seek and share information, and receive professional help, yet the potential benefits of these platforms remain unexamined. Similarly whilst guidelines for mainstream media exist with regard to safe communication about suicide, little exists to help young people communicate safely on social media platforms.
The #Chatsafe project is the first project, internationally, to develop evidence-informed guidelines to help young people communicate safely about suicide online. It is also the first to produce a national suicide prevention campaign designed by young people for young people.
Guidelines were developed based on a systematic review of peer-reviewed and grey literature, and using the Delphi Consensus methodology. The Delphi panels comprised suicide prevention experts, communications experts, and young people. A series of co-design workshops are now underway across the country with young people for a wide range of backgrounds, to create social media campaign materials based on these guidelines.
Both the guidelines and the findings from the first wave of co-design workshops will be presented, as well as the future directions for the project.
Current status of the evidence of digital interventions for the self-management of self-harm
Dr Katrina Witt
American Foundation for Suicide Prevention Post-Doctoral Fellow, Turning Point Alcohol and Drug Centre, Monash University
Digital interventions, including both online programs and mobile telephone applications (‘apps’) (collectively referred to here as ‘digital interventions’), have been proposed as one mechanism by which the scalability of effective treatments for self-harm and suicidal ideation may be improved. However, to date, the effectiveness of these digital interventions has not been routinely evaluated.
We searched 8 electronic databases for literature on the useability, safety, and effectiveness of digital interventions for the self-management of self-harm. 14 studies were included, reporting data on 3356 participants.
Whilst, overall, this review found some evidence that digital interventions may be associated with reductions in suicidal ideation, it is unclear whether these reductions would be clinically meaningful at present. There was no evidence to suggest these interventions are associated with reductions in self-harm or attempted suicide, although only three studies investigated these outcomes. Other issues such as adherence and evaluation of safety aspects were also highlighted as needing consideration.
This presentation will address some of the limitations of current methods used to evaluate digital interventions for the self-management of self-harm, as well as some of the future directions this work should take before we can confidently recommend these interventions to patients.
Snapshot of SMS SOS trial
Professor Greg Carter
Director, Dept of Consultation-Liaison Psychiatry, Calvary Mater Newcastle; Conjoint Professor, Centre for Brain & Mental Health Research, University of Newcastle
Hospital-treated Deliberate Self Harm (DSH) is common and costly. One of the most important outcomes of hospital treated DSH is repetition of the DSH event. Evidence based interventions for the reduction of repetition of DSH have been identified and recommended by the RANZCP and the NICE (UK) in their respective guidelines, including Dialectical Behaviour Therapy (DBT), Psycho-social therapies, Brief Contact Interventions (BCI)and a recent interventions combining formal therapy with telephone contacts. This talk will review the evidence base for these interventions and explore the issue of availability and scalability as the background for the evolution of these interventions into digital interventions, using RAFT (BCI + therapy) and the SMS-SOS Project (BCI) as examples. A update on the study design and 12 month recruitment for the SMS-SOS Project will be sued to characterise the key issues in designing such an intervention and running large-scale multi-centre efficacy trial in DSH populations.
Plenary Session VI – Technology and Health Promotion
Technology and health promotion
Professor John Wiggers
Director, Hunter New England Population Health
Professor, School of Medicine and Public Health, University of Newcastle
Director, University of Newcastle Priority Research Centre for Health Behaviour
Keynote Speech II
Deep Analytics and AI in Mental Health Therapeutics: A Study of Major Depressive Disorders (MDD)
Professor Ravishankar K. Iyer
George and Ann Fisher Distinguished Professor of Engineering, Department of Electrical and Computer Engineering, Department of Computer Science and Coordinated Science Laboratory, University of Illinois at Urbana-Champaign
The rapid growth and availability of clinical and biological data coupled with recent technological breakthroughs present an unprecedented opportunity to transform healthcare. An important challenge is to analyse a variety of large and complex clinical and biological data by combining cutting-edge analytics, machine learning and systems engineering expertise to generate Actionable Intelligence which can augment a physician’s ability to treat a patient. Engineers at the University of Illinois at Urbana-Champaign (UIUC) and clinicians from the Mayo Clinic have collaborated to develop tools and technologies to address these challenges. An example application is in using data, insights and extensive domain knowledge from Mayo in conjunction with deep analytics, ML, algorithmic and systems innovations from UIUC to drive therapeutics in Major Depressive Disorders (MDD). The work is incorporated into a new toolset ALMOND - Analytics and Machine Learning Framework for Omics and Clinical Big Data. The output from ALMOND informs biologists about biomarkers to pursue and allows clinicians to choose patient-specific treatments to maximize therapeutic success. This talk will outline these results and directions of new research.
Plenary Session VII – Rural and Remote Mental Health
Why using technologies is good for the health and wellbeing of providers?
Professor Peter Yellowlees
Professor of Psychiatry, and Vice Chair for Faculty Development
Past President, American Telemedicine Association
Department of Psychiatry, UC Davis
The goal of this presentation is to understand how telemedicine and clinical health technologies can reduce physician burnout and improve clinical efficiency and patient safety. Over 50% of US physicians suffer from some symptoms of burnout, and about 400 suicide each year. As a consequence the need to focus on developing a more engaged and satisfied workforce to provide better and safer patient care is increasingly accepted as essential, and many health systems are formally adopting a fourth aim, not just better care, better health and lower costs, but also better clinician wellbeing. To do this many health systems are appointing Chief Wellness Officers to their leadership group to enable strategic and cultural changes to occur, bringing back the joy of medicine to providers, and improving patient safety and outcomes. The intelligent use of telemedicine and health technologies as one of these strategic approaches, will be discussed.
Tele-mental health - city solution for rural residents?
Professor David Perkins
Director, Centre for Rural and Remote Mental Health
Plenary Session VIII – Early Career Researcher Showcase
Could a holistic mobile phone app improve Aboriginal women’s well-being and the wellbeing of their babies? Lived Experiences and Narratives of Aboriginal Women
Sarah Perkes & Noelene Skinner
PhD Candidate, Centre for Brian and Mental Health Research, University of Newcastle
Background: Aboriginal women want healthy pregnancies and strong healthy babies but few accepted community-based supports are available for healthy lifestyle and Social and Emotional Wellbeing (SEWB). The most vulnerable Aboriginal women experience tough challenges, including poverty, addiction, violence and poor SEWB, all of which carry high risks for their health and that of their babies. Aboriginal women are high users of social media, which may be an untapped resource for improving the health and wellbeing of Aboriginal women and babies.
Methodology: Two Aboriginal research assistants; 11 focus groups (89 women); cross sectional survey (137 women); and a research pre accelerator.
Results: Women said there are a number of barriers to accessing health support including shame, lack of culturally appropriate care, access, stress, confidentiality and disempowerment. 86% of the women (n=137) use Facebook and other online platforms regularly. Women indicated that they want a mobile phone app that is culturally responsive, safe, strengths based and inclusive of all health, including SEWB/mental health.
Conclusion: An app has great potential to promote SEWB during and post pregnancy, support women to track their baby’s development journey, network with other Aboriginal women for support and advice and promote early engagement with health services.
Internet use in low SES populations and the potential for an e-health intervention
Postdoctoral Research Associate, Hunter New England Population Health, University of Newcastle
A cross sectional survey of internet use among a highly disadvantaged population of tobacco smokers
Background: Tobacco smoking is highest among population groups which are the most socially disadvantaged. Internet-based smoking cessation programs have been found to be effective, though rates of internet access are not well known in these groups. This study describes the rates of internet use and types of technology used to access the internet by a population of socially disadvantaged smokers and examine relationships between these with sociodemographic and smoking behaviours.
Methods: A cross-sectional survey of 369 clients from two non-government community service organisations was conducted.
Findings: Over half of the participants reported weekly or more frequent use of the internet. The odds of using the internet decreased with age and as heaviness of smoking increased and was higher as income increased. Using a smartphone, tablet, or other person’s device to access the internet in the last 12 months decreased as age increased. The relationship between internet use and interest in using the internet to support health was significant.
Conclusion: Internet-based interventions appear to have majority reach for socially-disadvantaged populations in Australia. However, alternative modes of intervention are needed for disadvantaged people who are older and have the lowest levels of income.
E-cigarettes: perceptions and potential for harm reduction among drug and alcohol clients
Postdoctoral Research Academic, Centre for Brian and Mental Health Research, University of Newcastle
Introduction: Electronic nicotine devices (ENDs) are battery operated handheld devices that allow the individual to inhale a vapour that is aerosolized from a mixture of propylene glycol or vegetable glycerin and nicotine or flavouring. ENDs may be a potential quit support for smoking cessation, especially for those sub-populations with high smoking prevalence such as persons who are receiving alcohol and other drug treatment (AOD, 84.1%). We assessed awareness, attitudes, and use of ENDs among healthcare providers and clients of AOD services.
Methods: A cross-sectional survey was conducted with AOD healthcare providers and their clients from 32 AOD services in Australia between September - October 2016. Healthcare providers were asked whether they believed e-cigarettes could help smokers quit tobacco, whether they believe e-cigarettes are safer than tobacco smoking and whether they would recommend e-cigarettes to clients who are interested in quitting smoking from a list of “Yes/No” options. AOD clients were asked whether they had ever heard of e-cigarettes, whether they had ever used an e-cigarette, and if they do, whether it contained nicotine, and their reason for using e-cigarettes from a list of “Yes/No” options, and finally whether they currently use e-cigarettes.
Results: One hundred and twenty healthcare providers and 427 AOD clients responded. Nearly half (48%) of all healthcare providers reported agreeing with the statement that ENDs could help smokers quit tobacco and that ENDs were safer than tobacco smoking (55%). However, only 29% reported that they would recommend ENDs to clients. Most AOD clients (93%) reported awareness of ENDs, and 39% reported ever use however, only 7% reported current use. Of those reporting ever use, 52% used an END containing nicotine. The most common reasons for END use were “wanted to try” (72%) and “help cut down smoking” (70%).
Conclusions: Both AOD healthcare providers and clients are aware of ENDs and the potential for smoking cessation but are cautious in continuing use and recommending their use. This may be due in part to the highly restricted context of e-cigarettes in Australia. More data on e-cigarette safety and efficacy is needed.
Prevent Second Stroke: An online program for improving stroke survivors’ health-related quality of life
Heart Foundation Postdoctoral Research Fellow, Priority Research Centre for Health Behaviour, University of Newcastle
Recurrent stroke is a major contributor to stroke-related disability and costs. Improving health risk behaviours and mental health has the potential to significantly improve recovery, enhance health related quality of life (HRQoL), independent living, and lower risk of recurrent stroke. The PeRSiST trial tests the effectiveness of an online intervention to improve HRQoL amongst stroke survivors at six months follow-up. The trial uses an open-label randomised controlled design recruiting a total of 530 adults from a national stroke registry and block randomising them to the intervention or minimal care control group. The intervention group receive access to the Prevent 2nd Stroke (P2S) program, an online modularised and tailored program designed for individuals who have had a stroke to improve their HRQoL. The minimal care control group receive an email with internet addresses of generic health sites designed for the general population. The primary outcome, HRQoL, will be measured using the EuroQol-5D. Program effectiveness on four health behaviours, anxiety and depressions, cost-effectiveness, and impact on other hospital admissions will also be assessed. A low cost per user option to supplement current care, such as P2S, has the potential to increase HRQoL for stroke survivors, and reduce the risk of second stroke.