CaknaStrok Education Package for Stroke Caregivers

Supporting Stroke Caregivers With the CaknaStrok Education Package: A Feasibility Cluster Randomized Controlled Trial

This study evaluated the feasibility and potential effectiveness of the CaknaStrok Education Package (CEP), a culturally tailored education package developed to support informal caregivers of stroke survivors. The package consists of a mobile health application and a Malay-language caregiving guidebook covering stroke knowledge, caregiving strategies, rehabilitation, nutrition, secondary prevention and caregiver self-care. The study compared caregivers receiving the CaknaStrok Education Package in addition to usual care with those receiving usual care alone. The study assessed outcomes related to caregiving burden, quality of life and psychological well-being, as well as the feasibility of implementing the intervention within routine stroke care.

The CaknaStrok Education Package (CEP) is a culturally tailored, blended digital and print educational intervention developed to support informal caregivers of stroke survivors in Malaysia. The intervention consists of the CaknaStrok mobile application and a Malay-language caregiving guidebook. The mobile application provides video-based caregiving guidance, stress self-assessment, Barthel Index tracking, stroke-related resources and communication with the research team. The guidebook consists of six modules covering stroke knowledge, caregiving strategies, rehabilitation exercises, nutrition, secondary prevention and caregiver self-care.

This study adopted a feasibility cluster randomized trial design and was conducted at six hospitals representing different regions of Malaysia: Hospital Raja Perempuan Zainab II, Hospital Sultanah Nur Zahirah, Hospital Seberang Jaya, Hospital Umum Sarawak, Hospital Sultanah Aminah and Hospital Sungai Buloh. The study was conducted from 1 October 2024 to 31 August 2025.

Informal caregivers of stroke survivors were recruited during the patients' hospital admission. Eligible caregivers were adults aged 18 years or older who were spouses, family members or relatives providing informal care to stroke patients with acute stroke and a Modified Rankin Scale score of 4-5.

Participants in the intervention group received the CaknaStrok Education Package in addition to usual care, while participants in the control group received usual caregiver education provided as part of routine clinical care.

The study evaluated the feasibility of the intervention and its potential effects on caregivers' psychosocial outcomes, including caregiving burden, quality of life and psychological well-being.

Inclusion Criteria:

• Aged ≥18 years.
• Spouse, family member, or relative of the stroke patient.
• Informal caregiver of a patient diagnosed with acute stroke (within 14 days of stroke onset) with a Modified Rankin Scale (mRS) score of 4-5.
• Present during the patient's hospital admission.
• No prior caregiving experience before the current stroke event.
• Residing at home with the stroke patient.

Exclusion Criteria:

• Non-Malaysian/non-citizen.
• Maid, employee, or paid caregiver.
• Unavailable during the study period.