Digital Resilience-Based Course-Game Sequential Intervention for Social Participation in Stroke Survivors: Development and Usability Study

Background Social participation is a key goal of stroke rehabilitation, yet effective interventions remain limited. Existing approaches focus largely on functional training or general psychological support, rarely targeting resilience as a modifiable mechanism for enhancing social participation. Most interventions are delivered face-to-face, limiting accessibility and scalability. A theory-driven digital intervention that integrates resilience training with contextualized practice may offer a promising pathway to support social reintegration in stroke survivors. Objective This study aimed to develop a theory-driven, digital resilience-based course-game sequential intervention for improving social participation in stroke survivors and to evaluate its usability among the target population. Methods This was an intervention development and usability study. Following the first 4 steps of intervention mapping, we completed the following steps: (1) conducted a needs assessment based on prior empirical evidence identifying psychological resilience as a key determinant of social participation; (2) defined performance and change objectives grounded in the Kumpfer resilience framework, which delineates 5 protective factors (cognitive, emotional, spiritual, behavioral, and physical); (3) selected theory-based methods and practical applications; and (4) developed an intervention prototype through 4 phases: initial design integrating course learning and gamified experiential modules, expert review and refinement by an 8-member panel, development of the digital system via a WeChat mini-program, and finalization of comprehensive intervention scripts. Participants were recruited using convenience sampling from a rehabilitation hospital in Shanghai, China. Usability was evaluated with 14 stroke survivors through 5 representative tasks, the System Usability Scale (SUS), and semistructured qualitative interviews. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using conventional content analysis. Results The intervention comprised 2 sequential modules: a 7-session course learning module targeting 5 resilience factors, delivered weekly via narrative audio and multimodal content, and a gamified experiential module featuring a supermarket shopping scenario that enabled contextualized skill application. Each weekly course session was designed to last approximately 60 minutes. The duration of a single game session was 20 minutes. Participants had a mean age of 65.4 (SD 9.75) years, and 78.6% (11/14) had experienced an ischemic stroke. All participants completed the usability tasks successfully. The mean SUS score was 73.6 (SD 12.2, 95% CI 66.5-80.6; median 77.5, IQR 61.3-80.6), indicating good usability. Qualitative feedback revealed 3 themes: perceived ease of use and accessibility, perceived usefulness and engagement, and suggestions for improvement. Conclusions This study systematically developed a theory-driven, digital course-game sequential intervention that is innovative in targeting psychological resilience as a core mechanism for social participation, distinguishing it from conventional function-focused or generic resilience approaches. By integrating systematic course learning with contextualized gamified practice, it offers a scalable, low-burden tool that addresses key gaps in stroke rehabilitation. These findings support progression to feasibility and efficacy testing through randomized controlled trials in real-world settings.