Aspirational Rehabilitation Coaching for Holistic Health (ARCH) for Post-Stroke Families: Protocol and Implementation Outcomes

Abstract

Post-stroke hospital discharge holds complex psycho-socio-emotional disruptions for survivors and family caregivers, yet community services rarely extend beyond physical rehabilitation. To address this gap, Aspirational Rehabilitation Coaching for Holistic Health (ARCH) was developed as a strength-based dyadic intervention integrating psychoeducational coaching and blended learning resources, to enhance survivor-caregiver mutuality, resilience, and psychological wellbeing during this critical transition. This study reports the intervention protocol and evaluation outcomes of ARCH. 
Survivor-caregiver dyads were recruited within three months of discharge to receive the intervention. ARCH comprises four-weekly 90-minute coaching sessions with the following themes: Self-Compassion, Resilience, Goal-setting, and Fostering Mutuality. To examine implementation, 30 dyads completed semi-structured interviews analysed using Framework Analysis, with coding structured around the elements of (1) Acceptability, (2) Adoption, (3) Appropriateness, and (4) Sustainability in Proctor’s Taxonomy of Implementation Outcomes. 
Findings indicate strong adherence to (1) Acceptability: Participants reported that ARCH created structured and safe opportunities for emotional disclosure and dyadic communication, as well as restored meaning and agency in their lives, (2) Adoption: Participants emphasized the intervention’s value in bridging the post-discharge gap, and as an important complementary resource for recovery, (3) Appropriateness: Participants found the protocol’s structured yet flexible format relevant across diverse recovery trajectories, and (4) Sustainability: Participants described integrating self-compassion, reframing, and other ARCH-derived strategies into daily life.  
Findings support the robustness of ARCH as an acceptable and sustainable post-stroke dyadic intervention within the community, while pointing to its potential and scalability as a complementary family-centred, compassion-oriented stroke rehabilitation model in Singapore and beyond.