ORCID

Abstract

Background:Atrial fibrillation is the most common sustained arrhythmia and a leading cause of preventable stroke. Detection is challenging due to its paroxysmal nature and frequent lack of symptoms. Rural and housebound patients are particularly vulnerable, facing multimorbidity, reduced access to healthcare, and exclusion from population screening trials, resulting in delayed atrial fibrillation diagnosis and preventable strokes. Addressing atrial fibrillation detection in these underserved groups is crucial for equity and aligns with NHS priorities for cardiovascular disease prevention.Aim:To explore barriers and enablers to handheld electrocardiogram use for atrial fibrillation detection in rural and housebound populations, and to develop evidence-informed resources to support community implementation.Methods:A multi-phase, mixed-methods design was used, guided by the Knowledge-to-Action Framework’s knowledge creation funnel. A systematic review synthesised international evidence on healthcare professionals’ experiences with mobile electrocardiogram devices. Findings informed an online survey of UK based healthcare professionals to identify local barriers and enablers. Focus groups with stroke survivors and carers explored lived experience and acceptability, while healthcare professional interviews added contextual insight. A consensus group using Nominal Group Technique prioritised key implementation requirements, leading to the development of a decision aid and eLearning package.Results:Across the phases, four key themes were identified: (1) role clarity and workflow integration challenges, (2) variable digital confidence and training needs, (3) patient acceptability and reassurance value, and (4) operational and equity considerations for rural and housebound populations. Consensus prioritised access, awareness, training and primary prevention as critical enablers and priorities for future use. These findings directly shaped the development of a decision aid to support clinical use and an eLearning resource to address training gaps.Contribution to Knowledge:This is the first study to apply the Knowledge-to-Action Framework to atrial fibrillation detection in rural and housebound populations. It delivers a novel, co-produced decision aid and eLearning package designed to bridge the implementation gap and support equitable atrial fibrillation detection in underserved settings.Conclusion:The SPEED-AF study provides a rigorous, evidence-informed pathway from knowledge synthesis to tool development, directly addressing inequities in atrial fibrillation detection. The outputs have the potential to improve stroke prevention in line with national cardiovascular disease priorities.

Awarding Institution(s)

University of Plymouth

Supervisor

Bridie Kent, Jane March-McDonald

Document Type

Thesis

Publication Date

2025

Embargo Period

2025-11-06

Deposit Date

November 2025

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