System-integrated technology-enabled model of care for stroke secondary prevention in rural China.

The burden of stroke is increasing rapidly in rural China, but effective strategies to improve secondary prevention of stroke are lacking.

The SINEMA project aims to improve the secondary prevention of stroke by delivering essential care to stroke survivors in rural China via primary healthcare strengthening and digital health technologies. The delivery of SINEMA program is supported by a digital health system, consisting of (1) a mobile phone application developed to assist primary healthcare providers in receiving training, managing stroke patients and delivering high-quality follow-up visits and (2) patient-facing voice messages dispatched to patients daily to remind and educate patients in self-management.

The SINEMA program was implemented and evaluated by a cluster-randomized controlled trial involving 50 villages and 1,299 stroke patients from Nanhe County, Hebei Province, a rural area within the “stroke belt” in China.

Lead Researcher(s)

Lijing L. Yan (PI)
Brian Oldenburg
Enying Gong


The study is funded by the United Kingdom Medical Research Council, Economic and Social Research Council, Department for International Development, and Wellcome Trust (Grant No: MR/N015967/1).

Project Team Members

Other co-investigators: Janet Bettger
Elizabeth Turner
Shenglan Tang(Duke University)
Yilong Wang (Beijing Tiantan Hospital)
Ninghua Wang (Peking University First Hospital)


Gong, E., Gu, W., Sun, C., Turner, E. L., Zhou, Y., Li, Z., Bettger, JP., Oldenburg, B., Amaya-Burns A., Wang Y, Xu LQ., Yao J., Dong, D., Xu Z., Li C, Hou, M., Yan LL. (2019). System-integrated technology-enabled model of care to improve the health of stroke patients in rural China: protocol for SINEMA—a cluster-randomized controlled trial. American Heart Journal, 207, 27-39.

Gong, E., Yan, L.L., McCormack, K., Gallis, J.A., Bettger, J.P. and Turner, E.L., 2019. System-integrated technology-enabled model of care (SINEMA) to improve the health of stroke patients in rural China: Statistical analysis plan for a cluster-randomized controlled trial. International Journal of Stroke, 2020, 15 (2), 226-230

Wu, Na, Enying Gong, Bo Wang, Wanbing Gu, Nan Ding, Zhuoran Zhang, Mengyao Chen, Lijing L. Yan, Brian Oldenburg, and Li-Qun Xu. “A Smart and Multifaceted Mobile Health System for Delivering Evidence-Based Secondary Prevention of Stroke in Rural China: Design, Development, and Feasibility Study.” JMIR mHealth and uHealth, 2019;7 (7): e13503.

Gong E., Gu W, Luo E, Tan L, Donovan J., Sun C., Yang Y., Zang L., Bao P., Yan LL. Development and Local Contextualization of mHealth Messages for Enhancing Disease Management among Community-dwelling Stroke Patients in Rural China: Multimethod Study. JMIR mhealth uhealth, 2019;7(12):e15758

Enying Gong

PhD candidate at the School of Population and Global Health, University of Melbourne

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