Development and evaluation of a nurse-led, tailored stroke self-management intervention

Abstract

BackgroundCommunity nurses are well placed to promote and support stroke survivors to engage in self-management. The aim of this study was to develop a stroke self-management intervention that could be tailored towards stroke survivors’ self-management needs, goals and levels of activation, in the first year post-stroke.MethodsMixed method study, designed in accordance with the British Medical Research Council’s (MRC) guidance for the development and evaluation of complex interventions. The intervention was developed and evaluated in two phases. The intervention was underpinned by the theoretical concept of patient activation and was developed based on a review of published research on stroke self-management interventions and qualitative interviews and focus groups (phase 1). It was evaluated using qualitative interviews and focus groups with stroke survivors and stroke nurses (phase 2). Participants comprised 26 stroke survivors, between 3 and 12 months post stroke and 16 stroke nurses, from across three NHS Boards in Scotland.ResultsThe intervention consisted of a tailored self-management action plan, incorporating an individualised assessment of stroke survivor’s readiness to self-manage (using the Patient Activation Measure), goal setting and motivational interviewing. Evaluation showed that many of the individual components of the intervention were perceived as feasible and acceptable to both stroke survivors and stroke nurses.ConclusionsTo our knowledge, this is the first UK study to explore the use of patient activation as a theoretical underpinning in stroke self-management research and to involve stroke survivors and stroke nurses in the design and development of a tailored, person-centred stroke self-management support intervention. The study findings provide the first step in understanding how to effectively develop and deliver stroke self-management support interventions to stroke survivors living at home in the first year following stroke. Further work is needed to develop and refine the intervention and identify how to effectively embed it into nurses’ routine clinical practice.

Measuring patient activation: The utility of the Patient Activation Measure within a UK context—Results from four exemplar studies and potential future applications

“…The fourth exemplar specifically explored the feasibility and acceptability of using PAM as a basis for guiding the provision of tailored self-management support for stroke survivors. 32 Tailored coaching is not widely used as yet in the UK and there is little published evidence on this although it does hold potential and is of growing interest to researchers, practitioners, service providers and commissioners given the need to be more cost effective with resource use. This data illustrated that although PAM was useful for gauging PAM levels across a group of stroke survivors, some found it challenging to complete and the stroke nurses delivering the intervention reported that it did not enable tailoring of appropriate care and support.…”

“…Exemplar 4 -This research project explored how the PAM could be used to tailor self-management support intervention for stroke survivors (3 months post stroke) in the community. 32 The intervention consisted of a tailored self-management action plan, incorporating an individualised assessment of stroke survivors' levels of activation (using the PAM), goal setting and motivational interviewing and the study reported on both stroke survivors'(n=6) and professionals' (n=5) perspectives of the intervention and the use of the PAM to guide the provision of self-management support. In this study, the PAM was not used as an outcome measure but rather a process tool to identify participant's level of activation and align the provision of tailored support towards that based on the underpinning theory.…”

“…Levels 1 and 2, as shown in Figure 1). Perceptions on the use of PAM in this study are reported elsewhere 32 Exemplar 1 used PAM as a process/outcome measure to predict engagement, a different approach from the service evaluations described previously. This research project collected more clinical data with PAM which allowed richer analysis, however the same sample size and lack of repeat data collection makes further analysis difficult.…”

Implementing Supported Self-Management in Community-Based Stroke Care: A Secondary Analysis of Nurses’ Perspectives

“…The focus is on supporting people to develop the capacity and confidence to manage the impact of their stroke in the context of their lives in a way that is meaningful and purposeful for them, and to 'be in charge' of their own self-management decision making [6][7][8][9]. Contemporary notions of SSM position it as a move away from the traditional perceptions of education-compliance with professionally driven treatment plans and goals, and a focus on function and level of impairment-because this does not 'fit' with how people with long-term conditions typically perceive their own engagement in self-management [6,10,11].…”

Patient and Family Engagement Summit

“…[9][10][11][12] Healthcare organizations are expected to achieve the triple aim of providing quality care and improved health at a lower cost. 13 One approach to help reach the triple aim is more effectively engaging people in their own care.…”