Randomised controlled trial of an education and support package for stroke patients and their carers

Abstract

ObjectiveTailoring stroke information and providing reinforcement opportunities are two strategies proposed to enhance the effectiveness of education. This study aimed to evaluate the effects of an education package which utilised both strategies on the knowledge, health and psychosocial outcomes of stroke patients and carers.DesignMultisite, randomised trial comparing usual care with an education and support package.SettingTwo acute stroke units.ParticipantsPatients and their carers (N=138) were randomised (control n=67, intervention n=71) of which data for 119 participants (control n=59, intervention n=60) were analysed.InterventionThe package consisted of a computer-generated, tailored written information booklet and verbal reinforcement provided prior to, and for 3 months following, discharge.Outcome measuresOutcome measures were administered prior to hospital discharge and at 3-month follow-up by blinded assessors. The primary outcome was stroke knowledge (score range: 0–25). Secondary outcomes were: self-efficacy (1–10), anxiety and depression (0–21), ratings of importance of information (1–10), feelings of being informed (1–10), satisfaction with information (1–10), caregiver burden (carers) (0–13) and quality of life (patients) (1–5).ResultsIntervention group participants reported better: self-efficacy for accessing stroke information (adjusted mean difference (MD) of 1.0, 95% CI 0.3 to 1.7, p=0.004); feeling informed (MD 0.9, 95% CI 0.2 to 1.6, p=0.008); and satisfaction with medical (MD 2.0, 95% CI 1.1 to 2.8, p<0.001); practical (MD 1.1, 95% CI 0.3 to 1.9, p=0.008), services and benefits (MD 0.9, 95% CI 0.1 to 1.8, p=0.036) and secondary prevention information (MD 1.7, 95% CI 0.9 to 2.5, p<0.001). There was no significant effect on other outcomes.ConclusionsIntervention group participants had improved self-efficacy for accessing stroke information and satisfaction with information, but other outcomes were not significantly affected. Evaluation of a more intensive intervention in a trial with a larger sample size is required to establish the value of an educational intervention that uses tailoring and reinforcement strategies.ACTRN12608000469314

Video-based educational intervention associated with improved stroke literacy, self-efficacy, and patient satisfaction

“…[11] However, there is no broadly accepted best practice and few educational interventions have been specifically developed, implemented, and evaluated in the inpatient setting. The small number of stroke literacy studies that have been performed in recent stroke survivors have either utilized in-person written materials,[12–15] a computer program,[16] or in-person teaching sessions,[17] with variable and inconsistent impact on stroke knowledge and patient satisfaction.…”

Anxiety, Depression And Burnout Levels In Caregivers Of Stroke Patients In A Rehabilitation Hospital

“…Previous studies have also found that depression increased as the duration of care increased, and that anxiety was greater among female caregivers. [16][17][18][19][20][21] Investigations performed related to the gender of caregivers have demonstrated that the caregiving burden is perceived differently by female caregivers. [21] In many cultures, including our culture, caregiving is considered a simple task that should be performed by a woman, an attitude that increases the caregiving burden of women and may weaken their self-confidence.…”

A systematic review of human factors and ergonomics (HFE)-based healthcare system redesign for quality of care and patient safety

“…We found evidence of the effectiveness of HFE in improving quality of care, such as reduced task completion time (Chan et al 2010; Chan et al 2011a; Christofidis et al 2013; Johnson, Johnson and Zhang 2005; Lin, Vicente and Doyle 2001; Preece et al 2012; Rousek and Hallbeck 2011), decreased error rate (Chan et al 2010; Christofidis et al 2013; Kobayashi et al 2011; Kobayashi et al 2013; Lin, Vicente and Doyle 2001; Preece et al 2012), and improved compliance with best practices (de Korne et al 2012; de Vries et al 2009; Lesselroth et al 2011). There was also evidence of HFE-based interventions’ impact on patient safety, such as decreased complication rate (de Vries, Prins , et al 2010), decreased in-hospital mortality (de Vries, Prins , et al 2010), and increased self-efficacy of patients (Eames et al 2013; Hoffmann et al 2007). These studies are important as they show the positive impact of HFE-based healthcare system redesign on healthcare quality.…”