Tailoring and Evaluating an Intervention to Support Self-management After Stroke: Protocol for a Multi-case, Mixed Methods Comparison Study

Abstract

Background Self-management programs are recognized as a valuable approach to supporting people with long-term conditions, such as stroke, in managing their daily lives. Bridges Self-Management (Bridges) focuses on how practitioners interact and support patients’ confidence, skills, and knowledge, and it is an example of a complex intervention. Bridges has been developed and used across multiple health care pathways in the United Kingdom and is theoretically informed by social cognition theory and self-efficacy principles. Evidence shows that self-management programs based on the construct of self-efficacy can be effective. There is still much to learn about how health care services or pathways should implement support for self-management in a sustainable way and whether this implementation process is different depending on the context or culture of the team or service provided. Objective The aim of this study is to tailor and evaluate an intervention (Bridges) to support self-management after stroke in a Swedish context. Methods We will use a pretest-posttest design with a case study approach to evaluate the feasibility and implementation of self-management support in two stroke settings. This project includes a complex intervention and depends on the actions of individuals, different contexts, and the adaptation of behavior over time. A mixed methods approach was chosen to understand both outcomes and mechanisms of impact. Data collection will comprise outcome measurements and assessment tools as well as qualitative interviews. Data will be collected concurrently and integrated into a mixed methods design. Results Recruitment and data collection for the first site of the project ran from September 1, 2021, to January 17, 2022. The intervention at the first site was conducted from November 1, 2021, to March 5, 2022. The evaluation will start after the implementation phase. The second site has been recruited, and the baseline data collection will start in spring 2022. The intervention will start in early autumn 2022. Data collection will be completed by the end of 2022. Conclusions This study represents a unique, highly relevant, and innovative opportunity to maximize knowledge and minimize practice gaps in rehabilitation stroke care. The study will produce robust data on the intervention and in-depth data on the contextual factors and mechanisms related to the feasibility of the intervention and for whom it is feasible. Bridges has been used in the United Kingdom for more than 10 years, and this study will explore its contextualization and implementation within a Swedish stroke environment. The evaluation will study results at the patient, staff, and organizational levels and provide recommendations for the adoption and refinement of future efforts to support self-management. International Registered Report Identifier (IRRID) DERR1-10.2196/37672

The Swedish Stroke Self-Efficacy Questionnaire: translation and cross-cultural adaptation

“…To recruit expert panels in phase 2 we reached out to a reference group in an ongoing stroke research project [ 24 ]. Purposeful sampling was applied to obtain a range of views from different areas—from persons with lived experience of stroke, from health care professionals (HCP: s) in stroke care and from researchers within the field of stroke or instrument development and translation.…”

“…In phase 3, we included a cohort of persons with stroke ( n = 46) that were already recruited from two hospitals in southern Sweden into a larger self-management intervention study [ 24 ]. This convenience sample gave us an opportunity to test the instrument in a real-world setting.…”