Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2015

Open Access 01-12-2015 | Research article

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

Authors: Lisa Kidd, Maggie Lawrence, Jo Booth, Anne Rowat, Sian Russell

Published in: BMC Health Services Research | Issue 1/2015

Login to get access

Abstract

Background

Community 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.

Methods

Mixed 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.

Results

The 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.

Conclusions

To 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.
Literature
1.
World Health Organization. WHO STEPS Stroke Manual: The WHO STEPwise approach to stroke surveillance. Geneva: World Health Organization; 2006.
2.
The Stroke Association. Feeling overwhelmed: emotional impact of stroke, London Stroke Association (Summer 2013). 2013.
3.
Rees L, Marshall S, Hartridge C, Mackie D, Weiser M. Cognitive interventions post acquired brain injury. Brain Inj. 2007;21(2):161–200.CrossRefPubMed
4.
Jones F, Riasi A, Norris M. Self-management after stroke: time for some more questions. Disabil Rehabil. 2013;35(3):257–64.CrossRefPubMed
5.
Scottish Government. Long Term Conditions Collaborative: Improving Self Management Support. Edinburgh: Scottish, Government; 2009.
6.
Adams K, Greiner AC, Corrigan JM. Report of a summit. The 1st annual crossing the quality chasm summit-A focus on communities. Washington, DC: National Academies Press; 2004.
7.
Lorig K. Self-management of chronic illness: A model for the future. Generations. 1993;XVII(3):11–4.
8.
Battersby MW, Kit JA, Prideaux C, Harvey PW, Collins JP, Mills PD. Implementing the Flinders Model of Self-management Support with Aboriginal People who have Diabetes: Findings from a Pilot Study. Aus J Prim Health. 2008;14(1):66–74.CrossRef
9.
Kennedy A, Reeves D, Bower P, Lee V, Middleton E, Richardson G, et al. The effectiveness and cost-effectiveness of a national lay-led self-care programme for patients with long-term conditions: a pragmatic randomized controlled trial. J Epidemiol Community Health. 2007;61(3):254–61.CrossRefPubMedPubMedCentral
10.
Jones F, Mandy A, Partridge C. Changing self-efficacy in individuals following a first time stroke: preliminary study of a novel self-management intervention. Clin Rehabil. 2009;23(6):522–33.CrossRefPubMed
11.
Joice S, Johnston M, Bonetti D, Morrison V, MacWalter R. Stroke survivors’ evaluations of a stroke workbook-based intervention designed to increase perceived control over recovery. Health Edu J. 2012;71(1):17–29.CrossRef
12.
Leventhal H, Brissette I, Leventhal EA. The common-sense model of self-regulation of health and illness. In: Cameron L, Leventhal H, editors. The Self-Regulation of Health and Illness Behaviour. New York: Routledge; 2003. p. 42–65.
13.
McKenna S, Jones F, Glenfield P, Lennon S. Bridges self-management program for people with stroke in the community: a feasibility randomized controlled trial. Int J Stroke 2013, doi: 10.1111/ijs.12195. [Epub ahead of print].
14.
Kennedy A, Bower P, Reeves D, Blakeman T, Bowen R, Chew-Graham C, et al. Implementation of self management support for long term conditions in routine primary care settings: cluster randomised controlled trial. BMJ. 2013;346(1).
15.
Greeves CJ, Campbell JL. Supporting self-care in general practice. Br J Gen Pract. 2007;57(543):814–21.
16.
17.
Blakeman T, Macdonald W, Bower P, Gately C. A qualitative study of GPs’ attitudes to self-management of chronic disease. Br J Gen Pract. 2006;56(527):407–14.PubMedPubMedCentral
18.
Jones F, Livingstone E, Hawkes L. Getting the balance between encouragement and taking over: reflections on using a new stroke self-management programme. Physio Res Int. 2013;18(2):91–9.CrossRef
19.
20.
Hibbard J, Gilburt H. Supporting people to manage their health: an introduction to patient activation. London: The Kings Fund; 2014.
21.
Hibbard JH, Cunningham PJ. How engaged are consumers in their health and health care, and why does it matter? Health Syst Change Res Briefs. 2008;8:1–9.
22.
Donald M, Ware RS, Ozolins IZ, Begum N, Crowther R, Bain C. The role of patient activation in frequent attendance at primary care: a population-based study of people with chronic disease. Patient Educ Counsel. 2011;83(2):217–21.CrossRef
23.
Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004;39(4:part 1):1005–26.CrossRefPubMedPubMedCentral
24.
Ellins J, Coulter A. How engaged are people in their healthcare? Findings of a national telephone patient survey. London: Picker Institute; 2005.
25.
Deen D, Lu W-H, Rothstein D, Santana L, Gold MR. Asking questions: the effect of a brief intervention in community health centers on patient activation. Patient Educ Couns. 2011;84(2):257–60.CrossRefPubMed
26.
Campbell M, Fitzpatrick R, Haines A, Kinmonth AL, Sandercock P, Spiegelhalter D, et al. Framework for design and evaluation of complex interventions to improve health. BMJ. 2000;321:694–6.CrossRefPubMedPubMedCentral
27.
Craig P, Dieppe P, Macintyre S, Mitchie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337(a1655):979–83.
28.
Hoffman RC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;7(348):g1687.CrossRef
29.
Benzo RP. Mindfulness and motivational interviewing: two candidate methods for promoting self-management. Chronic Resp Dis. 2013;10(3):175–82.CrossRef
30.
31.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef
32.
Lawrence M, Kinn S. Defining and measuring patient-centred care: an example from a mixed-methods systematic review of the stroke literature. Health Expect. 2012;15(3):295–326.CrossRefPubMed
33.
Maitra KK, Erway F. Perception of client-centred practice in occupational therapists and their clients. Am J Occup Ther. 2006;60(3):298–310.CrossRefPubMed
34.
Rosewilliams S, Roskell CA, Pandyan AD. A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal setting in stroke rehabilitation. Clin Rehabil. 2011;25(6):501–14.CrossRef
35.
Wressle E, Eeg-Olofsson AM, Marcusson J, Henriksson C. Improved client participation in the rehabilitation process using a client-centred goal formulation structure. J Rehabil Med. 2002;34:5–11.CrossRefPubMed
36.
Boger EJ, Demain S, Latter S. Self-management: a systematic review of outcome measures adopted in self-management interventions for stroke. Disabil Rehabil. 2013;35(17):1415–28.CrossRefPubMed
37.
Norris M, Kilbride C. From dictatorship to a reluctant democracy: stroke therapists talking about self-management. Disabil Rehabil. 2014;36(1):32–8.CrossRefPubMed
38.
De Silva D. Helping measure person-centred care: a review of evidence about commonly used approaches and tools used to help measure person-centred care. London: The Health Foundation; 2014.
Metadata
Title
Development and evaluation of a nurse-led, tailored stroke self-management intervention
Authors
Lisa Kidd
Maggie Lawrence
Jo Booth
Anne Rowat
Sian Russell
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2015
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-015-1021-y

Other articles of this Issue 1/2015

BMC Health Services Research 1/2015 Go to the issue

Research article

Productivity loss and indirect costs associated with cardiovascular events and related clinical procedures

Research article

Costs and advance directives at the end of life: a case of the ‘Coaching Older Adults and Carers to have their preferences Heard (COACH)’ trial

Research article

The effect of patient, provider and financing regulations on the intensity of ambulatory physical therapy episodes: a multilevel analysis based on routinely available data

Research article

Ghana’s National Health insurance scheme and maternal and child health: a mixed methods study

Research article

Nurses’ evaluation of physicians’ non-clinical performance in emergency departments: advantages, disadvantages and lessons learned

Research article

The importance of older patients’ experiences with care delivery for their quality of life after hospitalization