Promoting psychosocial wellbeing following stroke using narratives and guided self-determination: a feasibility study

Abstract

BackgroundExtensive studies have documented the complex and comprehensive psychosocial consequences of stroke. Psychosocial difficulties significantly affect long-term functioning and quality of life. Many studies have explored psychosocial interventions to prevent or treat psychosocial problems, but most have found modest effects. This study evaluated, from the perspective of adult stroke survivors, (1) the content, structure and process and (2) experienced usefulness of a dialogue-based psychosocial nursing intervention in primary care aimed at promoting psychosocial health and wellbeing.MethodsThis was part of a feasibility study guided by the UK MRC complex interventions framework. It consisted of dialogue-based encounters with trained health professionals during approximately the first year poststroke. It was tested in two formats; individual or group encounters. Inclusion criteria were: Acute stroke, above 18 y.o., sufficient physical and cognitive functioning to participate. Data were collected immediately before, during and 14 days after the completion of the intervention. Pre- and post-data included medical and demographic data, quality of life, emotional wellbeing, life satisfaction, anxiety and depression. Qualitative interviews focusing on participant experiences were conducted two weeks following the intervention. Log notes taken by the health professionals conducting the intervention and work sheets filled in by participants also comprised data. Data analysis was case-oriented. The structured instruments were analysed regarding completeness of data and indication of changes in outcome variables. The qualitative interviews, log notes and work sheets were analysed using thematic content analysis.ResultsTwenty-five stroke survivors (17 men, 8 women), median age 64 (range 33–89), participated. Physical limitations varied from mild to severe. Seven participants had moderate to severe expressive aphasia. The participants found the content and process of the intervention relevant. Both the individual and group formats were found useful. Patients with aphasia reported that there were too few encounters (eight encounters were originally planned). The participants underscored the benefits of being supported through a difficult time, having a chance to tell and (re)create their story and being supported in their attempts to cope with the situation.ConclusionsThis study provides initial support for the usefulness of the psychosocial intervention and highlights areas requiring further consideration and development.Trial registration numberClinicalTrials.gov Identifier: NCT01912014

Young and Midlife Stroke Survivors’ Experiences With the Health Services and Long-Term Follow-Up Needs

“…Our previous analyses had shown us that, at the end of the intervention, the participants in the intervention study had expressed that the intervention had supported them through a difficult period and had provided support during their attempts to cope with the situation. The stroke survivors reported that the intervention provided the opportunity to tell and create their personal stories (Kirkevold, Martinsen, Bronken, & Kvigne, 2014). In this light, we expected to find a difference in how the two cohorts summarized their follow-up experiences and needs after stroke.…”

“…The psychosocial intervention supplemented ''usual care'' in the specialist and community health services. The findings from the initial study are reported elsewhere (Kirkevold, Martinsen, Bronken, & Kvigne, 2014). At the time of this study, the patients had lived with the stroke for approximately 1.5 years.…”

Developing Life Skills in Haemodialysis Using the Guided Self‐determination Method: A Qualitative Study

“…; Kirkevold et al . ). However, GSD has only previously been evaluated in a pilot study among patients dependent on HD.…”

“…; Kirkevold et al . ). Besides the promising results from the pilot study, an empowerment‐based method such as GSD is appropriate within HD research.…”

“…However, empowerment and person-centred interventions translated into clinical practice are needed. The guided self determination (GSD) method has proven effective in diabetes care and has been used in patients with other long-term conditions (Joergensen et al 2012;Kirkevold et al 2014). However, GSD has only previously been evaluated in a pilot study among patients dependent on HD.…”