Social psychological mechanisms and processes in a novel, health professional-led, self-management intervention for older stroke individuals: a synthesis and phenomenological study

Abstract

Background A good portion of stroke patients in Western countries are over 65 of age. Because of sequelae, they often lead more isolated lives after the stroke. In terms of social reintegration, this group of patients is especially vulnerable. Reintegration into the community post-stroke greatly depends on support from family. However, the stroke individual’s closest relatives are at risk of becoming overburdened. The objectives are to describe the social psychological mechanisms and processes involved in a novel self-management intervention, and to evaluate their feasibility and acceptability from the stroke individuals’, the informal caregivers’ and the mentors’ perspectives, before implementation into a randomised controlled trial. Methods Qualitative interviews were conducted and analysed using a phenomenological approach. Informants comprised four stroke individuals, three informal caregivers and two mentors. The UK Medical Research Council Framework for developing and evaluating complex interventions was used in the evaluation design of the intervention. Results Six social psychological mechanisms were revealed as the mentors’ focus areas in their interaction with stroke individuals and informal caregivers: a) Tailored approach – by individual preferences, b) Dialogue-based communication, c) Development of a good relationship, d) Transfer of activities to everyday and social contexts, e) Involvement of relatives and social networks, and f) Supporting tools – to optimise actions and communication. Furthermore, interaction processes between the stroke individual and the informal caregiver and the mentors occurred, and generated processes of change and learning in the stroke individual and the informal caregiver. The mechanisms and processes described were perceived as feasible and acceptable to the informants – with the exception of the technological supporting tool. Conclusion The social psychological mechanisms and processes involved in the intervention indicated a positive association to self-management behaviour from the informants’ perspectives. The informants evaluated them to be relevant and meaningful in the novel self-management intervention. Trial registration ClinicalTrials.gov NCT03183960. Reg. June 15, 2017. Electronic supplementary material The online version of this article (10.1186/s12913-019-4150-x) contains supplementary material, which is available to authorized users.

Indirect effects of social support and hope on quality of life via emotional distress among stroke survivors: A three-wave structural equation model

“…This could, in turn, alleviate their emotional distress and improve their physical and psychosocial QoL. It would also be beneficial to establish social support networks through mentorship schemes ( 53 , 54 ) and to encourage stroke survivors to proactively use this support as a resource and source of motivation during the recovery process.…”

Perception of post-stroke patients on case management conducted by nurses

“…Often, the support for the changes required to achieve the goals established by the participant and the case manager, is given by the family members, who provide the motivation and the help to adapt daily activities. Thus, the rehabilitation process must address both patients and caregivers, since the consequences of the stroke affect everyone (24) . Results from a Scottish study showed that the treatment of post-stroke patients was less difficult when it was shared with family and friends, who provide emotional support and assistance in daily living activities, increasing the patient's security to make decisions (25) .…”

Exploring self-management within hospital-based stroke care: current and future opportunities

“…The findings suggest that family involvement in self-management is frequently identified as a strategy to improve an individual's engagement; however, families may become overly involved and limit opportunities for patients to practise self-management behaviours [14,30,32,[37][38][39]. Families who are willing to support self-management outside of the therapistdriven sessions provide greater opportunity for patients to master self-management skills within the hospital setting [40], which is particularly valuable for time-poor clinicians [17].…”