http://bmjopen.bmj.com/content/7/4/e014109
Abstract
Objective
Self-management programmes could support long-term needs after stroke
and using methods integrated into rehabilitation is one option. To
explore theoretical assumptions and possible mechanisms of
implementation a process evaluation was delivered alongside a cluster
trial which has demonstrated feasibility of an integrated
self-management programme (Bridges SMP) in community-dwelling stroke
survivors. This paper aims to show the extent to which experiences from
stroke survivors receiving rehabilitation in control (usual care) and
intervention (integrated self-management) sites reflected the
differences in rehabilitation received and whether their understandings
aligned with the self-management approach employed.
Design Semistructured qualitative interviews carried out as part of a process evaluation analysed thematically.
Setting Study was based in South London; all interviews were carried out in participants' home setting.
Participants 22 stroke participants recruited; 12 from integrated self-management sites and 10 from usual care sites.
Results
All participants revealed shared appreciation of knowledge and support
from therapists but subtle differences emerged between sites in respect
to perceptions about responsibility, control and how previous
experiences were used. Accounts depicted a variance regarding who had
structured and planned their rehabilitation, with greater flexibility
about content and involvement perceived by participants from the
integrated self-management sites. They also provided accounts and
experiences which aligned with principles of the intervention, such as
self-discovery and problem-solving.
Conclusions
The findings reflect our theoretical assumptions and possible
mechanisms of implementation that rehabilitation with a focus on
supporting self-management is reflected in accounts and understandings
of stroke survivors. Taken together with our previous research this
justifies evaluating the effectiveness of Bridges SMP in a larger sample
to further contribute to an understanding of the functioning of the
intervention, implementation, contextual factors and mechanisms of
impact.
Trial registration number ISRCTN42534180; Post-results.
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