The Bridges Stroke Self-Management program for Stroke Survivors in the Community: Stroke, Carer and Health Professional Participants’ Perspectives

Special Article – Stroke Rehabilitation

Phys Med Rehabil Int. 2015;2(1): 1030.

The Bridges Stroke Self-Management program for Stroke Survivors in the Community: Stroke, Carer and Health Professional Participants’ Perspectives

Mc Kenna S1, Martin S2, Jones F3, Gracey J2 and Lennon S2,4*

1Northern Ireland Clinical Research Network, Belfast City Hospital, United Kingdom

2Institute of Nursing and Health Research, University of Ulster, United Kingdom

3Faculty of Health and Social Care Science, St George’s University of London & Kingston University, United Kingdom

4School of Health Sciences, Flinders University, Australia

*Corresponding author: Lennon S, Discipline of Physiotherapy, School of Health Sciences, Flinders University, GPO Box 2100, Adelaide 5001, South Australia

Received: December 24, 2014; Accepted: February 05, 2015 Published: February 06, 2015

Abstract

Objective: Self-management programs are considered to be one of the top priorities within health care and rehabilitation. Bridges is a stroke selfmanagement program based on self-efficacy principles that supports survivors to develop effective strategies for managing life after stroke. This study aimed to explore with stroke survivors, carers and health professionals their experiences of using the Bridges stroke self-management program in addition to usual rehabilitation delivered by the community stroke team.

Methods: A qualitative study using a purposive sampling method was used to recruit participants following stroke, who had been included in the intervention arm of feasibility randomised controlled trial, their careers and the health professionals who had delivered the Bridges programme. Interviews were conducted with eleven stroke survivors and two carers. Three health professionals took part in two focus groups. Inductive content analysis was conducted to explore key themes.

Results: Five themes were identified: managing progress; personalised goal setting; greater understanding of recovery; ownership; and factors influencing Bridges such as timing; participant characteristics; and health professionals’ skills in delivering Bridges.

Conclusion: This is one of the first qualitative studies to explore experiences of an individualised approach to supporting self-management. Support needs to be given to clinicians and patients’ to create a more collaborative selfmanagement approach. The Bridges program supports stroke survivors, and health professionals in providing more person-centred care. It was found to be beneficial and acceptable from the perspective of stroke survivors, carers and health professionals. Further evaluation of the Bridges self-management program is warranted.

Keywords: Stroke; Bridges self-management; Carers; Health professionals; Qualitative study

Introduction

Stroke is a neurological condition that is causing chronic disability worldwide [1]. The global burden of stroke suggests that one in six individual’s world-wide will experience a stroke in their lifetime [2]. With an increasing ageing population, the number of stroke survivors and the overall global burden of stroke is increasing [2].

Despite developments in acute and rehabilitative stroke care in recent decades individuals are still reporting a broad range of unmet needs including: emotional support, involvement in decisions about care, rehabilitation therapy, support for everyday activities, information provision, access to services, and help to return to work [3, 4, 5]. Stroke survivors report they do not feel ready to manage themselves after discharge from the supportive environment of acute care [5, 6]. Therefore there is growing interest in the process of adjustment and interventions that may facilitate the stroke survivor’s ability to cope with life after stroke.

Self-management programs (SMPs) are considered to be one of the top priorities within health care and rehabilitation [7]. Selfmanagement support enables people with long term conditions develop the knowledge, skills and confidence to manage their own health [8]. Emerging evidence has shown that self-management support can impact patients’ self-efficacy, knowledge about their condition, satisfaction, clinical and quality of life outcomes, and health and social care resources and costs [9]. Self-management interventions have also been identified as a way to support individuals coping with life after stroke [10, 11, 12].

The Bridges stroke self-management program is a UK developed program based on self-efficacy principles that supports survivors to develop effective strategies for managing life after stroke [13]. Bridges uses one-to one support from a health professionals and a patientheld workbook to support behaviour change, increase motivation and action through strategies such as problem solving and goal setting [13]. The Bridges workbook is used as a tool to facilitate a personal record of goals, progress and helpful self-management strategies. Bridges has been designed in consultation with stroke survivors and their families to reflect the range of challenges post stroke and solutions that recognising that stroke is a unique and complex event, it provides a mechanism for tailoring self-management support. It can be integrated into regular therapy or used after discharge from rehabilitation [14].

Research has shown preliminary proof of concept for the Bridges SMP, including the feasibility of delivery and acceptability to patients, carers and professionals [13, 15]. Promising results have also been reported regarding change in outcome following stroke [13, 16]. In a randomised controlled feasibility study, a greater change in functional activity, social integration and quality of life over a 6-week intervention period was shown for participants who received the Bridges SMP [16]. An important aspect of feasibility is the experiences of translating the intervention into practice and the exploration of the context, barriers and attitudes of those using and delivering the programme; this is the focus of this qualitative study.

Aim

The purpose of the qualitative study was to explore with stroke survivors, carers and health professional their experiences of the Bridges SMP to gain a greater understanding of: the outcomes experienced by stroke participants; the acceptability of the programme to all involved; and, any factors identified as barriers or facilitators to successful implementation of the programme.

Methods

Ethical approval was obtained from the Office for Research Ethics Committees Northern Ireland (ORECNI: 08/NIRO/67).

Participant selection

The carers and participants, who had experienced a stroke, who had been included in the intervention arm of feasibility, randomised controlled trial exploring the Bridges SMP and the health professional participants, who had delivered the program, were approached to participate in this qualitative study. Written informed consent was obtained from all participants.

Face to face interviews were conducted with each individual stroke participant in their respective homes following completion of the six weeks Bridges SMP. Telephone interviews with carers of stroke participants who had received the Bridges SSMP were conducted within three months of their relative having completed the Bridges SMP. Carers had requested that interviews be held by phone so that the interviews could be organised around their other commitments. These interviews were held in an enclosed office using a secure telephone system.

Two focus groups were conducted with health professional participants. A focus group design was chosen as group interactions can reveal more about clinicians’ understanding of a difficult clinical problem and the reasoning behind clinical decisions than may be gained using other data collection techniques [17]. The first focus group was used to pilot the topic framework and identify emerging themes and issues, which were then clarified in a second follow-up focus group. Semi-structured question frameworks were developed for stroke and carer participant interviews based on a set of open ended questions that explored the issues and context relating to engagement in the Bridges SMP (see Table 1). The topics included were informed by the findings of previous evaluation work on the Bridges SMP conducted by Jones and colleagues [13], and by identifying common queries raised in work within the subject area [9,11, 12].

Citation: Mc Kenna S, Martin S, Jones F, Gracey J and Lennon S. The Bridges Stroke Self-Management program for Stroke Survivors in the Community: Stroke, Carer and Health Professional Participants’ Perspectives. Phys Med Rehabil Int. 2015;2(1): 1030. ISSN:2471-0377