Abstract NS7: Strategies for Enhancing Stroke Self-management Among Older Stroke Survivors: A Mixed Methods Inquiry

Abstract

Introduction: Older stroke survivors often experience difficulties managing stroke due to coexistent nature of stroke related neurological deficits and age related physical changes. Identifying effective strategies for enhancing stroke self-management in older survivors is needed. Objective: Using a mixed methods inquiry approach, this secondary data analysis from a randomised controlled trial examines the role of patient empowerment on self-management among older stroke participants (aged 65 or above), and what strategies (if any) they used for self-management post-stroke. Methods: Phase I study composed of a sub-group analysis on 143 older stroke participants (age 77.1±7.6, 51.7% male, 80.4% ischemic stroke) who received a stroke patient empowerment intervention plus usual care (n=66) or usual care only (n=77). Generalized estimating equations were used to assess between-group changes in stroke self-management behaviors and functional recovery (Lawton Instrumental Activities of Daily Living-IADL) over time at baseline (T0) and 3-month post-intervention (T1), using intention-to-treat. During Phase II, in-depth individual interviews by purposive sampling (n=21) were conducted exploring self-management experience post-intervention. Content analysis at both latent and manifest levels were performed. Results: Participants receiving the empowerment intervention had significantly better self-management behaviors (all p<0.05, effect size range from 0.36-0.72), and IADL (p=0.003, effect size 0.54) at T1, compared to those receiving usual care only. Content analysis revealed four categories of self-management strategies adopted, namely Visualizing self-manager role; Enhancing resilience; Anticipatory help seeking and Collaborative symptom management. Three barriers to stroke self-management were identified: Accepting disability as part of ageing; Filial piety care concept and Fatigue. Conclusions: A patient empowerment intervention engaged older stroke survivors in self-management. Findings of this mixed methods analysis inform important contextual components of care for tailoring interventions for older stroke survivors to foster self-management post-stroke and improve functional recovery.