Clinicians' Perspectives on the Barriers and Facilitators to Implementation of An Evidence-Based Stroke Self-Management Program

Abstract

<h3>Research Objectives</h3> To explore barriers and facilitators to stroke self-management and to elicit feedback on the implementation of an evidence-based self-management program for stroke survivors. <h3>Design</h3> A qualitative descriptive study conducted via Skype or Zoom. <h3>Setting</h3> Clinicians were recruited from a comprehensive stroke center in the US southwestern region. <h3>Participants</h3> Ten clinicians, who provide direct care or services to persons with stroke, participated in one-on-one semi-structured interviews. The multi-disciplinary group of clinicians included a nurse/care manager (n=1), speech-language pathologist (n=1), occupational therapists (n=2), physical therapists (n=2), and physicians (n=4). <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Semi-structured interviews addressed facilitators and barriers to stroke self-management, the role of health care providers in facilitating stroke self-management, and feedback on how to implement successfully an evidence-based stroke self-management program. The clinician interviews lasted 30-45 minutes, were audio recorded, and transcribed by a professional transcription company. Two trained, independent coders analyzed and coded the transcripts. <h3>Results</h3> Thematic content analysis revealed a variety of facilitators and barriers to stroke self-management. Some facilitators identified include family/caregiver support, maintaining a healthy lifestyle, appropriate medication management, and having financial resources. Barriers to self-management include being uninsured, transportation, impaired cognition, lack of family support, limited financial resources, poor medication or blood pressure management, cultural beliefs, and poor health literacy. Clinicians provided a variety of profession-specific strategies to support patient self-management. Major considerations for implementing a stroke self-management program included timing, educational content, access for uninsured patients, addressing transportation needs, accounting for cognitive deficits, improving patient compliance, potential competition with other programs, funding to maintain the program, having a clear organizational structure, and need to evaluate the feasibility and implementation of the program. <h3>Conclusions</h3> The results of this study provides numerous considerations when implementing an evidence based stroke self-management program. Such programs should be low-cost, multidisciplinary in nature, incorporate family/caregivers, and consider the access and educational needs of stroke survivors from diverse backgrounds without transportation, insurance and financial resources. <h3>Author(s) Disclosures</h3> The authors have no disclosures to report.