Development of an evidence-based stroke self-management program to enhance post-stroke recovery

Abstract

Background: Stroke self-management programs are complex interventions. Developing these programs with an underpinning theoretical premise is crucial to enable its systematic development, implementation, and evaluation. However the approach of integrating the theoretical premise and the best available research evidence in developing the programs are not always well reported. Objective: To illustrate the process of developing and evaluating an evidence-based, theory-based stroke self-management program for community-dwelling stroke survivors. Methods: A systematic review was conducted to examine the evidence on effectiveness of theory-based stroke self-management programs. The results showed that Bandura's self-efficacy theory was commonly adopted to underpin these programs to enhance participants’ confidence in managing their condition. Significant improvement in stroke survivors’ quality of life and self-efficacy was reported. Some studies included in the review were limited in delineating the strategies to enhance stroke survivors’ capabilities in mastering self-management skills. One study neither linked the program to nor measured self-efficacy. Results: Based on the review findings, a nurse-led 3-week stroke self-management program underpinned by Bandura's self-efficacy and outcome expectation theory for community-dwelling stroke survivors is developed. It includes one individual home visit, two group sessions, and two follow-up phone calls to enable individualised assessment and vicarious experience. Video clips about sharing by stroke survivors successfully managed their stroke were developed for role modelling. Participants will be guided to reinterpret the symptoms and practice self-management skills including goal-setting to accomplish self-management behaviours. Verbal persuasion will be provided. Stroke-specific self-efficacy in performing self-management behaviours will be measured. Discussion: This new program adopts multiple strategies driven by self-efficacy theory to enhance stroke survivors’ self-efficacy in performing stroke self-management behaviours. A randomised controlled trial will be conducted to evaluate the program. Conclusion: The results will be important to inform future design and evaluation of best approaches to deliver nurse-led stroke self-management programs for community-dwelling stroke survivors.