Social psychological mechanisms and processes in a novel, health professional-led, self-management intervention for older stroke individuals: a synthesis and phenomenological study

Abstract

BackgroundA good portion of stroke patients in Western countries are over 65 of age. Because of sequelae, they often lead more isolated lives after the stroke. In terms of social reintegration, this group of patients is especially vulnerable. Reintegration into the community post-stroke greatly depends on support from family. However, the stroke individual’s closest relatives are at risk of becoming overburdened.The objectives are to describe the social psychological mechanisms and processes involved in a novel self-management intervention, and to evaluate their feasibility and acceptability from the stroke individuals’, the informal caregivers’ and the mentors’ perspectives, before implementation into a randomised controlled trial.MethodsQualitative interviews were conducted and analysed using a phenomenological approach. Informants comprised four stroke individuals, three informal caregivers and two mentors.The UK Medical Research Council Framework for developing and evaluating complex interventions was used in the evaluation design of the intervention.ResultsSix social psychological mechanisms were revealed as the mentors’ focus areas in their interaction with stroke individuals and informal caregivers: a) Tailored approach – by individual preferences, b) Dialogue-based communication, c) Development of a good relationship, d) Transfer of activities to everyday and social contexts, e) Involvement of relatives and social networks, and f) Supporting tools – to optimise actions and communication. Furthermore, interaction processes between the stroke individual and the informal caregiver and the mentors occurred, and generated processes of change and learning in the stroke individual and the informal caregiver. The mechanisms and processes described were perceived as feasible and acceptable to the informants – with the exception of the technological supporting tool.ConclusionThe social psychological mechanisms and processes involved in the intervention indicated a positive association to self-management behaviour from the informants’ perspectives. The informants evaluated them to be relevant and meaningful in the novel self-management intervention.Trial registrationClinicalTrials.gov NCT03183960. Reg. June 15, 2017.