Self-management: challenges for allied healthcare professionals in stroke rehabilitation – a focus group study

Abstract

Purpose: Self-management has become an important concept in stroke rehabilitation. This study explored allied healthcare professionals' (AHPs) perceptions and beliefs regarding the self-management of stroke survivors and their knowledge and skills regarding stroke self-management interventions. Method: Four focus group interviews were conducted with 27 professionals. Verbal questions and mind mapping were used to collect data. A constant comparative framework was used for analysis. Results: The AHPs discussed different levels of post-stroke self-management, depending on factors such as pre-stroke skills, recovery-phases post-stroke and cognitive abilities of the stroke patients. They hesitated about stroke clients' capacities to self-manage. AHPs questioned whether their own attitudes and skills were really supportive for stroke clients' self-management and criticised stroke services as being too medically oriented. They recommended that self-management programmes should focus both on clients and caregivers and be delivered at peoples' homes. Conclusion: Professional perceptions and beliefs are important factors to take into account when implementing stroke self-management programmes. Before professionals can enable stroke survivors to self-manage, they first need support in acquiring knowledge and skills regarding post-stroke self-management. Moreover, professionals could benefit from behavioural change models, and professionals recognised that stroke self-management interventions would be most beneficial when delivered post-discharge at people's homes.

Implications for Rehabilitation

• Post-stroke self-management is a learning process with different levels dependent on pre-stroke lifestyle and self-management skills, the post-stroke phase of recovery, the cognitive abilities of stroke survivors and the support of caregivers (co-management).

• Persons with cognitive impairments are not persons who cannot learn to self-manage; rather, they need more specific self-management support.

• Case studies describing the abilities of stroke survivors, who are successful in self-management post-stroke, can help to develop “ability oriented” stroke-illness scripts.

• Addressing “ability oriented” stroke-illness scripts in bachelor and post-graduate education will enhance positive professional beliefs concerning the self-management post-stroke, and will help professionals in coaching in stroke survivors' goal setting in self-management programmes.

• Professionals' account suggests that stroke self-management programmes should also be delivered post-discharge at stroke survivors' own homes.

• Focus group
• illness scripts
• professional beliefs
• self-management
• stroke

Acknowledgements

We are grateful to the allied health professionals in the focus groups, who were willing to share their reflections with us, as well as the members of a rehabilitation team who commented on the preliminary findings of the study. Furthermore, we thank Ellen van Boxtel, Evelien Derksen, and Renske van der Sluijs, who organised the focus groups and assisted in the transcription of the data, and Nienke van der Heijden (NH) and Esther van Iren (IE), who assisted in the analysis of the data.

Declaration of interest

The authors report no declarations of interest. This study was supported by a PhD grant from the HAN University of Applied Sciences, Nijmegen, The Netherlands.