Goal attainment, adjustment and disengagement in the first year after stroke: A qualitative study

Figures & data

Table 1. Final Thematic framework.

Themes	Sub themes
Identifying personal goals	Personal Context (Who I am, what I like to do, my lifestyle & attitude) My goals, hopes & priorities Coming up with the goals
2. Motivating & sustaining goal pursuit	My goals & plans (action plans/ coping plans) Mechanisms of action
3. Experience of success	Goal attainment (engage in important activities, experience sense of self, enhanced wellbeing) Important steps Emotional response
4. Experience of setbacks/ failure	Goals proving difficult to achieve Emotional response Maintain goal expectations Understand & accept limitations
5. Gauging progress & making informed goal decisions	Continued goal pursuit Goal adjustment Goal disengagement
6. The Goal setting & Action Planning record	Positives Negatives

Table 2. Stroke survivors included in the study.

Pseudonym	Gender/Age	Main stroke related issues	Comorbidities (Yes/No)	Modified Rankin Scale	Team
1. Tom	Male, 67	Hemiparesis	Y	2	1
2. Paul	Male, 56	Hemiparesis; anxiety & depression	Y	3	1
3. Lorna	Female, 59	Hemiparesis; cognitive impairment	Y	2	1
4. Peter	Male; 73	Hemiparesis	Y	2	1
5. Alana	Female, 68	Impaired balance; anxiety	Y	3	1
6. Colin	Male, 67	Hemiparesis; cognitive & communication impairment	Y	2	1
7. Andrew	Male, 75	Hemiparesis	Y	2	2
8. Kim	Female, 28	Hemiparesis; depression	Y	3	2
9. Jim	Male, 85	Ataxia; balance impairment; dysarthria; double vision	Y	4	1
10. Henry	Male, 81	Hemiparesis; Dysarthria	Y	4	1
11. Agnes	Female, 85	Hemiparesis right; communication impairment	Y	3	1
12. Liz	Female, 65	Hemiparesis; anxiety; cognitive impairment; neuropathic pain	Y	3	2
13. Janet	Female, 72	Hemiparesis; dysarthria	Y	2	2
14. Pamela	Female, 64	Cognitive impairment; hemianopia	Y	3	3
15. Jane	Female, 49	Hemiparesis; cognitive & communication impairment	Y	2	3
16. Grant	Male, 55	Communication impairment; fatigue	Y	2	3
17. Allan	Male, 52	Speech & swallowing difficulties; emotionalism; fatigue	Y	2	3
18. Alexander	Male, 45	Hemiparesis; dysarthria	N	2	3

MRS – Modified Rankin Scale: 0 No symptoms; 1 No significant disability; 2 Slight disability; 3 Moderate disability; 4 Moderately-severe disability; 5 Severe disability.

Figure 1. Pathways to goal attainment and non attainment.

Table 3. Motivating and sustaining goal pursuit.

Mechanisms	Stroke survivor accounts
Impetus for change	“That was the real turning point [setting goals], you decide you’re going to have a go at something, you don't know whether you’re going to achieve it or not but you have a go. And so, that was the starting point really.” Peter (age 73)
	“I think it was helpful to know that these [goals] were there and I had to work for them, yes … It stopped me just accepting that that's the way I was and I’d never be any different.” Henry (age 81)
Focus and motivation	“Well everybody needs to set a standard target … you need some kind of formal motivation.” (Colin, age 67)
	“It [my goal] motivated me to get the stuff done! I think it helps you to focus on a target rather than just a global thing.’” (Jane, age 49).
	“If I feel myself going back a step or two, I go right back to the goals and say ‘no, I don't want to do this, how can I achieve this?’” (Kim, age 28)
‘Stepping stones’	“You can achieve them [goals] if you just break them down, as little as you want, you can achieve it.” Kim (age 28).
	“The end objective is not doing the exercise; it is putting that exercise into a chain of things that will lead to something bigger [being able to walk to the café with his family].” Peter (age 73)
Motivating practise	“ … you can see from the ticks in the boxes [on the exercise sheet in his record], you know, I was doing them [the exercises] pretty regularly”. Peter (age 73)
	“Well, the most direct thing is the strength in my arm and hand, now basically that's just exercise, exercise, exercise, constantly every day.” Janet (age 72).
	“I wouldn't have done it [my action plans] if it hadn't been written down [in the record].” (Andrew, age 75)
	“It's helpful [the record] for her [daughter] to see what I’ve got to do … she encourages me … she’ll say, ‘have you been using you left hand?’” (Paul, age 56).
Overcoming barriers	Tom's (age 67) action plan was to practise walking outside everyday but he predicted he wouldn't be motivated to do it (barrier). The occupational therapist suggested he should put his jacket on before taking rubbish out to the bin and just ‘keep going’ to complete his daily walking practise (coping plan). Tom said:
	“That was a good idea [the coping plan] to think, well I’ve motivated myself to take the rubbish to here and then I’ve put my coat on, so I’ll carry on down”.

Table 4. Experiences of successful action plan completion.

Positive outcome	Stroke survivor accounts
Sense of achievement	“I walked down and round the garden … and then came back on up, so yes it was quite a remarkable achievement.” (Peter, age 73).
	“Yeah, I think that was an achievement [being able to work for 5 hours], aye [yes] I think so, I now feel more part of the [work] team.” (Allan, age 52)
Building confidence	Interviewer: “Did it have any impact on your confidence when you were able to walk round the garden?”
	“Yes, yes it did. You felt that's another notch on the belt … if you can do that one you can do other ones.” (Peter, age 73)
	Interviewer: “So your goal was to be confident using the laptop, and the first action plan was to turn on the computer?”
	“Aye, yes it took me a long time to actually switch on and off the computer, I couldn't get it in my head. Once I’d done it, I was quite happy to sit on my own and do it.” (Liz, age 65)
Enhanced sense of self and emotional wellbeing	“It made me feel as if ‘right, I’m getting that bit of myself back again’ [being able to read a book for 20 minutes]. I felt great because I thought that's ‘me’ coming back.” (Jane, age 49).
	“I think it has an impact on your mental wellbeing [completing action plans], you know, and how you feel about yourself.” (Paul, age 56)