Stroke self-management and the role of self-efficacy

Abstract

Purpose

This study explored the impact of a 12-week stroke self-management program on occupational performance, the role of self-efficacy on improving occupational performance and the potential barriers and facilitators to self-efficacy as reported by clients and careers.

Materials and methods

Participants (n = 40) were recruited to participate in a self-management program after admission to hospital with diagnosis of stroke. A pre-post study was conducted and data were obtained from participants using: the Canadian Occupational Performance Measure, Stroke Self-efficacy Questionnaire, and semi-structured interviews with five participants and two careers. Data analysis was conducted using parametric statistics and thematic analysis.

Results

Significant improvements were observed in occupational performance (t = 11.2; p = 0.001) and satisfaction (t = 9.7; p = 0.001). Self-efficacy was shown to be a significant mediator to improvements in occupational performance (F = 7.08; p < 0.01) and satisfaction (F = 6.52; p = 0.02). Three key barriers and facilitators emerged from the thematic analysis: “Support in making the transition home,” “Getting back to normal,” and “Reflecting on shared experiences.”

Conclusions

Engagement in a stroke-specific self-management program can improve client-perceived occupational performance and satisfaction. Self-efficacy was shown to be a mediating variable to occupational performance improvements. Future research should explore further the facilitatory strategies of self-efficacy during stroke self-management programs to maximize rehabilitation outcomes.

Implications for rehabilitation

• Multi-modal self-management programs are recommended as effective for improving client-perceived occupational performance of people who have experienced stroke.

• Returning to valued occupations, goal setting, shared experiences, and local support are recommended components of a self-management program for stroke survivors.

• Focusing on enhancing client confidence, competence, and self-efficacy is recommended to achieve occupational performance gains through self-management.

• Occupational therapy coaching is recommended to guide participants through the self-management processes of goal-setting, shared problem-solving, performance evaluation, and reflection.

Keywords:

• Stroke
• self-management
• self-efficacy
• occupational performance
• rehabilitation
• occupational therapy coaching

Acknowledgements

The authors would like to thank each participant who voluntarily gave up their much-valued time to participate in the semi-structured interviews conducted: Ron, Phillis, Wal, Loren, Flossie, Lynette, and George. The authors also gratefully thank and acknowledge Albury Wodonga Health and Wagga Wagga Health Service for their consent and contribution to the project.

Disclosure statement

The authors reports no declarations of interest.

Additional information

Funding

This study was supported by the NSW Health Translational Research Grants Scheme (TRGS).