A Nurse-Led, Evidence-Based Stroke Self-management Program for Community-Residing Stroke Survivors: Development and Design
Lo, Hoi Shan
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Session presented on Saturday, July 26, 2014: Background: Stroke recovery is long-term and demanding. It is important to optimise stroke survivors' capability to manage their own health after stroke. Previous systematic reviews showed potential benefits of stroke self-management programs. However some programs were not well designed with a theoretical framework. Aim: The aim of this paper is to illustrate the design and development of a nurse-led, evidence-based, self-efficacy enhancing stroke self-management program for community-dwelling stroke survivors. Methods: The development of the program is divided into two phases. Phase I included the conduct of a systematic review to assess the best available research evidence regarding the effectiveness of community-based stroke self-management programs underpinned by a theoretical framework. Phase II included the development of a theory-based stroke self-management program for community-dwelling stroke survivors'based on the review findings. Results: The results of the systematic review showed that Bandura's self-efficacy theory was frequently adopted to underpin the stroke self-management programs. Significant improvement in quality of life and self-efficacy among stroke survivors after receiving the program was reported. However some of the included studies did not measure stroke survivors' changes in self-efficacy. Description about strategies to enhance stroke survivors' self-efficacy in performing stroke self-management behaviours were also limited. Based on the review results, a nurse-led stroke self-management program underpinned by Bandura's self-efficacy theory for community-dwelling stroke survivors is developed. It is a three-week program including an individual home visit, two group sessions, and two follow-up phone calls. Individualised assessment and education on self-management skills will be provided to enable mastery experience. Video clips about experience sharing by stroke survivors were developed to provide vicarious experience. Verbal persuasion and skills in reinterpreting the signs and symptoms will also be provided. Furthermore stroke survivors' outcome expectation of performing stroke self-management will be assessed to tailor-make the strategies to enhance their participation in self-management. Discussion and Conclusion: This new program adopts multifaceted strategies driven by the 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.