Information, social support, and behavioural strategies are most useful for enhancing self care: Wha

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Information, social support, and behavioural
strategies are most useful for enhancing self
care What does the stroke survivor perceive as
most useful?

• Sara Joice
• Marie Johnston
• Debbie Bonetti
• Ron MacWalter

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Background

• Interventions continually being developed to
  reduce stroke induced disability
• Benefits to patients - mixed results
• Patients still report being dissatisfied with
  information
• Satisfaction with information is associated with
  non-adherence

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Aim

• To evaluate patients satisfaction with a stroke
  workbook intervention in terms of its perceived
  usefulness.

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Research Questions

• Which aspects of the intervention do patients
  find most useful?
• Are some aspects found more or less useful by
  some subgroups?

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Method

• Retrospective evaluation of a stroke workbook
  intervention being tested in an RCT
• Baseline measures - two weeks post-discharge
  from hospital prior to randomisation
• Outcome measure 5 weeks later at end of
  intervention period

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FindingsReduced disability
Recovery Observer Assessed Activity Limitations
plt.05 Bonetti 2001
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Increased confidence in recovery
Confidence in Recovery plt.001 Bonetti 2001
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Participants

• 103 participants randomised to receive a stroke
  workbook
• 59 participants had complete evaluation data
  (mean age 68 years, male n 33)
• Reasons for incomplete data
• 12 Re-hospitalised or died
• 13 Withdrew from trial
• 19 Evaluation not carried out

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Stroke Workbook Intervention

• was designed to
• enhance control beliefs over recovery from
  disability
• by
• ? Knowledge
• ? Coping
• ? Self management skills
• using
• Written materials behavioural tasks

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The Stroke Workbook
An A4 loose leafed folder containing 90 pages of
information about stroke and recovery.
Contents Why a workbook? Coping with various
aspects of recovery Cognitive behavioural
techniques Support networks
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Intervention Implementation
Wk 0 ? Wk 1 ?? Wk 2 ? ? ?? Wks 3/4? Wk 5 ? ? ??

• Read information.
• Complete 5 quizzes
• Complete 15 tasks.
• Identify record achievable goals.
• Keep a diary to monitor recovery.
• Use the relaxation tape daily.

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Baseline Measures

• Demographic
• Gender, age, with a carer
• Clinical
• Affected side, previous stroke, length of
  hospital stay, severity (Modified Rankin, Barthel
  Index)
• Psychological
• Mood, (Hospital Anxiety and Depression Score)
  cognitions ( Recovery locus of control, Desire
  for the Workbook, Confidence in Recovery)

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Outcome Measure

• Satisfaction
• 20 item questionnaire evaluating various aspects
  of stroke workbook intervention
• Participants to rate on a four point scale from 0
  not at all useful to 3 very useful on 20 items
• Of the chosen very useful items participant asked
  to rank them from the most useful

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Principle Components Analysis
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Aspects of the intervention participants found
useful
F (2, 116) 65.88, p .001
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Most important aspects
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Are some aspects more or less useful to some
subgroups?

• Demographic male/female, ??70 years of age
  with/without carer
• Clinical left/right side, 1st /further stroke,
  ?? 16/7 inpatient, ?? Rankin, ?? Barthel
• Psychological ?? HADS, ?? RLOC, ?? Desire, ??
  Confidence

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Demographic Sub-groups
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Clinical Sub-groups

• No significant clinical differences between
• Affected side
• Previous stroke
• Length of hospital stay
• Severity
• Modified Rankin
• Barthel Index

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Mood Sub-groups
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Psychological Cognition Sub-groups
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Multiple regressions predicting satisfaction

• General information was explained by desire for
  the intervention (19)
• Support information was explained by desire for
  the intervention (6)
• Behavioural information was accounted for by
  desire for the intervention and being less
  depressed (34)

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Summary

• Information about stroke, recovery prevention
  was perceived to be most useful
• Stroke survivors perceived general and support
  information significantly more useful than
  behavioural
• Women and those without a carer found behavioural
  information more useful than men and those with a
  carer
• Clinical status does not influence satisfaction
  with information

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Summary continued

• Those with high perceived control perceived the
  supportive information significantly more useful
  than those with low control
• Desire for the intervention is predictive of
  satisfaction with all aspects of information

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Results suggest that

• Stroke patients are possibly poorly informed at
  point of discharge
• Perceived usefulness of information is not
  associated with clinical factors
• Demographic and psychological factors to be taken
  into account when giving different types of
  information
• Patients desire for the information is predictive
  of its value
• Confident patients still value support!

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To enhance self care

• Patients do not necessarily perceive the same
  things to be useful as health professionals do
• Being dissatisfied with information does not mean
  that that information is not beneficial
• May need to design interventions to assist the
  patient involvement with further interventions

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The evaluation of a stroke workbook intervention

• Sara Joice,
• Marie Johnston, Debbie Bonetti
• Acknowledgments to Val Morrison and Beth Pollard
• s.joice_at_dundee.ac.uk

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Clinical Sub-groups
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Clinical Sub-groups
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General Information
Using enter method, a significant model emerged
(F7,51 2.94, p gt .01 Adjusted R square .19
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Support Information
Using enter method, a non-significant model
emerged (F7,51 1.49, p .19 Adjusted R square
.06
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Behavioural Information
Using enter method, a significant model emerged
(F7,51 5.34, p gt .001 Adjusted R square .34