Kahraman A.1,2
1University College London, Instutute of Neurology, London, United Kingdom, 2St George's University of London and Kingston University, School of Rehabilitation Sciences, London, United Kingdom
Background: Self-management is an attractive option for the management of people with long-term conditions. However, there is no consensus on definitions of self-management and self-care which are used interchangeably in the literature and policy documents. Despite the extent of self-management focused health care policy and clinical guidelines recommendations, the meaning of self-management as a concept within stroke care has not been well explored or understood. In addition, how self-management might operate in stroke remains unclear.
Purpose: This study aimed to understand self-management from the perspectives of those with stroke and from the perspectives of healthcare professionals working in stroke care pathways through an interview study and to conceptualise the self-management and successful self-management in stroke.
Methods: This study adopted a qualitative design through use of in depth semi-structured interviews and thematic analysis. A total of 14 consenting participants (7 stroke survivors and 7 healthcare professionals who met the inclusion and exclusion criterion were recruited.
Results: Four main themes defined stroke survivor definitions and meanings of self-management:
(1) knowing, understanding and managing post-stroke limitations;
(2) caring for self and daily needs;
(3) being in charge of goals and
(4) coping (with stroke and its consequences).
Stroke survivors definitions and meanings of successful self-management in the context of living with stroke were categorised into two main themes:
(1) accepting and adjusting to limitations and
(2) having signs of successful self-management (i.e. caring for self and daily needs, mental adjustment to stroke, having goals and ambition).
Healthcare professionals definitions and meanings of self-management were organized into one main theme (Patients autonomy) and 3 sub-themes
sub-theme 1: goals;
sub-theme 2: being in control (of therapy, rehabilitation, recovery);
sub-theme 3: taking ownership and responsibility (of stroke and disability and the strategies for managing those).
Healthcare professionals definitions of successful self-management were organised into five main themes and four sub-themes within those themes:
(1) having confidence (to manage stroke);
(2) having tools (knowledge / education / information / strategies / experience) to problem-solve and manage own condition (sub- theme 1: being independent); (3) having goals; (4) having cognitive awareness (sub- theme 1: having an awareness of disabilities); (5) being in the mood (to self-manage) (sub-theme 1: having motivation, focus, determination) and (sub-theme 2: making progress in grieving process (for reconciliation / acceptance / adaptation / moving on)).
Conclusion(s): This study, for the first time, conceptualised the meaning of self-management and successful self-management in stroke from the perspectives of the stroke survivors and the healthcare professionals.The findings also provide some valuable ground work that will help to inform development of valid and reliable PROMs to assess change in stroke self-management interventions. Future work is warranted for further development of self-management interventions to promote self-management.
Implications: The findings from this study will help to address some of the current gaps in our understanding of self-management in stroke and offer some evidence base in explaining the current uncertainty in the theoretical underpinning of self-management interventions and theoretical mechanisms affecting change with such interventions.
Funding acknowledgements: This study was funded by the FHSCE at Kingston University and St. George's, University of London.
Topic: Professional practice: other
Ethics approval: This study was approved by the Wandsworth Research Ethics Committee (London, UK).
All authors, affiliations and abstracts have been published as submitted.
