Development of a self-management intervention for stroke survivors with aphasia using co-production and behaviour change theory: An outline of methods and processes

Building Family Interventions for Scalability and Impact

Family nursing researchers are charged with addressing the conceptual and methodological underpinnings of family research when developing family-focused interventions. Step-by-step guidance is needed that integrates current science of intervention development with family science and helps researchers progress from foundational work to experimental work with policy integration. The purpose of this manuscript is to provide pragmatic, evidence-based guidance for advancing family intervention research from foundational work through efficacy testing. Guidance regarding the development of family interventions is presented using the first three of Sidani's five-stage method: (a) foundational work to understand the problem targeted for change; (b) intervention development and assessment of acceptability and feasibility; and (c) efficacy testing. Each stage of family intervention development is described in terms of process, design considerations, and policy and practice implications. Examples are included to emphasize the family lens. This manuscript provides guidance to family scientists for intervention development and implementation to advance family nursing science and inform policy.

What helps confidence in communication - Perspectives of adults with aphasia: "Get maze…not stay out it"

INTRODUCTION

The ultimate aim of speech-language therapy for adults with aphasia is to enhance their life participation. One key factor which may influence an individual's decisions to participate in meaningful life activities is their confidence in communication. The aim of the current study was to explore what helps confidence in communication from the perspective of adults with aphasia.

METHODS

The study, part of a larger investigation, used a qualitative descriptive research approach underpinned by an interpretivist paradigm. Fifteen adult participants who had post-stroke aphasia and lived at home or in long-term care were recruited. Due to COVID-19 restrictions, participants had to be able to complete an online qualitative interview, given conversational support. Maximum variation sampling was used to ensure diversity within the sample. The researchers conducted individual interviews over Zoom based on a topic guide exploring the person's experiences with confidence in communicating and their perceptions about what has helped their confidence in communication since the onset of aphasia. The interviews were video-recorded and transcribed verbatim. The transcripts were analyzed using qualitative content analysis.

RESULTS

Categories of what helps confidence in communication included: Attitudes, Advocating for themselves, Having individualized strategies to deal with communication difficulties, Practicing communication, Other people with aphasia (PWA), Factors related to communication partners, Factors related to the communication context, and Other factors.

CONCLUSIONS

To enhance confidence, speech-language pathologists could help PWA to develop strategies to deal with inevitable communication breakdowns. They could also support PWA to experience communication success in everyday situations and to advocate for themselves.

Construction and validation of a serial album for companions of patients with stroke

OBJECTIVES

to construct and validate a serial album, to be used in hospital discharge planning of patients with stroke.

METHODS

a methodological study, with construction of a serial album, validity by 22 judges and assessment by 22 companions. Data were collected from the Health Education Content Validity Instrument, with the companions, from the Suitability Assessment of Materials.

RESULTS

the serial album has 21 pages. The overall Content Validity Index was equal to 0.87 among expert judges and 1.0 among companions.

CONCLUSIONS

the educational technology constructed was considered valid by the judges and assessed as understandable by the companions so that it presented itself as a viable technological resource for use in the health education of companions of patients with stroke.

Motivation as a Predictor of Aphasia Treatment Outcomes: A Scoping Review

PURPOSE

Motivation is a complex phenomenon that can influence a person's ability to make progress in treatment. We sought to understand how motivation is currently measured and utilized in aphasia rehabilitation by identifying treatment studies that (1) include measurement of motivation and (2) use motivation to predict treatment response.

METHOD

A scoping review was conducted by systematically searching PubMed, CINAHL, EBSCO, Ovid MEDLINE, and APA PsycInfo using the following search terms: (measurement OR treatment OR rehabilitation OR predict*) AND (motiv* OR engagement OR adherence OR compliance) AND (aphasia OR dysphasia).

RESULTS

Two studies met our inclusion criteria. Motivation was measured differently across studies. No studies used motivation to predict treatment outcomes.

DISCUSSION/CONCLUSIONS

Despite the importance of motivation in aphasia rehabilitation success, studies that include its measurement are sparse. Additional research is needed and should include development of measurement tools and evaluation of the predictive value of motivation on treatment outcomes.

Tailoring and Evaluating an Intervention to Support Self-management After Stroke: Protocol for a Multi-case, Mixed Methods Comparison Study

Background

Self-management programs are recognized as a valuable approach to supporting people with long-term conditions, such as stroke, in managing their daily lives. Bridges Self-Management (Bridges) focuses on how practitioners interact and support patients’ confidence, skills, and knowledge, and it is an example of a complex intervention. Bridges has been developed and used across multiple health care pathways in the United Kingdom and is theoretically informed by social cognition theory and self-efficacy principles. Evidence shows that self-management programs based on the construct of self-efficacy can be effective. There is still much to learn about how health care services or pathways should implement support for self-management in a sustainable way and whether this implementation process is different depending on the context or culture of the team or service provided.

Objective

The aim of this study is to tailor and evaluate an intervention (Bridges) to support self-management after stroke in a Swedish context.

Methods

We will use a pretest-posttest design with a case study approach to evaluate the feasibility and implementation of self-management support in two stroke settings. This project includes a complex intervention and depends on the actions of individuals, different contexts, and the adaptation of behavior over time. A mixed methods approach was chosen to understand both outcomes and mechanisms of impact. Data collection will comprise outcome measurements and assessment tools as well as qualitative interviews. Data will be collected concurrently and integrated into a mixed methods design.

Results

Recruitment and data collection for the first site of the project ran from September 1, 2021, to January 17, 2022. The intervention at the first site was conducted from November 1, 2021, to March 5, 2022. The evaluation will start after the implementation phase. The second site has been recruited, and the baseline data collection will start in spring 2022. The intervention will start in early autumn 2022. Data collection will be completed by the end of 2022.

Conclusions

This study represents a unique, highly relevant, and innovative opportunity to maximize knowledge and minimize practice gaps in rehabilitation stroke care. The study will produce robust data on the intervention and in-depth data on the contextual factors and mechanisms related to the feasibility of the intervention and for whom it is feasible. Bridges has been used in the United Kingdom for more than 10 years, and this study will explore its contextualization and implementation within a Swedish stroke environment. The evaluation will study results at the patient, staff, and organizational levels and provide recommendations for the adoption and refinement of future efforts to support self-management.

International Registered Report Identifier (IRRID)

DERR1-10.2196/37672