Implementing supported self-management in stroke

• Research type

  Research Study

• Full title

  Supported stroke self-management: what does it look like and what makes it work?

• IRAS ID

  264558

• Contact name

  Lisa Kidd

• Contact email

  lisa.kidd@glasgow.ac.uk

• Sponsor organisation

  NHS Greater Glasgow and Clyde

• Duration of Study in the UK

  1 years, 7 months, 26 days

• Research summary

  Summary of Research

  BACKGROUND
  Stroke is the leading cause of complex disability in adults (Adamson et al., 2004) and up to two thirds of stroke survivors have difficulties after stroke (Stroke Association 2018) meaning they need to be able to ‘self-manage’.
  Supported self-management’ (SSM) is a term that is often used to describe the help and support that stroke survivors and their families are offered when they have been discharged from hospital.

  Research has shown that supporting people to ‘self-manage’ can be beneficial for helping stroke survivors and their families to cope with and ‘self-manage’ the lasting effects of their stroke and enjoy a good quality of life. However, the type and standard of the support available can vary depending on where people live. We don’t yet know how best to provide this support tailored to different parts of the UK that are geographically different or where people’s needs for support are different.

  AIM
  To understand what supported self-management in stroke is, what outcomes of self-management are important to different groups of people, and what makes it work well (or stops it working) in the delivery of community-based stroke services.

  METHODS
  We will conduct focus groups with clinicians, and interviews (audio-recorded) with stroke survivors and managers lasting approximately one hour, at four sites across Scotland (NHS Greater Glasgow and Clyde, NHS Highland, NHS Lanarkshire, and NHS Grampian) at two time points a few months apart to explore what works for whom and why for supported self-management in stroke.
  IMPLICATIONS
  The information we find in this new project will help to tell us how best to provide this support in different parts of Scotland, and the UK. This will mean that regardless of where people live, they are offered the same high standard of support to help them to self-manage and feel more in control and confident after their stroke.

  Summary of Results

  What we did:
  We carried out research on the way community and rehabilitation services offer supported self-management to people after they have had a stroke. We wanted to find out how people could best be supported to self-manage after a stroke. The purpose of the research was to improve the help and support available to people for self-managing after a stroke.

  How we did it:
  We spoke to people from across Scotland including:
   stroke survivors,
   stroke health professionals working in community, and
   stroke managers

  We used a method called Realist Evaluation. This method helped us to understand how supported self-management currently works (or doesn’t work) and what needs to happen or be in place to help make sure it meets people’s needs after a stroke.

  What we found:
  Our research had two main findings.
  Finding 1 was called ‘embedding the ethos of supported self-management’. This finding focussed on how to help health professionals understand what good supported self-management is. It also focussed on how to help them develop the confidence and skills to work with stroke survivors and families to address their needs.

  We found three strategies that can help with this:

  o Leaders and champions – who can offer inspiration and support to health professionals and help to spread the message that supporting self-management is important
  o Training for health professionals – which can help them to better understand what supported self-management is and how to deliver it well
  o Network of support amongst health professionals – which can help them to build confidence and support each other to try out different ways of working that can help with stroke survivors’ self-management

  These strategies work well when:
  o Health professionals know who to ask for help or advice with self-management within their teams or health boards, or elsewhere in Scotland
  o Health professionals feel confident about working in different ways to meet people’s needs
  o Stroke team leaders are passionate and compassionate with others and encourage and support their staff to try new things and work in different ways

  When this happens:
  o Health professionals are more likely to understand what self-management and supported self-management is
  o Health professionals are more likely to value the importance of supporting self-management and work with stroke survivors to address their personal priorities for self-management
  o Health professionals are given opportunities to develop their confidence and skills to work together with colleagues or with stroke survivors and families to help with people’s self-management.
  o Health professionals feel supported by their colleagues, leaders and managers to work in partnership with stroke survivors to address their priorities for self-management.

  Finding 2 was called building trust and confidence. This finding focussed on the relationship between health professionals and stroke survivors. In particular, it focussed on how trust and confidence can be developed so that support offered can be personalised to stroke survivors.

  The main strategy we found that helps to build trust and confidence for self-management is through meaningful conversations. Meaningful conversations are important because they offer an opportunity for:
  o Health professionals and stroke survivors to listen to and properly get to know each other, and to build a rapport with each other
  o Talking about what’s important to people in their self-management after a stroke and if and how they wish to become involved in self-management
  o Reflecting on goals and progress
  o A safe space where stroke survivors feel their ideas are valued and that they are encouraged to try out new things and to take the lead (when ready) in their self-management
  o Creating a sense of shared responsibility for self-management where stroke survivors know they are not on their own and have the support of health professionals

  Meaningful conversations work well when:
  o Health professionals understand what supported self-management is
  o Health professionals feel confident and supported by their colleagues, leaders and managers to work with stroke survivors in different ways to address their self-management priorities
  o Stroke survivors have insight into their self-management priorities and want to build their confidence and skills for self-management

  When this happens:
  o Stroke survivors and health professionals work together in partnership to support self-management
  o Stroke survivors feel confident in themselves and their self-management skills
  o Stroke survivors feel valued and motivated to self-manage
  o Stroke survivors have fewer unmet needs
  o Health professionals feel having meaningful conversations and working in partnership with stroke survivors is rewarding and beneficial for stroke survivors

  Implications for future:
  The findings from this project have helped us to understand more about how supported self-management works and what helps it work better or what stops it from working The findings will help us to develop recommendations to facilitate and sustain the provision of self-management approaches and services that are tailored to, and fit with, the needs of stroke survivors and their families in local areas.

• REC name

  East of Scotland Research Ethics Service REC 1

• REC reference

  19/ES/0055

• Date of REC Opinion

  31 May 2019

• REC opinion

  Favourable Opinion