[ARTICLE] Process evaluation of the Restore4stroke Self-Management intervention ‘Plan Ahead!’: a stroke-specific self-management intervention – Full Text

Self-management can be defined as a person’s abilities to manage the consequences of a condition and its impact on daily life.1 Most stroke-specific self-management interventions aim either to adjust the participants’ goals or self-efficacy, or to teach reactive strategies for dealing with stroke-related problems only after the problem has occurred.29 Nevertheless, in practice, patients often fail to achieve their goals, hindered by unexpected stroke consequences such as fatigue.10 Therefore, it seems worthwhile to teach both stroke patients and their partners to anticipate potential barriers during the process of goal-setting. This allows the patients and their partners to think of potential solutions to these barriers before undertaking an activity.

Within the Restore4Stroke programme, we developed a stroke-specific self-management intervention named ‘Plan ahead!’ to enhance stroke patients’ and their partners’ participation in vocational, leisure and social activities by teaching them proactive coping strategies.11 The effectiveness of this intervention has been evaluated in a randomized controlled trial.12,13 As many processes influence the outcomes of such trials, it is important to conduct a process evaluation to reveal factors influencing outcomes, providing a correct interpretation and explanation of the intervention effects.1416 Moreover, such insights provide opportunities to facilitate intervention implementation.17

A process evaluation is a method that enables researchers to look into the black-box of processes underlying the outcomes of a clinical trial.16 Such a process can provide information about the factors influencing the effectiveness of an intervention,14,15 the internal and external validity of the trial17 and the experiences of healthcare professionals and participants exposed to the intervention.15 Such information can be useful for duplicating the study or comparing it with other studies.14,15 Moreover, the information provides opportunities for better implementation or improvement of the intervention.17

In this article, we present the outcomes of our process evaluation, which was performed alongside the Restore4Stroke Self-Management trial. In this evaluation, we investigated the degree to which the intervention was implemented as intended, as well as the involvement and satisfaction of the target audience (i.e. patients, partners and therapists). The study was based on the following elements of the process evaluation framework proposed by Saunders et al.:18 (1) reach (i.e. the proportion of target audience that participates in the intervention), (2) dose delivered (i.e. the extent to which the intervention components were delivered to the participants), (3) dose received in terms of exposure (i.e. the extent to which the participants actively engage in the intervention), (4) dose received in terms of satisfaction (i.e. the participants’ and the therapists’ satisfaction with the intervention), and (5) recruitment (i.e. procedures to approach the participants and ensure the participants’ continued participation in the intervention).

Continue —> Process evaluation of the Restore4stroke Self-Management intervention ‘Plan Ahead!’: a stroke-specific self-management interventionClinical Rehabilitation – Nienke S Tielemans, Vera PM Schepers, Johanna MA Visser-Meily, Jolanda CM van Haastregt, Wendy JM van Veen, Haike E van Stralen, Caroline M van Heugten, 2016

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