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Open Access Research article

Promoting psychosocial wellbeing following stroke using narratives and guided self-determination: a feasibility study

Marit Kirkevold1*, Randi Martinsen2, Berit Arnesveen Bronken2 and Kari Kvigne2

Author Affiliations

1 Research Center for Habilitation and Rehabilitation Models and Services (CHARM) and Department of Nursing Science, Institute of health and Society, University of Oslo, P.O. Box 1153 Blindern, N-0318 Oslo, Norway

2 Department of Nursing and Mental Health, Hedmark University College, PO Box 400, 2418 Elverum, Norway

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BMC Psychology 2014, 2:4  doi:10.1186/2050-7283-2-4

Published: 3 February 2014

Abstract

Background

Extensive studies have documented the complex and comprehensive psychosocial consequences of stroke. Psychosocial difficulties significantly affect long-term functioning and quality of life. Many studies have explored psychosocial interventions to prevent or treat psychosocial problems, but most have found modest effects. This study evaluated, from the perspective of adult stroke survivors, (1) the content, structure and process and (2) experienced usefulness of a dialogue-based psychosocial nursing intervention in primary care aimed at promoting psychosocial health and wellbeing.

Methods

This was part of a feasibility study guided by the UK MRC complex interventions framework. It consisted of dialogue-based encounters with trained health professionals during approximately the first year poststroke. It was tested in two formats; individual or group encounters. Inclusion criteria were: Acute stroke, above 18 y.o., sufficient physical and cognitive functioning to participate. Data were collected immediately before, during and 14 days after the completion of the intervention. Pre- and post-data included medical and demographic data, quality of life, emotional wellbeing, life satisfaction, anxiety and depression. Qualitative interviews focusing on participant experiences were conducted two weeks following the intervention. Log notes taken by the health professionals conducting the intervention and work sheets filled in by participants also comprised data. Data analysis was case-oriented. The structured instruments were analysed regarding completeness of data and indication of changes in outcome variables. The qualitative interviews, log notes and work sheets were analysed using thematic content analysis.

Results

Twenty-five stroke survivors (17 men, 8 women), median age 64 (range 33–89), participated. Physical limitations varied from mild to severe. Seven participants had moderate to severe expressive aphasia. The participants found the content and process of the intervention relevant. Both the individual and group formats were found useful. Patients with aphasia reported that there were too few encounters (eight encounters were originally planned). The participants underscored the benefits of being supported through a difficult time, having a chance to tell and (re)create their story and being supported in their attempts to cope with the situation.

Conclusions

This study provides initial support for the usefulness of the psychosocial intervention and highlights areas requiring further consideration and development.

Trial registration number

ClinicalTrials.gov Identifier: NCT01912014

Keywords:
Complex intervention; Nursing intervention development; Psychosocial wellbeing; Stroke; Feasibility study; Multiple case study; Narrative; Quality of life; Patient-centred; Goal-setting