Changing self-efficacy in individuals following a first time stroke: preliminary study of a novel self-management intervention

Abstract

Objective: To examine the effects of a self-management workbook intervention designed for use with individuals disabled after first time stroke.

Design: Multiple-participant two-phase (baseline followed by treatment) single subject design. The intervention was introduced at a randomly generated time-point.

Setting: Community.

Subjects: Seven men and three women, with a mean age of 61.5 years (SD 8.15), on average 24.2 weeks (SD 18.29) following first stroke, all with residual restriction of activity and participation.

Intervention: An individualized self-management workbook based on self-efficacy principles, incorporating sections to increase mastery, vicarious experience and feedback.

Main measures: Stroke Self-Efficacy Questionnaire, General Self-Efficacy Scale, Recovery Locus of Control Scale, Rivermead Mobility Index, Rivermead Activities of Daily Living Scale, Subjective Index of Physical and Social Outcome and the Hospital Anxiety and Depression Scale. Individual data were analysed with weighted mean trend test and two standard deviation band test. Group data were analysed with a randomization test.

Results: Visual inspection of the data over the 14-week period showed steady improvement for all of the 10 participants on the majority of variables. A randomization test indicated a statistically significant change in Stroke Self-Efficacy Questionnaire scores and Recovery Locus of Control Scale scores which followed introduction of the intervention. Measures of activity, participation and mood scores did not show a statistically significant change.

Conclusion: There is preliminary evidence that the use of an individualized stroke self-management intervention is acceptable and can lead to a change in self-efficacy in this small sample.

Get full access to this article

View all access options for this article.

References

Department of Heanth/Vascular Programme/ Stroke. A new ambition for stroke: a consultation on a national strategy. London, Department of Health, 2007 .

Norris S. , Engelgau M. , Narayan K. Effectiveness of self-management training in type 2 diabetes: a systematic review of randomised controlled trials. Diabetes Care 2001; 24: 561-87.

Monninkhof E. , van der Valk P. , van der Palen J. , van Herwaarden C. , Zielhuis G. Effects of a comprehensive self-management programme in patients with COPD. Eur Respir J 2003; 22: 815-20.

Barlow J. , Sturt J. , Hearnshaw H. Self-management interventions for people with chronic conditions in primary care: examples from arthritis, asthma and diabetes. Health Educ J 2002; 61: 365-78.

Dowswell G. , Lawler J. , Dowswell T. , Young J. , Forster A. , Hearn J. Investigating recovery from stroke: a qualitative study. J Clin Nurs 2000; 9: 507-15.

Cox E. , Dooley A. , Liston M. , Miller M. Coping with stroke: Perceptions of elderly who have experienced stroke and rehabilitation interventions. Top Stroke Rehabil 1998; 4: 76-88.

Pound P. , Gompertz P. , Ebrahim S. Social and practical strategies used by people living with stroke. Health Soc Care Community 1999; 7: 120-28.

Lorig K. , Holman H. Self-management education: history, definition, outcomes and mechanisms. Ann Behav Med 2003; 26: 1-7.

Holman H. , Lorig K. Patient self-management: A key to effectiveness and efficiency in care of chronic disease. Public Health Rep 2004; 119: 239-43.

10.

Bandura A. Human agency in social cognition theory. Am Psychol 1989; 44: 1175-84.

11.

Bandura A. The nature and structure of self-efficacy. In Bandura A. ed. Self-efficacy: the exercise of control. New York, WH Freeman and Company, 1997.

12.

LeBrasseur N. , Sayers S. , Oullette M. , Fielding R. Muscle impairments and behavioural factors mediate functional limitations and disability following stroke. Phys Ther 2006; 86: 1342-50.

13.

Robinson-Smith G. , Johnston M. , Allen J. Self-care self-efficacy, quality of life, and depression after stroke. Arch Phys Med Rehabil 2000; 81: 460-65.

14.

Hellstrom K. , Lindmark B. , Wahlberg B. , Fugl-Meyer A. Self-efficacy in relation to impairments and activities of daily living in elderly patients with stroke: a prospective investigation. J Rehabil Med 2003; 35: 202-07.

15.

Jones F. , Mandy A. , Partridge C. Reasons for recovery after stroke: a perspective based on personal experiences . Disabil Rehabil 2007; 28: 841-47.

16.

Kwakkel G. , Kollen B. , Lindeman E. Understanding the pattern of functional recovery after stroke: facts and theories . Restorative Neurol Neurosci 2004; 22: 281-99.

17.

Todman J. , Dugard P. Single-case and small-n experimental designs: a practical guide to randomisation tests. New Jersey, Lawrence Erlbaum Associates, 2001.

18.

Bland M. Directory of randomisation software and services. Accessed 27 October 2008, from www.users.york.ac.uk/∼mb55/guide/randsery.htm

19.

Schwartzer R. , Jerusalem M. Causal and control beliefs: the generalised self-efficacy scale. In Weinman J , Wright S , Johnston M. eds. Measures in health psychology: a user's portfolio. Windsor, NFER-Nelson, 1995, 35-37.

20.

Partridge C. , Johnston M. Perceived control of recovery from physical disability: measurement and prediction. Br J Clin Psychol 1989; 28: 53-59.

21.

Jones F. , Reid F. , Partridge C. The Stroke Self-Efficacy Questionnaire (SSEQ): measuring individual confidence in functional performance after stroke. J Nurs Healthcare Chronic Illness 2008; 17: 244-52.

22.

Jones F, Partridge C, Mandy A, Reid F. eds. Towards a new measurement of self-efficacy following stroke. Paper presented at the British Geriatric Society Conference, Harrogate , 2004.

23.

Collen F. , Wade D. , Robb G. , Bradshaw C. The Rivermead Mobility Index: A further development of the Rivermead Motor Assessment. Int Disabil Stud 1991; 13: 50-54.

24.

Whiting S. , Lincoln N. An ADL assessment for stroke patients. Br J Occup Ther 1980; 43: 44-46.

25.

Trigg R. , Wood V. The subjective index of physical and social outcome: A new measure for the use with stroke patients. Clin Rehabil 2000 ; 14: 288-99.

26.

Zigmond A. , Snaith R. The Hospital Anxiety and Depression scale. Acta Psychiatr Scand 1983; 67: 361-70.

27.

Nugent W. Single Case Design Visual Analysis Procedures for use in Practice Evaluation . J Soc Serv Pract 2000; 27: 39-75.

28.

Kasdin A. Single-case research designs: methods for clinical and applied settings. New York, Oxford University Press, 1982.

29.

Nourbakhsh M. , Ottenbacher K. The statistical analysis of single-subject data: A comparative examination. Phys Ther 1994; 74: 768-76.

30.

Morrison V. , Johnston M. , MacWalter R. Predictors of distress following an acute stroke: disability, control cognitions, and satisfaction with care. Psychol Health 2000; 15: 395-407.

31.

Kendall E. , Catalano T. , Kuipers P. , Posner N. , Buys N. , Charker J. Recovery following stroke: the role of self-management education. Soc Sci Med 2007; 64: 735-46.

32.

Johnston M. , Bonetti D. , Joice S. et al. Recovery from disability after stroke as a target for a behavioural intervention: results of a randomized controlled trial. Disabil Rehabil 2007; 29: 1117-27.

33.

Fisher K. , Johnston M. Experimental manipulation of perceived control and its effect on disability . Psychol Health 1996; 11: 657-69.

34.

Schreurs K. , Colland V. , Kuijer R. , de Ridder D. , van Elderen T. Development, content, and process evaluation of a short self-management intervention in patients with chronic diseases requiring self-care behaviours. Patient Educ Counsel 2003; 51: 133-41.