A qualitative study of sedentary behaviours in stroke survivors: non-participant observations and interviews with stroke service staff in stroke units and community services

Abstract Background: Stroke survivors are more sedentary than healthy, age-matched controls, independent of functional capacity. Interventions are needed to encourage a reduction in overall sedentary time, and regular breaks in prolonged periods of sedentary behaviour. This study captured the views and experiences of stroke survivors and their caregivers related to sedentary behaviour after stroke, to inform the development of an intervention to reduce sedentary behaviour.Methods: Mixed-methods qualitative study. Non-participant observations were completed in two stroke services, inclusive of inpatient and community settings in the United Kingdom. Semi-structured interviews were conducted with stroke survivors and their caregivers (if available) at six- or nine-months post-stroke. Underpinned by the capability, opportunity and motivation (COM-B) model of behaviour change, observational data (132 hours) were analysed thematically and interview data (n=31 stroke survivors, n=12 caregivers) were analysed using the Framework approach.Findings: Observation participants differed in functional ability whereas stroke survivor interviewees were all ambulant. Six themes related to sedentary behaviour after stroke were generated: (1) sedentary behaviour levels and patterns after stroke; (2) the physical and social environment in the stroke service and in the home; (3) standing and movement capability after stroke; (4) emotion and motivation after stroke; (5) caregivers’ influence on, and role in influencing stroke survivors’ sedentary behaviour; and (6) intervening to reduce sedentary behaviour after stroke. Capability, opportunity and motivation were influenced by the impact of the stroke and caregivers’ inclination to support sedentary behaviour reduction. Stroke survivors reported being more sedentary than they were pre-stroke due to impaired balance and co-ordination, increased fatigue, and reduced confidence in mobilising. Caregivers inclination to support stroke survivors to reduce sedentary behaviour depended on factors including their willingness to withdraw from the caregiver role, and their perception of whether the stroke survivor would act on their encouragement. Conclusions: Many stroke survivors indicate being open to reducing sedentary behaviour, with appropriate support from stroke service staff and caregivers. The findings from this study have contributed to an intervention development process using the Behaviour Change Wheel (BCW) approach to develop strategies to reduce sedentary behaviour after stroke.

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Factors influencing sedentary behaviours after stroke: findings from qualitative observations and interviews with stroke survivors and their caregivers

10.21203/rs.2.17808/v1 ◽

2019 ◽

Author(s):

Jennifer Hall ◽

Sarah Morton ◽

Claire F Fitzsimons ◽

Jessica Faye Hall ◽

Rekesh Corepal ◽

...

Keyword(s):

Sedentary Behaviour ◽

Behaviour Change ◽

Intervention Development ◽

Stroke Survivor ◽

Stroke Survivors ◽

Structured Interviews ◽

Stroke Service ◽

Service Staff ◽

Framework Approach ◽

The Impact

Abstract Background: Stroke survivors are highly sedentary. Interventions are needed to encourage a reduction in overall sedentary time, and regular breaks in prolonged periods of sedentary behaviour. This study captured the views and experiences of stroke survivors and their caregivers related to sedentary behaviour after stroke, to inform the development of an intervention to reduce sedentary behaviour. Methods: Mixed-methods qualitative study. Non-participant observations were completed in two stroke services, inclusive of inpatient and community settings in the United Kingdom. Semi-structured interviews were conducted with stroke survivors and their caregivers (if available) at six- or nine-months post-stroke. Underpinned by the capability, opportunity and motivation (COM-B) model of behaviour change, observational data (132 hours) were analysed thematically and interview data (n=31 stroke survivors, n=12 caregivers) were analysed using the Framework approach. Findings: Six themes related to sedentary behaviour after stroke were generated: (1) sedentary behaviour levels and patterns after stroke; (2) the physical and social environment in the stroke service and in the home; (3) standing and movement capability after stroke; (4) emotion and motivation after stroke; (5) caregivers’ influence on, and role in influencing stroke survivors’ sedentary behaviour; and (6) intervening to reduce sedentary behaviour after stroke. Capability, opportunity and motivation were influenced by the impact of the stroke and caregivers’ inclination to support sedentary behaviour reduction. Stroke survivors reported being more sedentary than they were pre-stroke due to impaired balance and co-ordination, increased fatigue, and reduced confidence in mobilising. Caregivers inclination to support stroke survivors to reduce sedentary behaviour depended on factors including their willingness to withdraw from the caregiver role, and their perception of whether the stroke survivor would act on their encouragement. Conclusions: Many stroke survivors indicate being open to reducing sedentary behaviour, with appropriate support from stroke service staff and caregivers. The findings from this study have contributed to an intervention development process using the Behaviour Change Wheel (BCW) approach [1] to develop strategies to reduce sedentary behaviour after stroke.

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Psychometric evaluation of a newly developed measure of emotionalism after stroke (TEARS-Q)

Clinical Rehabilitation ◽

10.1177/0269215520981727 ◽

2020 ◽

pp. 026921552098172

Author(s):

Niall M Broomfield ◽

Robert West ◽

Allan House ◽

Theresa Munyombwe ◽

Mark Barber ◽

...

Keyword(s):

Item Response ◽

Psychometric Evaluation ◽

Self Report ◽

Stroke Survivors ◽

Reference Standard ◽

Stroke Units ◽

Post Stroke ◽

Response Variance ◽

Mild Stroke ◽

Functional Outcome Measures

Objective: To evaluate, psychometrically, a new measure of tearful emotionalism following stroke: Testing Emotionalism After Recent Stroke – Questionnaire (TEARS-Q). Setting: Acute stroke units based in nine Scottish hospitals, in the context of a longitudinal cohort study of post-stroke emotionalism. Subjects: A total of 224 clinically diagnosed stroke survivors recruited between October 1st 2015 and September 30th 2018, within 2 weeks of their stroke. Measures: The measure was the self-report questionnaire TEARS-Q, constructed based on post-stroke tearful emotionalism diagnostic criteria: (i) increased tearfulness, (ii) crying comes on suddenly, with no warning (iii) crying not under usual social control and (iv) crying episodes occur at least once weekly. The reference standard was presence/absence of emotionalism on a diagnostic, semi-structured post-stroke emotionalism interview, administered at the same assessment point. Stroke, mood, cognition and functional outcome measures were also completed by the subjects. Results: A total of 97 subjects were female, with a mean age 65.1 years. 205 subjects had sustained ischaemic stroke. 61 subjects were classified as mild stroke. TEARS-Q was internally consistent (Cronbach’s alpha 0.87). TEARS-Q scores readily discriminated the two groups, with a mean difference of −7.18, 95% CI (−8.07 to −6.29). A cut off score of 2 on TEARS-Q correctly identified 53 of the 61 stroke survivors with tearful emotionalism and 140 of the 156 stroke survivors without tearful emotionalism. One factor accounted for 57% of the item response variance, and all eight TEARS-Q items acceptably discriminated underlying emotionalism. Conclusion: TEARS-Q accurately diagnoses tearful emotionalism after stroke.

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Qualitative study of Stroke Survivors’ Perceptions of Secondary Prevention

Journal of Advanced Nursing ◽

10.1111/jan.15079 ◽

2021 ◽

Author(s):

Beilei Lin ◽

Zhenxiang Zhang ◽

Amanda G. Thrift ◽

Wenna Wang ◽

Yongxia Mei ◽

...

Keyword(s):

Qualitative Study ◽

Secondary Prevention ◽

Stroke Survivors

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A qualitative study using the Theoretical Domains Framework to investigate why patients were or were not assessed for rehabilitation after stroke

Clinical Rehabilitation ◽

10.1177/0269215516658938 ◽

2016 ◽

Vol 31 (7) ◽

pp. 966-977 ◽

Cited By ~ 6

Author(s):

Elizabeth A Lynch ◽

Julie A Luker ◽

Dominique A Cadilhac ◽

Caroline E Fryer ◽

Susan L Hillier

Keyword(s):

Qualitative Study ◽

Acute Stroke ◽

Health Professionals ◽

Assessment Tool ◽

Theoretical Domains Framework ◽

Assessment Practices ◽

Stroke Units ◽

Changing Practice ◽

Referral Practices ◽

Rehabilitation Assessment

Objective: To explore the factors perceived to affect rehabilitation assessment and referral practices for patients with stroke. Design: Qualitative study using data from focus groups analysed thematically and then mapped to the Theoretical Domains Framework. Setting: Eight acute stroke units in two states of Australia. Subjects: Health professionals working in acute stroke units. Interventions: Health professionals at all sites had participated in interventions to improve rehabilitation assessment and referral practices, which included provision of copies of an evidence-based decision-making rehabilitation Assessment Tool and pathway. Results: Eight focus groups were conducted (32 total participants). Reported rehabilitation assessment and referral practices varied markedly between units. Continence and mood were not routinely assessed (4 units), and people with stroke symptoms were not consistently referred to rehabilitation (4 units). Key factors influencing practice were identified and included whether health professionals perceived that use of the Assessment Tool would improve rehabilitation assessment practices (theoretical domain ‘social and professional role’); beliefs about outcomes from changing practice such as increased equity for patients or conversely that changing rehabilitation referral patterns would not affect access to rehabilitation (‘belief about consequences’); the influence of the unit’s relationships with other groups including rehabilitation teams (‘social influences’ domain) and understanding within the acute stroke unit team of the purpose of changing assessment practices (‘knowledge’ domain). Conclusion: This study has identified that health professionals’ perceived roles, beliefs about consequences from changing practice and relationships with rehabilitation service providers were perceived to influence rehabilitation assessment and referral practices on Australian acute stroke units.

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Provision of palliative and end-of-life care in stroke units: A qualitative study

Palliative Medicine ◽

10.1177/0269216313483846 ◽

2013 ◽

Vol 27 (9) ◽

pp. 855-860 ◽

Cited By ~ 15

Author(s):

Clare Gardiner ◽

Madeleine Harrison ◽

Tony Ryan ◽

Amanda Jones

Keyword(s):

Qualitative Study ◽

End Of Life ◽

End Of Life Care ◽

Life Care ◽

Stroke Units

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Perceptions of self-rated health among stroke survivors: a qualitative study in the United Kingdom

BMC Geriatrics ◽

10.1186/s12877-018-0765-8 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 6

Author(s):

N. Mavaddat ◽

E. Sadler ◽

L. Lim ◽

K. Williams ◽

E. Warburton ◽

...

Keyword(s):

United Kingdom ◽

Qualitative Study ◽

Stroke Survivors ◽

Self Rated Health ◽

The United Kingdom

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Experience of family caregivers of community-dwelling stroke survivors and risk of elder abuse: a qualitative study

The Journal of Adult Protection ◽

10.1108/jap-03-2014-0007 ◽

2014 ◽

Vol 16 (5) ◽

pp. 276-293 ◽

Cited By ~ 7

Author(s):

Celia Chow ◽

Agnes Tiwari

Keyword(s):

Qualitative Study ◽

Family Caregivers ◽

Local Community ◽

Service Providers ◽

Elder Abuse ◽

Community Dwelling ◽

Stroke Survivors ◽

Content Type ◽

The Disabled ◽

Personal Resilience

Purpose – The purpose of this paper is to explore the following questions. First, what are the experiences of family caregivers in caring for community-dwelling stroke survivors? Second, what services help or do not help the caregivers in managing their caregiving role? Design/methodology/approach – A qualitative study was conducted with a total of six focus group interviews with 29 stroke caregivers selected using convenience sampling in a local community centre. All interviews were recorded and transcribed for content analysis. Findings – The results pointed to three main themes working together to facilitate desirable outcomes in caregiving and prevent elder abuse: factors contributing to caregiver stress and factors that have a buffering effect on caregiver stress and unmet needs identified from caregivers’ experiences. Research limitations/implications – The authors found that there were a number of factors contributing to caregiver stress. The findings matched with the concept that caregiver stress should not be considered as the primary cause of elder abuse. Findings provided information for further research to investigate positive coping and adjustment for stroke survivors, caregivers and their families. Practical implications – Policy makers and service providers may consider specific policies and tailor-made services to enhance the effectiveness of current practice. The themes emerging from the study could be further reviewed in a longitudinal way to explore the cost-effectiveness, the outcomes and trajectory of interventional programmes. Social implications – Education would be essential to let the public understand caregivers’ difficulties and needs. Prevention of elder abuse may be approached with a range of risk factors for both perpetrating and being elder abuse victim. Originality/value – From the findings of the study, the authors found that there were service gaps within policy and interventions. Concrete suggestions for improving the public's attitude and public facilities/transport for the disabled were captured in the study. In addition to personal resilience, caregivers had a strong wish for a supportive environment and services that would facilitate a better caregiving outcome.

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COPING STRATEGIES BY STROKE CAREGIVERS: EVIDENCE FROM A QUALITATIVE STUDY IN SARAWAK, MALAYSIA

Malaysian Journal of Public Health Medicine ◽

10.37268/mjphm/vol.20/no.1/art.550 ◽

2020 ◽

Vol 20 (1) ◽

pp. 48-54

Author(s):

Md Mizanur Rahman ◽

Zabidah binti Putit ◽

Norliza binti Suut ◽

Mohamad Taha Arif ◽

Asri bin Said ◽

...

Keyword(s):

Qualitative Study ◽

Coping Strategies ◽

Qualitative Data ◽

Service Providers ◽

Stroke Survivor ◽

Stroke Survivors ◽

Rehabilitation Centre ◽

Emotion Suppression ◽

Self Blame ◽

Community Rehabilitation

Caring for stroke survivors is inevitably a burden to caregivers. It is not uncommon for stroke survivors who are discharged from the hospital and found themselves at home without any help and care from the supposed caregivers. However, in instances where there are available and willing caregivers, a sudden and unpredictable task of caring for stroke survivors require the stroke caregivers to apply their coping strategies due to the demanding nature of looking after a survivor. This study aimed to determine coping strategies undertaken by stroke caregivers in caring for stroke survivors. This was an exploratory qualitative study and data was collected from the caregivers of stroke survivor using a semi-structured guided questionnaire. A total of 18 caregivers were included in the study. The data were collected from November 2015 until June 2016 at a selected community rehabilitation centre in Kuching, Sarawak. The qualitative data analysis revealed that the coping strategies undertaken by stroke caregivers include change of role in life, self-motivation, sharing with other people, crying, trying to forget things that happen, hoping survivors will get better, emotion suppression and self-blame. The study highlighted the experiences by the caregivers for caring for stroke patients and focused on the coping strategies undertaken by the caregivers. Better ununderstanding of these experiences does help the service providers to provide better support and resources for caregivers in caring for stroke survivors.

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A co-production approach guided by the Behaviour Change Wheel to develop an intervention for reducing sedentary behaviour after stroke

10.21203/rs.3.rs-17919/v2 ◽

2020 ◽

Author(s):

Jennifer Hall ◽

Sarah Morton ◽

Jessica Hall ◽

David J Clarke ◽

Claire F Fitzsimons ◽

...

Keyword(s):

Sedentary Behaviour ◽

Behaviour Change ◽

Intervention Development ◽

Inpatient Setting ◽

Stroke Survivors ◽

Behaviour Change Wheel ◽

Target Behaviour ◽

Service Staff ◽

Stroke Services ◽

Production Approach

Abstract Background: Stroke survivors are highly sedentary; thus, breaking up long uninterrupted bouts of sedentary behaviour could have substantial health benefit. However, there are no intervention strategies specifically aimed at reducing sedentary behaviour tailored for stroke survivors. The purpose of this study was to use co-production approaches to develop an intervention to reduce sedentary behaviour after stroke.Methods: A series of five co-production workshops with stroke survivors, their caregivers, stroke service staff, exercise professionals, and researchers were conducted in parallel in two stroke services (England and Scotland). Workshop format was informed by the Behaviour Change Wheel (BCW) framework for developing interventions and incorporated systematic review and empirical evidence. Taking an iterative approach, data from activities and audio recordings were analysed following each workshop and findings used to inform subsequent workshops, to inform both the activities of the next workshop and ongoing intervention development.Findings: Co-production workshop participants (n = 43) included 17 staff, 14 stroke survivors, six caregivers, and six researchers. The target behaviour for stroke survivors is to increase standing and moving, and the target behaviour for caregivers and staff is to support and encourage stroke survivors to increase standing and moving. The developed intervention is primarily based on co-produced solutions to barriers to achieving the target behaviour. The developed intervention includes 34 behaviour change techniques. The intervention is to be delivered through stroke services, commencing in the inpatient setting and following through discharge into the community. Participants reported that taking part in intervention development was a positive experience. Conclusions: To our knowledge, this is the first study that has combined the use of co-production and the BCW to develop an intervention for use in stroke care. In-depth reporting of how a co-production approach was combined with the BCW framework, including the design of bespoke materials for workshop activities, should prove useful to other researchers and practitioners involved in intervention development in stroke.

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