Open Access Open Access  Restricted Access Subscription Access

How can we train stroke practitioners about patient self-management? Description and evaluation of a pathway wide training programme

Fiona Jones, Nicola Bailey


Objectives: This paper describes the evaluation of pathway-wide training for practitioners in a stroke self-management programme (SSMP). The Bridges SSMP teaches professionals to facilitate self-management skills in stroke survivors, using an individualised workbook. This was the first time professionals working throughout the stroke pathway received training together. The mixed-methods evaluation focused on the impact of Bridges training and the experiences of health and social care practitioners using the programme within the stroke pathway. It was informed by Normalisation Process Theory and Realist Evaluation. This paper discusses the need for a whole systems approach to stroke self-management, considering the patient, professional and organisational context to ensure sustainability in the longer term.

Method: Semi-structured interviews were carried out with stroke practitioners before and after training, exploring their experiences of the stroke pathway, perceptions of self-management and experiences using Bridges. Content thematic analysis was used to categorise recurrent and common themes in the data. Questionnaires were completed before and after training, to evaluate participants’ change in beliefs, knowledge and practice of self-management.

Results: Analysis of qualitative interviews and questionnaires revealed that participants were generally positive about Bridges. However, they reported specific challenges in delivering an SMP to stroke patients, which necessitated adaptations to their everyday practice and flexibility in strategies used. The majority of participants felt their practice had changed following the training and they were more mindful of using patient-led approaches.

Conclusions: Evaluation revealed a number of positive findings and ideas for promoting sustainability of the SSMP in the longer term of direct relevance to patient self-management.

Full Text:



Lee, S., Shafe, A. & Cowie, M. (2011). UK stroke incidence, mortality and cardiovascular risk management 199-2008: time trend analysis from the General Practice Research Database. British Medical Journal Open 1 (2) 1-8.

McKevitt, C., Fudge, N., Redfern, J., Sheldenkar, A., Crichton, S., Rudd, A.R., Forster, A., Young, J., Nazareth, I., Silver, L.E., Rothwell, P.M. & Wolfe, C.D. (2011). Self-reported long-term needs after stroke. Stroke 42, 1398-1403.

Rittman, M., Boylstein, C., Hinojosa, R., Hinojosa, M.S. & Haun, J. (2007). Transition experiences of stroke survivors following discharge home. Topics in Stroke Rehabilitation 14 (2) 21-31.

Kendall, E., Catalano, T., Kuipers, P., Posner, N., Buys, N. & Charker, J. (2007). Recovery following stroke: the role of self-management education. Social Science and Medicine 64, 735-746.

Jones, F. & Lennon, S. (2009). A new stroke self-management programme: preliminary analysis of training for practitioners. International Journal of Stroke 4 (Supplement 2) 23.

Huijbregts, M.P.J., McEwen, S. & Taylor, D. (2009). Exploring the feasibility and efficacy of a telehealth stroke self-management programme: a pilot study. Physiotherapy Canada 61 (4) 210-220.

Hardeman, W. & Mitchie, S. (2009). Training and quality assurance of self-management interventions. In: Chronic physical illness: self-management and behavioral interventions, pp. 98-120. Newman, S., Steed, L. & Mulligan, K., eds. Berkshire: Open University Press.

de Silva, D. (2011). Helping people help themselves: A review of the evidence considering whether it is worthwhile to support self-management. London: The Health Foundation.

Imison, C., Naylor, C., Goodwin, N., Buck, D., Curry, N., Addicott, R. & Zollinger-Read, P. (2011). Transforming our health care system: Ten priorities for commissioners. London: The Kings Fund.

Department of Health. (2012). Long Term Conditions Compendium of Information: Third Edition. London: Department of Health.

Kennedy, A., Rogers, A. & Bower, P. (2007). Support for self care for patients with chronic disease. British Medical Journal 335, 968-970.

Lawn, S. & Schoo, A. (2010). Supporting self-management of chronic health conditions: Common approaches. Patient Education and Counseling 80, 205-211.

Lawn, S., McMillan, J. & Pulvirenti, M. (2011). Chronic condition self-management: expectations of responsibility. Patient Education and Counseling 84, e5-8.

Lake, A. & Staiger, P. (2010). Seeking the views of health professionals on translating chronic disease self-management models into practice. Patient Education and Counseling 79 (1) 62-68.

Intercollegiate Stroke Working Party. (2010). National Sentinel Stroke Clinical Audit Round 7. London: Royal College of Physicians.

Levack, W., Dean, S.G., Siegert, R.J. & McPherson, K. (2011). Navigating patient-centred goal setting in inpatient stroke rehabilitation: How clinicians control the process to meet perceived professional responsibilities. Patient Education and Counseling 85 (2) 206-213.

Jones, F., Livingstone, E. & Hawkes, L. (2012). 'Getting the balance between encouragement and taking over'- reflections on using a new stroke self-management programme. Physiotherapy Research International doi: 10.1002/pri.1531.

National Institute for Health and Clinical Excellence. (2010). Quality Standard for Stroke. Available from: guidance/ qualitystandards/stroke/strokequalitystandard.jsp.

McKenna, S., Jones, F., Glenfield, P. & Lennon, S. (2011). “Bridges” – Promoting self-management for stroke survivors in the community: A feasibility randomised controlled trial. International Journal of Stroke 6 (Supplement 2) 50.

Jones, F., Mandy, A. & Partridge, C. (2009). Changing self-efficacy in individuals following first stroke: preliminary study of a novel self-management intervention. Clinical Rehabilitation 23 (6) 522-533.

Skills for Care Skills for Health. (2008). Common Core Principles to Support Self-care:a guide to support implementation. London: DH Publications.

Healthcare for London. (2008). Stroke Strategy for London. London: NHS.

Intercollegiate Stroke Working Party. (2012). National Sentinel Stroke Clinical Audit 2010,Round 7, Public Report for England, Wales and Northern Ireland.

Corben, S. & Rosen, R. (2005). Self-management for long-term conditions: Patients' perspectives on the way ahead. London: Kings Fund.

Coulter, A. & Ellins, J. (2006). QEI Review: patient-focused interventions. Chapter 3 Improving self-care, pp.85-142.London: The Health Foundation.

Newman, S., Steed, L. & Mulligan, K. (2009). Chronic Physical Illness: Self-management and Behavioural Interventions. Berkshire: Open University Press.

Kielman, T., Huby, G., Powell, A., Sheikh, A., Price, D., Williams, S. & Pinnock, H. (2010). From support to boundary: a qualitative study of the border between self-care and professional care. Patient Education and Counseling 79, 55-61.

May, C., Finch, T., Mair, F., Ballini, L., Dowrick, C. & Eccles, M. (2007). Understanding the implementation of complex interventions in health care: the normalization process model. BMC Health Services Research 19, 148.

Pawson, R., Greenhalgh, T., Harvey, G. & Walshe, K. (2004). Realist synthesis: an introduction Manchester: ESRC Research Methods Programme. University of Manchester.

Care Quality Commission. (2011). Supporting life after stroke: A review of services for people who have had a stroke and their carers. London: Care Quality Commission.

Kennedy, A., Rogers, A. & Gately, C. (2005). From patients to providers: prospects for self-care skills trainers in the National Health Service. Health & Social Care in the Community 13, 431-440.

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

Wade, D.T, Langton-Hewer, R.L, David R.M. & Enderby, P.M. (1986). Aphasia after stroke: Natural history and associated deficits. Journal of Neurology, Neurosurgery and Psychiatry 49 (1) 11-16.

Redmond, B. (2004). Reflection in action: Developing reflective practice in health and social services. Hants, England: Asgate.



  • There are currently no refbacks.