Implementing and evaluating the bridges stroke self-management programme into a new zealand district health board stroke service: a case study

Abstract

The impact of stroke is lifelong; affecting independence and quality of life. Stroke survivors need support to manage their recovery. The Bridges stroke self-management approach (Bridges) empowers stroke survivors and facilitates self-management within usual rehabilitation. We implemented Bridges into a New Zealand stroke service, aiming to identify context-specific delivery factors and long-term sustainability strategies. Using a case study design, data were collected from multiple sources, including meeting and training notes, researcher observations, workshop evaluations, and in-depth semi-structured interviews (n = 7). Data were compared for congruency or disparity, and integrated to develop a comprehensive case description. Overall, 69 health professionals were trained. Collectively, the data found Bridges to be conceptually acceptable and contextually appropriate, raising awareness of self-management support across the service. Identified key factors that would assist with the implementation of this new intervention, including the need for time and sustained support for staff; an initial small, contained inter-professional team; ongoing communication to staff by managers about their expectations and endorsement of the intervention; and staff “champions”, requiring training, resources, and managerial support. Whilst staff may value Bridges, they needed time and the opportunity to develop knowledge, skills, and self-efficacy to support patient self-management.