Designing a self-management intervention for stroke survivors with communication difficulties.

Background: Stroke survivors with communication difficulties have poor outcome in the longer-term and may benefit from the support typically offered by self-management approaches. Aim: To critically examine the suitability of self-management as an approach for stroke survivors with communication difficulties and to use this knowledge to design an intervention to support stroke survivors with communication difficulties in the longer-term. Methods: Medical Research Council guidance for the development of complex interventions provided a framework for designing the intervention (MRC, 2008). In line with this guidance the intervention was designed iteratively using a staged approach. The design of the intervention was informed by a mixed methods systematic literature review and qualitative fieldwork undertaken with key stakeholders (stroke survivors with communication difficulties, carers and speech and language therapists). The Behaviour Change Wheel (BCW) provided a theoretical framework to identify which behaviours the intervention should target and appropriate behaviour change techniques. A Delphi survey was conducted to gain an expert consensus on the design of the intervention. Results: Stroke survivors with communication difficulties need further support to manage the consequences of their condition in the longer-term. Self-management may provide a structured and clearly defined intervention to support this group of stroke survivors with the challenges they face. However, existing self-management interventions do not address the needs of stroke survivors with communication difficulties and a condition specific self-management intervention is required. A novel self-management intervention for stroke survivors with communication difficulties was designed using the BCW as a theoretical framework. Feedback from an expert panel was used to refine the design of the intervention. Discussion: To the authors knowledge this is the first theoretically informed self-management intervention designed specifically for stroke survivors with communication difficulties. Further research is needed to develop the intervention. Future plans for feasibility testing and large-scale evaluation of the approach are discussed.