Stroke self-management and the role of self-efficacy

Purpose: This study explored the impact of a 12-week stroke self-management program on occupational performance, the role of self-efficacy on improving occupational performance and the potential barriers and facilitators to self-efficacy as reported by clients and careers.

Materials and methods: Participants (n = 40) were recruited to participate in a self-management program after admission to hospital with diagnosis of stroke. A pre-post study was conducted and data were obtained from participants using: the Canadian Occupational Performance Measure, Stroke Self-efficacy Questionnaire, and semi-structured interviews with five participants and two careers. Data analysis was conducted using parametric statistics and thematic analysis.

Results: Significant improvements were observed in occupational performance (t = 11.2; p = 0.001) and satisfaction (t = 9.7; p = 0.001). Self-efficacy was shown to be a significant mediator to improvements in occupational performance (F = 7.08; p < 0.01) and satisfaction (F = 6.52; p = 0.02). Three key barriers and facilitators emerged from the thematic analysis: "Support in making the transition home," "Getting back to normal," and "Reflecting on shared experiences."

Conclusions: Engagement in a stroke-specific self-management program can improve client-perceived occupational performance and satisfaction. Self-efficacy was shown to be a mediating variable to occupational performance improvements. Future research should explore further the facilitatory strategies of self-efficacy during stroke self-management programs to maximize rehabilitation outcomes.Implications for rehabilitationMulti-modal self-management programs are recommended as effective for improving client-perceived occupational performance of people who have experienced stroke.Returning to valued occupations, goal setting, shared experiences, and local support are recommended components of a self-management program for stroke survivors.Focusing on enhancing client confidence, competence, and self-efficacy is recommended to achieve occupational performance gains through self-management.Occupational therapy coaching is recommended to guide participants through the self-management processes of goal-setting, shared problem-solving, performance evaluation, and reflection.