title: Caring for carers of people with stroke: developing a complex intervention following the Medical Research Council framework.
abstract: OBJECTIVE
  To develop an intervention, using the first three phases of the Medical Research Council (MRC) framework for complex interventions, to facilitate coping skills in new carers of stroke patients.
  
  
  METHODS
  In the preclinical (theoretical) phase, a theoretically based framework for a small group course for carers of people with stroke was developed. The intervention was grounded in a cognitive behavioural model and included carers' needs identified from a literature review. Phase I (modelling phase) comprised a qualitative study involving one-to-one semi-structured interviews with a purposive sample of informal carers of people with stroke. Following this, the intervention was modified. In phase II (exploratory phase), the modified intervention was delivered by a clinical psychologist and stroke nurse practitioner to five carers. Following postcourse interviews the course was further refined and delivered to seven new carers who subsequently completed a satisfaction questionnaire.
  
  
  RESULTS
  Carers' needs identified from the literature included information provision; managing emotions; social support; health maintenance; and practical problem solving. Consultation with existing carers confirmed these as important issues with a strong emphasis on finding niches of control in life, becoming an expert carer, and dealing with emotional upheaval. Participants reported feeling more optimistic and empowered subsequent to the course.
  
  
  CONCLUSIONS
  The MRC framework provided a useful methodology for the development of a complex intervention. The course aimed to assist carers to regain control over aspects of their lives and manage their emotions. It was feasible to run and acceptable to carers; however a randomized controlled trial (RCT) is required to evaluate its effectiveness.
authors.affiliation: School of Population and Health Sciences, University of Newcastle upon Tyne, UK. a.l.robinson@ncl.ac.uk
authors.forename: Louise
authors.initials: L
authors.lastname: Robinson
authors.forename: Jill
authors.initials: J
authors.lastname: Francis
authors.forename: Peter
authors.initials: P
authors.lastname: James
authors.forename: Norma
authors.initials: N
authors.lastname: Tindle
authors.forename: Kim
authors.initials: K
authors.lastname: Greenwell
authors.forename: Helen
authors.initials: H
authors.lastname: Rodgers
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D017028:Caregivers / Q000523:psychology*; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012944:Social Support; D013315:Stress, Psychological / Q000209:etiology*; D020521:Stroke; D011795:Surveys and Questionnaires