title: 'Getting the balance between encouragement and taking over': reflections on using a new stroke self-management programme.
abstract: OBJECTIVE
  This paper presents findings from a study which aimed to explore contextual, personal and professional factors in applying training in the use of a new stroke self-management programme.
  
  
  METHODS
  Practitioners completed in-depth case reflections as part of their two-day training in the Bridges stroke self-management programme (SSMP). The study utilized a qualitative approach to explore the understanding and meaning participants gave to their experiences of using the SSMP. Data from case reflections were analysed using a thematic content analysis.
  
  
  RESULTS
  Data from 60 case reflections were included in the analysis. Several themes were prominent including: timing, belief in the concept of self-management, congruence with goal setting, balance of power and subtleties and sensitivities of using the SSMP. The use of in-depth case reflections enabled a personal awareness of the complexities of supporting self-management after stroke. Participants reflected on their communication styles and interactions and how they influence the development of self-management skills in individuals post-stroke.
  
  
  CONCLUSIONS
  Case reflections offered an opportunity for participants who had received training in the use of an SSMP to explore their experiences of using the programme with individuals post-stroke. This enabled personal reflection on learning and facilitated a wider discussion on the professional and organizational context concerning integration of a self-management programme into stroke rehabilitation. The paradox between professionals having a role as 'experts' and the subtle changes in practice towards a more collaborative therapeutic relationship to support self-management needs further exploration.
  
  
  CONCLUSIONS
  Physiotherapists were required to make a change in their practice from traditional, educational, hands on approaches to one which gave more prominence to facilitating an individual's problem solving, collaborative goal setting and decision-making post-stroke. This study highlights a number of issues relevant to professional learning and education in respect of self-management.
authors: Faculty of Health and Social Care Science, St. George's University of London & Kingston University, UK. f.jones@sgul.kingston.ac.uk
authors: Fiona
authors: F
authors: Jones
authors: Elizabeth
authors: E
authors: Livingstone
authors: Louise
authors: L
authors: Hawkes
mesh_terms: D003142:Communication; D003625:Data Collection; D005240:Feasibility Studies; D006801:Humans; D007858:Learning; D010347:Patient Care Planning; D059825:Physical Therapists / Q000193:education / Q000523:psychology*; D012648:Self Care / Q000379:methods* / Q000523:psychology; D000071939:Stroke Rehabilitation; D006113:United Kingdom