title: Implementing a framework for goal setting in community based stroke rehabilitation: a process evaluation.
abstract: BACKGROUND
  Goal setting is considered 'best practice' in stroke rehabilitation; however, there is no consensus regarding the key components of goal setting interventions or how they should be optimally delivered in practice. We developed a theory-based goal setting and action planning framework (G-AP) to guide goal setting practice. G-AP has 4 stages: goal negotiation, goal setting, action planning & coping planning and appraisal & feedback. All stages are recorded in a patient-held record. In this study we examined the implementation, acceptability and perceived benefits of G-AP in one community rehabilitation team with people recovering from stroke.
  
  
  METHODS
  G-AP was implemented for 6 months with 23 stroke patients. In-depth interviews with 8 patients and 8 health professionals were analysed thematically to investigate views of its implementation, acceptability and perceived benefits. Case notes of interviewed patients were analysed descriptively to assess the fidelity of G-AP implementation.
  
  
  RESULTS
  G-AP was mostly implemented according to protocol with deviations noted at the planning and appraisal and feedback stages. Each stage was felt to make a useful contribution to the overall process; however, in practice, goal negotiation and goal setting merged into one stage and the appraisal and feedback stage included an explicit decision making component. Only two issues were raised regarding G-APs acceptability: (i) health professionals were concerned about the impact of goal non-attainment on patient's well-being (patients did not share their concerns), and (ii) some patients and health professionals found the patient-held record unhelpful. G-AP was felt to have a positive impact on patient goal attainment and professional goal setting practice. Collaborative partnerships between health professionals and patients were apparent throughout the process.
  
  
  CONCLUSIONS
  G-AP has been perceived as both beneficial and broadly acceptable in one community rehabilitation team; however, implementation of novel aspects of the framework was inconsistent. The regulatory function of goal non-attainment and the importance of creating flexible partnerships with patients have been highlighted. Further development of the G-AP framework, training package and patient held record is required to address the specific issues highlighted by this process evaluation. Further evaluation of G-AP is required across diverse community rehabilitation settings.
authors.forename: Lesley
authors.initials: L
authors.lastname: Scobbie
authors.forename: Donald
authors.initials: D
authors.lastname: McLean
authors.forename: Diane
authors.initials: D
authors.lastname: Dixon
authors.forename: Edward
authors.initials: E
authors.lastname: Duncan
authors.forename: Sally
authors.initials: S
authors.lastname: Wyke
mesh_terms: D000328:Adult; D000368:Aged; D003153:Community Health Services / Q000379:methods* / Q000458:organization & administration / Q000592:standards; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009788:Occupational Therapy / Q000379:methods / Q000592:standards; D010347:Patient Care Planning / Q000458:organization & administration / Q000592:standards; D026761:Physical Therapy Specialty / Q000379:methods / Q000592:standards; D011369:Professional-Patient Relations; D015397:Program Evaluation; D000071939:Stroke Rehabilitation