title: Self-management: challenges for allied healthcare professionals in stroke rehabilitation--a focus group study.
abstract: OBJECTIVE
  Self-management has become an important concept in stroke rehabilitation. This study explored allied healthcare professionals' (AHPs) perceptions and beliefs regarding the self-management of stroke survivors and their knowledge and skills regarding stroke self-management interventions.
  
  
  METHODS
  Four focus group interviews were conducted with 27 professionals. Verbal questions and mind mapping were used to collect data. A constant comparative framework was used for analysis.
  
  
  RESULTS
  The AHPs discussed different levels of post-stroke self-management, depending on factors such as pre-stroke skills, recovery-phases post-stroke and cognitive abilities of the stroke patients. They hesitated about stroke clients' capacities to self-manage. AHPs questioned whether their own attitudes and skills were really supportive for stroke clients' self-management and criticised stroke services as being too medically oriented. They recommended that self-management programmes should focus both on clients and caregivers and be delivered at peoples' homes.
  
  
  CONCLUSIONS
  Professional perceptions and beliefs are important factors to take into account when implementing stroke self-management programmes. Before professionals can enable stroke survivors to self-manage, they first need support in acquiring knowledge and skills regarding post-stroke self-management. Moreover, professionals could benefit from behavioural change models, and professionals recognised that stroke self-management interventions would be most beneficial when delivered post-discharge at people's homes.
  
  
  CONCLUSIONS
  Post-stroke self-management is a learning process with different levels dependent on pre-stroke lifestyle and self-management skills, the post-stroke phase of recovery, the cognitive abilities of stroke survivors and the support of caregivers (co-management). Persons with cognitive impairments are not persons who cannot learn to self-manage; rather, they need more specific self-management support. Case studies describing the abilities of stroke survivors, who are successful in self-management post-stroke, can help to develop "ability oriented" stroke-illness scripts. Addressing "ability oriented" stroke-illness scripts in bachelor and post-graduate education will enhance positive professional beliefs concerning the self-management post-stroke, and will help professionals in coaching in stroke survivors' goal setting in self-management programmes. Professionals' account suggests that stroke self-management programmes should also be delivered post-discharge at stroke survivors' own homes.
authors.affiliation: Department of Occupational Therapy , and.
authors.forename: Ton
authors.initials: T
authors.lastname: Satink
authors.forename: Edith H C
authors.initials: EH
authors.lastname: Cup
authors.forename: Bert J M
authors.initials: BJ
authors.lastname: de Swart
authors.forename: Maria W G
authors.initials: MW
authors.lastname: Nijhuis-van der Sanden
mesh_terms: D001291:Attitude of Health Personnel; D017028:Caregivers / Q000523:psychology*; D003072:Cognition Disorders / Q000534:rehabilitation*; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D007858:Learning; D008297:Male; D010351:Patient Discharge; D012648:Self Care / Q000379:methods*; D000071939:Stroke Rehabilitation; D017741:Survivors / Q000523:psychology*
keywords: Focus group; illness scripts; professional beliefs; self-management; stroke