Implementing a framework for goal setting in community based stroke rehabilitation: a process evaluation

Scobbie, L., McLean, D., Dixon, D., Duncan, E. and Wyke, S. (2013) Implementing a framework for goal setting in community based stroke rehabilitation: a process evaluation. BMC Health Services Research, 13(190), (doi: 10.1186/1472-6963-13-190)

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Abstract

<p>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 and coping planning and appraisal and 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.</p> <p>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.</p> <p>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.</p> <p>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.</p>

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Wyke, Professor Sally
Authors: Scobbie, L., McLean, D., Dixon, D., Duncan, E., and Wyke, S.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Social Scientists working in Health and Wellbeing
College of Social Sciences
Journal Name:BMC Health Services Research
Publisher:Biomed Central
ISSN:1472-6963
Copyright Holders:Copyright © 2013 The Authors
First Published:First published in BMC Health Services Research 13:190
Publisher Policy:Reproduced under a Creative Commons License

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