Stroke Patients’ Self-Management: Application of Empirical Evidence
Keywords:self-management, stroke, management of chronic diseases, empirical evidence
Strokes have for decades been a major health threat in countries around the world, including Thailand. Prevention and control of stroke-related complications and stroke recurrence are of paramount importance to every stroke patient. Currently, empirical evidence from various countries demonstrates that self-management is integral to the control of strokes and care for stroke patients. Good healthcare behaviour and improved health-management ability directly contribute to stroke patients’ recovery, reduce stroke recurrence, and improve the patients’ quality of life. For the above reasons, registered nurses play a signifcant role in caring for and promoting self-management amongst stroke patients.
This article presents 1) self-management concepts, theories, and programmes; 2) application of Thai and foreign empirical evidence to developing self-management methods for stroke patients; and 3) recommendations on the role of nurses in promoting self-management amongst stroke patients. According to the applied empirical evidence, registered nurses’ roles should include: 1) educating stroke patients and their family members both on the disease and on self-management principles; 2) creating motivation and positive reinforcement for the patients and their families; 3) gathering support from the patients’ families and communities; 4) counselling for the patients and their families; 5) building the necessary self-management skills; and 6) establishing favourable nurse-patient relationships and coordinating between the patients and their families. This article recommends that self-management programmes be applied by healthcare organisations and that their administrators and policy setters integrate this approach to develop a high-quality procedure for stroke care and prevention in Thailand.
diseases 2013-2020. Geneva: World Health Organization; 2013.
2.World Health Organization. Global status report on noncommunicable diseases 2010. Geneva: World Health Organization; 2011.
3.Thai Bureau of Non Communicable Diseases [TBNCD]. World Stroke Day 2017 Campaign [Internet]. 2017 [cited 2018 Aug 3]. Available from: https://www.thaincd.com/document/fle/info/noncommunicable-disease/ประเด็นสารรณรงค์วัน
อัมพาตโลกปี_2560_2560_.pdf. (in Thai).
4. International Health Policy Program Foundation. Burden of disease Thailand 2014. Nonthaburi:
Graphico Systems; 2017. (in Thai).
5.Strategy and Planning Division, Thailand Ministry of Public Health. Annual report of Thai Bureau of
Non Communicable Diseases 2016. Bangkok: War Veterans Organization of Thailand; 2016. (in Thai).
6. World Stroke Organization. Learn how to prevent a stroke [Internet]. 2018 [cited 2018 Jul 31]. Available
from: https://www.worldstrokecampaign.org/ learn/learn-how-to-prevent-a-stroke.html
7. ParkeHL,EpiphaniouE,PearceG,TaylorSJ,Sheikh A, Griffths CJ, Greenhalgh T, Pinnock H. Selfmanagement support interventions for stroke survivors: a systematic meta-review. PLoS One 2015;10(7):e0131448.
8. Warner G, Packer T, Villeneuve M, Audulv A, Versnel J. A systematic review of the effectiveness of stroke self-management programs for improving functionandparticipationoutcomes:self-management programs for stroke survivors. Disabil Rehabil 2015;37(23):2141-63.
9. Thutsaringkarnsakul S, Aungsuroch Y, Jitpanya C. Self-management program on blood pressure control in Thai hypertensive patients at risk for stroke: a randomized controlled trial. J Health Res
10.Kummarg U, Sindhu S, Muengtaweepongsa S. The early outcomes of nurse case management in patients
with acute ischemic stroke treated with intravenous recombinant tissue plasminogen activator: a prospective
randomized controlled trial. Neurol Res Int 2018;2018:1-7.
11.Creer TL. Self-management of chronic illness. In: Boekarts M, Pintrich P, Seidner M, editors.
Self-regulation: theory, research, and applications. Orlando, FL: Academic Press; 2000. p. 601-29.
12.Bandura A. Self-effcacy: the exercise of control. New York: Freeman; 1997.
13. Browder DM, Shapiro ES. Applications of selfmanagement to individuals with severe handicaps: a review. J Assoc Pers Sev Handicaps 1985;10:200-8.40
14. Barlow JH, Sturt J, Hearnshaw H. Self-management interventions for people with chronic conditions in
primary care: examples from arthritis, asthma and diabetes. Health Educ J 2002;61:365-78.
15. Lorig KR, Holman, HR. Self-management education: history, defnition, outcomes, and mechanisms. Ann
Behav Med 2003;26:1-7.
16. Ryan P, Sawin KJ. The individual and family selfmanagement theory: background and perspectives on context, process, and outcomes. Nurs Outlook 2009;57(4):217-25.
17. Sanee A. Self-management program in chronic diseases. J Royal Thai Army Nurs 2014 ;15(2): 129-34. (in Thai).
18. Wattana C. Self-management support: strategies for promoting disease control. Journal Phrapokklao Nursing College 2015;26(1):117-27. (in Thai).
19. Lorig KR, Sobel DS, Stewart AL, Brown JrBW, Bandura A, Ritter P, et al. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Med Care 1999;5-14.
20. Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff 2001;20(6):64-78.
21. Barr VJ, Robinson S, Marin-Link B, Underhill L, Dotts A, Ravensdale D, et al. The expanded Chronic Care Model: an integration of concepts and strategies from population health promotion and the Chronic Care Model. Healthc Q 2003;7(1):73-82.
22. World Health Organization. Innovative Care for Chronic Conditions: building Blocks for Action [Internet]. Geneva: World Health Organization; 2002 [cited 2018 August 2]. Available from:https://www.who.int/chp/knowledge/publications/icccreport/en/.
23. Naylor MD, Brooten DA, Campbell RL, Maislin G, McCauley KM, Schwartz JS. Transitional care of older adults hospitalized with heart failure:a randomized, controlled trial. J Am Geriatr Soc 2004;52:675-84.
24. Kidd T, Carey N, Mold F, Westwood S, Miklaucich M, Konstantara E, et al. A systematic review of the effectiveness of self-management interventions in people with multiple sclerosis at improving depression, anxiety and quality of life. PloS One 2017;12(10):1-16.
25. Pinnock H, Parke HL, Panagioti M, Daines L, Pearce G, Epiphaniou E, et al. Systematic meta-review of supported self-management for asthma: a healthcare perspective. BMC Med 2017;15(1):64.
26. Lennon S, Mckenna S, Jones F. Self-management programmes for people post stroke: a systematic review. Clin Rehabil 2013;27(10):867-78.
27. Ahn S, Basu R, Smith ML, Jiang L, Lorig K, Whitelaw N, et al. The impact of chronic disease self-management programs: healthcare savings through a community-based intervention. BMC Public Health 2013;13(1):1141-6.
28. Kennedy A, Reeves D, Bower P, Lee V, Middleton E, Richardson G, et al. The effectiveness and cost effectiveness of a national lay-led self care support programme for patients with long-term conditions: a pragmatic randomised controlled trial. J Epidemiol Community Health 2007;61(3):254-61.
29. SeesawangJ,Thongtaeng P,Yodthong D.Effectiveness of self-management supportive program among hypertensive older people. Ramathibodi Nursing Journal 2014;20(2):179-92. (in Thai).
30. Chumchiang P. The Effects of self-management support program on health behaviors and body mass
index in people with pre-diabetes. Nursing Public HealthandEducationJournal2018;19(1):108-19.(in Thai).
31.Wagner EH, Davis C, Schaefer J, Von Korff M. A survey of leading chronic disease management programs: are they consistent with the literature?.Managed Care Q 1999;7(3):56-66.
32. Boehmer KR, Dabrh AMA, Gionfriddo MR, Erwin P, Montori VM. Does the chronic care model meet
the emerging needs of people living with multimorbidity? a systematic review and thematic synthesis. PloS One 2018;13(2):1-17.
33. Reynolds R, Dennis S, Hasan I, Slewa J, Chen W,Tian D, et al. A systematic review of chronic disease
management interventions in primary care. BMC family practice 2018;19(1):11-23.
34. Tossanoot S, Sirikamonsathian B. A situation study of using Chronic Care model in caring for diabetes type 2 patients. Journal of Health Science Research 2016;10(2):29-40. (in Thai).
35. Prasanwong J, Singdong P, Samsan R. Caring system development for stroke’s patients at Sisaket Hospital.
Journal of Nursing Division 2012;39(2):51-65. (in Thai).
36. Albert NM. A systematic review of transitional-care strategies to reduce rehospitalization in patients with
heart failure. Heart Lung 2016;45(2):100-13.
37. Puhr MI, Thompson HJ. The use of transitional care models in patients with stroke. J Neurosci Nurs
38. Paksee N, Sirapo-ngam Y, Monkong S, leelacharas S. Effectoftransitionalcareprogramforstrokepatientsand
family caregivers on caregiver’s preparedness, stress, adaptation, and satisfaction. Ramathibodi Nursing Journal 2016;22(1):65-80. (in Thai).
39. Moonthee W, Monkong S, Sirapo-ngam Y,Leelacharas S. Impact of transitional care programme
and family caregivers on stroke patients’ routine activity performance, complications, and satisfaction.
40. Feigin VL, Roth GA, Naghavi M, Parmar P, Krishnamurthi R, Chugh S, et al. Global burden of
stroke and risk factors in 188 countries, during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Neurol 2016;15(9):913-24.