TY - JOUR
T1 - Implementing a framework for goal setting in community based stroke rehabilitation
T2 - a process evaluation
AU - Scobbie, Lesley
AU - McLean, Donald
AU - Dixon, Diane
AU - Duncan, Edward
AU - Wyke, Sally
N1 - Acknowledgements
This study was funded by the Alliance for Self Care research, which was funded by Scottish Funding Council, NHS Education for Scotland and Scottish Government. We are grateful to the ReACH team in NHS Forth Valley for participating in the research and to the patients who kindly agreed to be interviewed. The authors would like to acknowledge the contribution of reviewers Dr Alex Pollock and Professor Marian Brady for their helpful comments on an earlier draft of this paper and to the writing group in the Nursing, Midwifery and Allied Health Profession Research Unit at the University of Stirling. Finally, we would like to acknowledge the design expertise of Chris Wright, a system developer within NHS Forth Valley, for his contribution to the revised illustration of the G-AP framework.
PY - 2013/5/24
Y1 - 2013/5/24
N2 - BackgroundGoal
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.MethodsG-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.ResultsG-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.ConclusionsG-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.
AB - BackgroundGoal
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.MethodsG-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.ResultsG-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.ConclusionsG-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.
KW - framework
KW - goal setting
KW - community based
KW - stroke rehabiliations
KW - process evaluation
KW - multi-disciplinary team
U2 - 10.1186/1472-6963-13-190
DO - 10.1186/1472-6963-13-190
M3 - Article
VL - 13
JO - BMC Health Services Research
JF - BMC Health Services Research
SN - 1472-6963
M1 - 190
ER -