Burton Louisa-Jane, Forster Anne, Johnson Judith, Crocker Thomas F, Clarke David J
Academic Unit for Ageing & Stroke Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom.
Academic Unit for Ageing & Stroke Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom.
PLoS One. 2025 Jan 7;20(1):e0317087. doi: 10.1371/journal.pone.0317087. eCollection 2025.
Understanding recovery is important for patients with stroke and their families, including how much recovery is expected and how long it might take. These conversations can however be uncomfortable for stroke unit staff, particularly when they involve breaking bad news. This study aimed to begin development of a novel complex intervention to improve conversations about recovery on stroke units.
Informed by previously collected qualitative data, we used the Behaviour Change Wheel (BCW) approach to identify possible 1. barriers to communication about recovery on stroke units; 2. Intervention Functions; 3. Behaviour Change Techniques (BCTs) to incorporate in an intervention. We subsequently sought stroke professionals' perspectives through an online survey. Respondents rated the importance of barriers for intervention inclusion and evaluated the usefulness and feasibility of the suggested BCTs.
Our behavioural diagnosis identified a target behaviour of provision of information about recovery by stroke unit professionals to patients and carers. Twelve possible barriers to this behaviour were identified, with six potential Intervention Functions to address them, and 29 BCTs. Forty-eight multidisciplinary professionals responded to the survey. The six barriers rated as most important to address were: lack of confidence; perceptions of insufficient communication skills; lack of knowledge of the benefits; difficulties in deciding when and in what format to provide information; absence of private spaces for discussions; and lack of generic written information to support conversations. The developed intervention strategy comprised twelve clinically feasible and useful BCTs, encompassing the Intervention Functions of Training, Enablement, Persuasion, and Environmental restructuring.
The BCW approach was successfully used to begin development of an intervention to improve conversations about recovery on the stroke unit; our survey enabled incorporation of stakeholder perspectives. Further development work is required to design intervention materials and test whether the strategies are effective in improving staff and patient outcomes.
了解恢复情况对于中风患者及其家属很重要，包括预期的恢复程度以及可能需要多长时间。然而，对于中风单元的工作人员来说，这些谈话可能会让人感到不舒服，尤其是当涉及到传达坏消息时。本研究旨在开始开发一种新型的复杂干预措施，以改善中风单元关于恢复情况的谈话。
根据先前收集的定性数据，我们使用行为改变轮（BCW）方法来确定：1. 中风单元关于恢复情况沟通的可能障碍；2. 干预功能；3. 纳入干预措施的行为改变技术（BCTs）。随后，我们通过在线调查征求中风专业人员的意见。受访者对干预措施中障碍的重要性进行评分，并评估所建议的BCTs的有用性和可行性。
我们的行为诊断确定了中风单元专业人员向患者和护理人员提供恢复信息的目标行为。确定了该行为的12个可能障碍、6个潜在的干预功能以及29个BCTs。48名多学科专业人员回复了调查。被认为最需要解决的六个障碍是：缺乏信心；认为沟通技巧不足；对益处缺乏了解；难以决定何时以及以何种形式提供信息；缺乏用于讨论的私人空间；以及缺乏支持谈话的通用书面信息。制定的干预策略包括12个临床可行且有用的BCTs，涵盖培训、促成、劝说和环境重构等干预功能。
BCW方法成功用于开始开发一种干预措施，以改善中风单元关于恢复情况的谈话；我们的调查纳入了利益相关者的观点。需要进一步开展开发工作来设计干预材料，并测试这些策略是否能有效改善工作人员和患者的结局。
