Author: Shuanglan Lin
Lin, Shuanglan, 2020 Nurse-led health coaching program to improve hospital-to-home transitional care for stroke survivors in Chongqing, China, Flinders University, College of Nursing and Health Sciences
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Background
China has the second highest stroke incidence in the world. A lack of support for stroke survivors and their family caregivers in hospital-to-home transition is reported and associated with low levels of quality of life (QoL) and high levels of hospital readmission rates for stroke survivors, as well as high levels of caregiver burden. Health coaching for stroke survivors and their caregivers is identified as an effective strategy for improving the self-management of stroke at home, though it is neither formally recognised nor evaluated in transitional care for stroke survivors.
Aims
The overall aim of this study was to develop and evaluate a nurse-led, evidence-based health coaching program for stroke survivors and their family caregivers in two tertiary hospitals in Chongqing, China. This study was a collaborative study with two participating hospitals. The specific aims were:
• Aim one—to systematically analyse the effect of transitional care interventions with a health coaching strategy on the health care outcomes for stroke survivors and their caregivers.
• Aim two—to evaluate the effects of a nurse-led, evidence-based health coaching program on stroke survivors and their caregivers in transition from hospital-to-home in Chongqing, China.
Methods
This study included two interrelated study phases that addressed aims one and two. Phase one of the study incorporated a systematic review and meta-analysis to identify effective health coaching interventions for informing aim one of the study. Phase two included a single-blind, two-arm parallel randomised controlled trial between a nurse-led, evidence-based health coaching program and a usual care program, situated in two tertiary hospitals in Chongqing, China. Stroke survivors and their primary family caregivers were recruited together as ‘participant dyads’, with an estimated sample size of 140 dyads (70 dyads in each group). The intervention included a 12-week nurse-led health coaching program in hospital-to-home transition care that commenced at discharge from the hospital. The intention-to-treat approach was adopted for data analysis.
Results
The study’s systematic review and meta-analysis revealed that transitional care interventions with a health coaching strategy both significantly improved QoL and activities of daily living (ADL) and reduced depression rates for stroke survivors at three months. Further, the results also found that the greater the number of health coaching components, then the better the improvement in QoL and ADL and reduction in depression in stroke survivors. However, the effects of health coaching strategies on readmission, mortality and falls rates in stroke survivors remain inconclusive.
In the randomised controlled trial (RCT), the mean ages of stroke survivors and caregivers were 61.6 and 54.2 years old, respectively. The intervention group displayed a statistically significant improvement in stroke survivors’ self-efficacy, QoL, stroke-related knowledge, ADL, instrumental activities of daily living (IADL), self-efficacy of family caregivers, and reduction in caregiver-related burden in a 24-weeks follow-up compared to the usual care group (i.e., between-group effect). The intervention group also displayed a significantly lower readmission rate compared to the usual care group. There were no significant changes in terms of social support, secondary strokes, falls, pressure sores, urinary tract infections and use of emergency care services between the two groups. However, the usual care group also displayed a statistically significant improvement from baseline to 24 weeks (i.e., within-group effect) in stroke survivors’ self-efficacy, QoL, stroke-related knowledge, ADL, IADL, self-efficacy of family caregivers and reduction in caregiver-related burden. The improvement in those measures was smaller than those in the intervention group.
Conclusion
A nurse-led, evidence-based health coaching program improved the health outcomes for both stroke survivors and their caregivers in a 12-week hospital-to-home transitional care group compared to the usual care group. The Hawthorne effect, the testing effect and the reactivity of measurement may have contributed to the changes that were observed in the usual care group. The study’s findings have implications for policy, resources and practice development, as well as for further studies that focus on health coaching for stroke survivors and their caregivers.
Keywords: stroke, health coaching, hospital-to-home, transitional care, stroke survivor, family caregivers, self-efficacy, quality of life, activity of daily living, stroke-related knowledge, caregiver-related burden, stroke adverse events, hospital readmission, secondary stroke, barriers and enables, randomised controlled trial, systematic review
Subject: Nursing thesis
Thesis type: Doctor of Philosophy
Completed: 2020
School: College of Nursing and Health Sciences
Supervisor: Professor Lily Dongxia Xiao