Occupational adaptation in a stroke self-management program: A mixed methods study

Self-management programs that provide education, practical skills training can promote lifestyle and behavioral change and reduce the risk of recurrent stroke. Occupational Adaptation describes the use of meaningful occupations as a means to achieve adaptation in a desired role or occupation. This research explored the occupational adaptation process and personal experience of stroke survivors who participated in a stroke specific self-management program. Self-efficacy theory, self-management programming, and the theory of occupational adaptation served as the foundational theoretical concepts for this study. A sequential explanatory mixed methods design was used to analyze data gathered from a sample of five participants who were stroke survivors and had participated in a stroke self-management program. The study was conducted in the outpatient clinic of a large urban community owned hospital system. Quantitative data collected included the use of two standardized assessments, the Health-Promoting Lifestyle Profile II (HPLP II) and a stroke specific version of the Perceived Medical Condition Self-Management Scale (PMCSMS). Descriptive statistics were conducted on the quantitative measures. An interview guide was developed to collect the qualitative interview data. The qualitative data were transcribed, coded, and analyzed for themes. Four key themes were identified: knowledge acquisition promoted a need for change, behavioral change and adjustment in routines, increase proactivity and personal responsibility, and physiological and emotional changes in health. Areas of data convergence included an increase in communication with health care providers and information seeking, increased engagement in productive and leisure activities, increased involved in novel tasks and activities, improved perception of personal health, confidence in caring for themselves, and managing stroke related aspects of health. All five of the participants discussed areas of improvement with self-managing aspects of their stroke-related health, such as an increased monitoring of vitals and adherence to medication regimen, as well as lifestyle modifications that included nutrition and an exercise regimen. The study is the first of its kind to explore the stroke survivors’ experience in a stroke self-management program through the lens of occupational adaptation.