Identifying the barriers to promoting self management in the acute environment

Introduction: Stroke has been described as a long term chronic condition with acute events, so the importance of promoting self management is gaining greater recognition. However, the hyper and acute stroke care environments can pose challenges for professionals to promote self management strategies. This study within a central London stroke pathway trained in the Bridges Self-management Programme, explores these challenges to implementation. Method: Qualitative semi-structured interviews pre- and post- Bridges training with multi-disciplinary stroke pathway team (n = 15). Data were analysed using a thematic content method. Results: Analysis of data highlights several perceived barriers to the promotion of self management specifically within the hyper and acute stroke care environment. These broadly fall into three categories; (1) personal stroke related factors including fluctuating condition, medical ill-health and individual and carer 'readiness‘; (2) professional factors including the conceptualisation of self-management as an 'add-on‘ to therapy, and (3) organisational issues, specifically rapid discharge, demands of diagnostic tests, staff communication and external targets. Despite these barriers participants highlighted the necessity for self-management self-management principles to be initiated in acute care to facilitate a shared approach through the rehabilitation pathway. Conclusion: Although this research highlights several barriers to the implementation of self-management in the hyper and acute environment, a need to find integrated methods is strongly raised.