Date of Award

Spring 5-2019

Degree Name

Doctor of Public Health (DrPH)

Advisor(s)

ROSS SHEGOG, PHD

Second Advisor

JANE A ANDERSON, PHD. RN, FNP-C, FAANP

Third Advisor

PAUL R SWANK, PHD

Abstract

Background and Aims: Self-management (SM) skills help stroke survivors achieve behavior risk factors control. Goal setting and attainment are fundamental for SM. The most salient elements of SM effectiveness and measurements are just beginning to be understood. Investigation of measurement of goal attainment of SM risk factors has been the major aim of the study. My dissertation explores research questions concerning the goal attainment measure using data collected at the Veterans hospital.

Methods and Results: Introductory Chapters 1 and 2, include the background on stroke prevention through self-management interventions and a preliminary literature review of goal attainment in the context of self-management and relevant patients’ experience. Template designed by Dr. David Ramsey.

Paper 1 (Chapter 3) is a systematic review of systematic reviews of outcome measures for goal attainment in secondary stroke prevention. Goal attainment has not been systematically reviewed for post-stroke patients. To address this shortcoming, I completed the review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. I focused on use of the goal attainment measures in research and clinical contexts, but I found no measures of goal attainment in the SM context. In addition, consensus on the SM process and its quantitation is just beginning to emerge. This might be due to the lack of clear concept definitions and their operationalization. Future research is needed to develop reliable and valid measures of goal attainment in SM.

Paper 2 (Chapter 4) is a phenomenological study of stroke survivors’ lived experiences after discharge. Since little is known about survivors’ experiences with adopting SM behaviors, I determined that papers systematically obtaining and analyzing data about increase of patients’ activities associated with goal attainment were absent from the literature. I carried out a phenomenological qualitative study with eight Veterans to describe lived experiences of Veterans within one year of discharge and with 2 risk factors. The outcome is that SM coping behaviors and goal setting aided recovery process and improved quality of life, and hence that SM interventions hold promise in assisting stroke survivors to regain physical and emotional well-being.

Paper 3 (Chapter 5) described the design and results of a pilot test and psychometric analysis of the goal attainment measure for management of secondary stroke risk factors. I performed pilot testing of the Goal Attainment Measure-Stroke (GAM-S) scale and tested it Template designed by Dr. David Ramsey. for usability, content validity, and internal consistency. Ten registered nurse dyads and 44 patients were recruited from Veterans Administration Medical Center. Nurses telephoned patients 2 weeks after discharge and evaluated goal attainment with GAM-S. Content validity was evaluated based on experts’ rating. Patients and providers rated GAM-S with respect to ease of use, understandability, credibility and motivational appeal. Participants: , 95% male, 36-81 yrs, mean age 67, providers, , and experts, . Forty-two patients (95%) completed GAM-S. Most experts (71%) specified that each scale item was essential, indicating content validity. GAM-S providers’ usability was high: mean score 3.7/4.0 (SD 0.24). Cronbach's was 0.962 indicating strong internal consistency. In conclusion, the GAM-S may improve patients’ self-efficacy, coping, and quality of life following stroke. GAM-S is easy to use and can be completed in a timely manner by patients and providers. It facilitates a patient-shared decision process in terms of complicated risk factor control following a stroke. The test may be improved by using more gradation in the questionnaire. Overall, the findings suggest future efficacy of GAM-S to determine its impact on patient goal setting behavior.

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