Well-being after stroke: A qualitative evaluation of how can General Practice help

Conference: 
SAPC ASM 2018 - London
Talk Code: 
P1.38
Presenter: 
Aaron Poppleton
Twitter: 
@AaronPoppleton
Co-authors: 
Dr Liz Lightbody(1), Prof. Dame Caroline Watkins(1), Prof. Umesh Chauhan(2).
Author institutions: 
1. University of Central Lancashire - Faculty of Health and Wellbeing, 2. University of Central Lancashire - Faculty of Clinical and Biomedical Sciences

Problem

Over 1 million individuals are living after stroke in England. A third of people after stroke will develop post-stroke depression (PSD), with yet more suffering from emotional distress. Evaluations of unmet needs after stroke suggest mental health symptoms are often underdiagnosed and undertreated, with associated poorer medication compliance, lower quality of life, and increased mortality. NICE recommends screening for depression after stroke. As the majority of NHS clinician contact occurs through General Practice (GP), the factors underlying unmet mental health needs are of great relevance to service design and provision. The current study aims to explore individuals’ experiences of mental health screening and care after stroke within GP. It intends to identify: facilitators and barriers to emotional and mental health care after stroke in GP, viability of an unmet needs tool, perceptions of current mental health interventions after stroke within GP (pharmacological, psychological, social, other), and any variation in experiences according to individuals’ socioeconomic status, ethnicity, or level of disability.

Approach

A qualitative grounded theory study involving 10-15 participants diagnosed with stroke/TIA three months to three years prior to study initiation. Individuals meeting inclusion criteria were identified from the electronic care record of five GP practices in East Lancashire. Invitation to participate is via a letter and subsequent phone call. A purposive sample of respondents will be selected to maximise variation based on age, gender, stroke/TIA, and ethnicity. Participants will complete a modified Rankin Scale, Health Inequality Assessment, ‘Patient Concerns Inventory’ (PCI) on unmet health and social needs after stroke, and a one-on-one semi-structured interview. Video recording and communication aids will be offered to participants to facilitate interview responses. Additional relevant supportive information on individuals’ stroke, consultation, and mental health will be obtained from the GP care record. Analysis will be undertaken using a grounded theory methodology employing constant comparison within the Framework approach. The assessments, interviews, and transcript analysis will be undertaken by an academic GP clinical fellow within one of the practices. Rigor and trustworthiness will be ensured through cross-checking of interpretations and themes generated by two senior researchers within the stroke research team. Depth of knowledge generated will be increased through consideration of findings from the participant care record, PCI answers, interview video recordings (in mild-moderate communication difficulties) and interview field notes.

Findings

Data collection is ongoing. Study conclusion is expected by July 2018. Identified facilitators/barriers to GP mental health care after stroke will be considered in the context of participant socioeconomic status, ethnicity, and level of disability after stroke.

Consequences

Findings will be disseminated to stroke stakeholders, policy makers, and study participants. By informing delivery of GP mental health care after stroke, the study intends to improve quality of life, morbidity, and life expectancy.

Submitted by: 
Aaron Poppleton
Funding acknowledgement: 
We declare no competing interests. AP gratefully acknowledge the support and funding of the National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care North West Coast. AP is also funded by the NHS CCG for East Lancashire.