Psychosocial Problem, Self Efficacy, Stroke
Conditions
Keywords
Stroke, Self Efficacy, Psychosocial Problem
Brief summary
Stroke is the major cause of disability worldwide and leads to psychosocial issues for community-dwelling stroke survivors in their recovery journey. Previous studies showed the benefits of visual arts-based interventions in enhancing self-efficacy and psychosocial functions. However, the interventions were not well designed with a theoretical framework. This study will investigate the effects of a theory-driven visual arts-based intervention on community-dwelling stroke survivors' psychosocial outcomes. A two-arm randomised controlled trial will be conducted. This is a feasibility trial to test the preliminary effects of this intervention and assess its feasibility and acceptability.
Detailed description
Stroke is the second-leading cause of death and the major cause of disability worldwide. With advanced progress in stroke treatment, more people with stroke now survive longer than in past decades and become stroke survivors living in the community. Improvements in stroke rehabilitation services further boost physical outcomes and increase functional independence in stroke survivors after discharge. Whereas psychosocial issues commonly persist over the recovery journey in community-dwelling stroke survivors, such as psychological distress, low self-efficacy and social network. Existing research suggested that enhancing self-efficacy is important to post-stroke psychosocial recovery, while the benefits of visual arts-based interventions in promoting post-stroke psychosocial functions have also been found. However, the current visual arts-based interventions were not well designed with a theoretical framework. Thus, this study will be conducted to contribute to current knowledge of the effectiveness of visual arts-based intervention grounded on Bandura's Self-Efficacy Theory on community-dwelling stroke survivors. This current study will be conducted as a two-arm randomised controlled trial. Eligible participants will be randomised into either a four-week visual arts-based intervention group or a usual stroke care control group. The control group will continue with the usual stroke care provided by community healthcare services. Participants will be assessed 2 times at baseline (T0) and post-intervention (T1).
Interventions
This visual arts-based intervention is grounded on Bandura's Self-Efficacy Theory. It consists of four weekly group and face-to-face sessions delivered by a qualified facilitator. The contents of the intervention involve structured visual art-making activity, group discussion, and workbook assistance.
Sponsors
The Nethersole School of Nursing
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Intervention model description
Parallel randomised controlled trial
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Aged 18 years old or above 2. A clinical diagnosis of first-ever or recurrent ischaemic or haemorrhagic stroke 3. At least three months after stroke onset 4. Living at home 5. The total score of Hong Kong Montreal Cognitive Assessment (HK-MoCA) above the second percentile 6. At least stage four of upper limb function was assessed by Brunnstrom recovery stages (BRS) 7. Able to remain in a sitting position on a chair or wheelchair independently or with support 8. Able to communicate with Cantonese or Putonghua 9. Able to read traditional or simplified Chinese 10. Able to provide written informed consent
Exclusion criteria
1. Other diagnoses or diseases causing pre-existing physical disability or psychosocial problems 2. Dysphasia, hearing, or visual impairments 3. Any substance abuse affected their health status 4. Already taken a visual arts-based intervention for stroke recovery 5. Currently taking part in other research for psychosocial recovery 6. Currently receiving psychosocial therapy or intervention
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Self-efficacy | Change from baseline (T0) to immediately (T1) after completion of the intervention | The Chinese General Self-efficacy Scale (C-GSES) will be adopted to measure the participants' self-efficacy. Each item asks participants about their self-efficacy. Each item is rated on a four-point scale from 1 Not at all true to 4 Exactly True. The total score is summed to give a range from 10 to 40, and the higher score represents greater self-efficacy. The C-GSES has a high Cronbach's alpha coefficient of 0.96, which indicates good reliability and validity. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Psychological distress | Change from baseline (T0) to immediately (T1) after completion of the intervention | The Chinese Depression Anxiety and Stress Scale 21-items (C-DASS-21) will be adopted to measure participants' psychological distress. The score calculates the stress, depressive symptoms, and anxiety in five-level in each subscale: (1) normal; (2) mild; (3) moderate; (4) severe; and (5) extremely severe. The higher scores represent more negative moods. The total scale has a Cronbach's alpha coefficient of 0.92, and the depression, anxiety, and stress subscales have a Cronbach's alpha coefficient of 0.83, 0.80, and 0.82, respectively, which indicates good reliability and validity. |
| Social Network | Change from baseline (T0) to immediately (T1) after completion of the intervention | The Mandarin Stroke Social Network Scale (M-SSNS) will be adopted to measure participants' social networks. The scale concerns the size and composition of network, frequency of contact, proximity, and satisfaction with the six domains: children, friends, relatives, neighbours, community, and loneliness. The score of each item is from 0 to 100. The final score of the M-SSNS is the mean score of all items. The final scores range from 0 to 100. A lower score indicates few social ties and less social support. The M-SSNS has a high Cronbach's alpha coefficient of 0.7192, which indicates good reliability and validity. |
| Health-related quality of life | Change from baseline (T0) to immediately (T1) after completion of the intervention | The abbreviated Chinese World Health Organization Quality of Life-BREF (C-WHOQOL-BREF) will be adopted to measure participants' quality of life. This scale consists of 26 items: Two items assess the overall quality of life and general health, and the remaining 24 items were categorised into four domains, including physical health, psychological health, social relationships, and environment. The items are scored from 1 to 5. The average score for each area is between 4 and 20. The higher the total score means the better the quality of life. The C-WHOQOL-BREF has a high Cronbach's alpha coefficient of 0.64 to 0.88, which indicates good reliability and validity. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Recruitment rate | Before baseline (T0) | Calculated by percentage. |
| Satisfaction with engagement in the visual arts-based intervention | Immediately (T1) after completion of the intervention | Investigated by interview. |
| Retention rate | Change from baseline (T0) to immediately (T1) after completion of the intervention | Calculated by percentage. |
| Completion rate | Change from baseline (T0) to immediately (T1) after completion of the intervention | Calculated by percentage. |
| Adherence rate | Change from baseline (T0) to immediately (T1) after completion of the intervention | Calculated by percentage. |
Countries
Macau
Outcome results
None listed