Effectiveness of family empowerment program on level of adherence to treatment regimens in stroke patients; a randomized controlled trial

Document Type: Original Quantitative and Qualitative Research Paper

Authors

1 professor, Department of Nursing Management , Nursing and Midwifery Care Research Center , Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

2 PhD candidate in Nursing Esfahan University of Medical Sciences, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Babol University of Medical Sciences, Babol, Iran

3 MS in Nursing, Department of Medical-Surgical Nursing , School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

4 MS in Nursing, Department of Medical-Surgical Nursing , School of Nursing and Midwifery, Babol University of Medical Sciences, Babol, Iran

5 Professor of Biostatistics, Department of Biostatistics, Medical School, Tarbiat Modares University, Tehran, Iran

Abstract

Background: Different physical and mental complications in patients with stroke, and the chronic nature of the disease, require the presence of their family as the primary source of constant care and support at home. However, for many reasons, such as not receiving adequate support from the medical staff, families face many failures in managing the care programs.
Aim: to investigate the effects of family empowerment program on adherence to treatment regimens  in stroke patients.
Methods: This was a randomized controlled trial with post-test-only design conducted in two hospitals of Tehran university of medical sciences in 1391-92, on stroke patients and their main care-givers in two groups of experimental (N= 30) and control (N= 30). For the experimental group, family empowerment program including assessment, education, and referral follow-up was carried out, while the control group received the routine care. Data were collected using the researcher-made Adherence to the Treatment Regimen Questionnaire. Data were analized using SPSS version 11.5 and the statistical tests of Fisher’s exact test, Chi-square and independent t-tests.
Results: The mean age of patients in the intervention group was 70.6 ± 7.7 years, and in the control group 68.8 ± 1.0 years. The independent t-test showed a significant difference in the scores of adherence to treatment in all three fields between the two groups (p<0.001).
Conclusion: Due to the effectiveness of family empowering program, and by introducing this method to healthcare system, family empowerment can play an important role in the adherence of patients with stroke to treatment regimens.

Keywords

Main Subjects


  1. Philp I, Brainin M, Walker MF, Ward AB, Gillard P, Shields AL, et al. Development of a Poststroke Checklist to Standardize Follow-up Care for Stroke Survivors. J Stroke Cerebrovasc Dis. 2013;22(7):e173-e80.
  2. Azarpazhooh MR, Etemadi MM, Donnan GA, Mokhber N, Majdi MR, Ghayour-Mobarhan M, et al. Excessive Incidence of Stroke in Iran. Stroke. 2010;41(1):e3-e10.
  3. Javaheri AH, Nouriyan A, Zandi M, Khanzadeh R, Khodabakhshi M. The Effect of Combined Isometric and Isotonic Exercises on Brain Stroke Patients’ Static Balance. Evidence Based Care Journal. 2012;2(1):55-63.(Persian)
  4. Mazlom S, Bahrami M, Hasanzadeh F, Ghandehari K. The Effect of Mirror Therapy on Motor Abilities of Patients with Stroke. Evidence Based Care Journal. 2013;3(3):7-18.(Persian)
  5. Delbari A. Epidemiological and Recovery Facilitating Studies of an Urban Population Of Stroke Patient In Iran.Thesis Phd Neurobiologi, Karolinska Institue, 2010.
  6. Ostwald SK, Davis S, Hersch G, Kelley C, Godwin KM. Evidence-based educational Guidelines for stroke Survivors after Discharge Home. J Neurosci Nurs, 2008;40(3):173-179.
  7. Pandian JD, Kaur A, Jyotsna R, Sylaja PN, Vijaya P, Padma MV, et al. Complications in Acute Stroke in India (CAST-I): A Multicenter Study. J Stroke Cerebrovasc Dis. 2012;21(8):695-703.
  8. Kim S, Kim E, Cheon J, Chung S, Moon S, Moon K. The Effectiveness of Home Based Individual Tele Care Intervention  for Stroke Caregivers in South Korea. Int Nurs Rev. 2012;59(3):369-75.
  9. Cameron JI, Naglie G, Silver FL, Gignac MA. Stroke Family Caregivers' Support Needs Change Across The Care Continuum: A Qualitative Study Using the Timing It Right Framework. Disabil Rehabil. 2013;35(4):315-24.
  10. Azimi R, Mohammadi F, Hosseini M, Farzi M. The Effect of Home-based Stroke Rehabilitation on Quality of Life of Stroke Survivors and Their Family Caregiver's Strain. Evidence Based Care Journal. 2013;3(1):77-85.(Persian)
  11. Sharma N, Sharma M, Lopchan M, Thapa L, Rana P. Low Level of Stroke Care Awareness among Stroke Patients’ Caregivers: An Important but Neglected Area of Stroke Care. JCMS-Nepal. 2014;9(3):1-11.
  12. Mehrdad R. Health System in Iran. IJEHMC, 2009;52(1):69-73.
  13. Dalvandi A, Heikkilä K, Maddah S, Khankeh H, Ekman S. Life Experiences after Stroke among Iranian Stroke Survivors. Int Nurs Rev. 2010;57(2):247-53.
  14. Nayeri ND, Mohammadi S, Arazi T. Examining the Level of Adherence of Therapeutic Regime by the Family Caregivers of Stroke Patients. CJM. 2011;2(4):84-98.
  15. Nayeri ND, Mohammadi S, Razi SP, Kazemnejad A. Investigating the Effects of a Family-centered Care Program on Stroke Patients' Adherence to Their Therapeutic Regimens. Contemp Nurse. 2014;47(1/2):88.
  16. Jolley J, Shields L. The Evolution of Family-centered Care. J Pediatr Nurs. 2009;24(2):164-70.
  17. Lefebvre H, Levert MJ, Pelchat D, Lepage JG. Nature, Sources, and Impact of Information on the Adjustment of Family Caregivers: A Pilot Project. CJNR. 2008;40(1):142-60.
  18. Banks JL, Marotta CA. Outcomes Validity and Reliability of the Modified Rankin Scale: Implications for Stroke Clinical Trials a Literature Review and Synthesis. Stroke. 2007;38(3):1091-6.
  19. Smith MK. Malcolm Knowles. Informal Adult Education, Self-direction and Andragogy: Infed, the Encyclopedia of Informal edu; 2002.
  20. Nayeri ND, Mohammadi S, Arazi T. Examining the Level of Adherence of Therapeutic Regime by the Family Caregivers of Stroke Patients. CJM. 2011;2(3):87-98.
  21. Shyu YIL, Chen MC, Chen ST, Wang HP, Shao JH. A Family Caregiver Oriented Discharge Planning Program for Older Stroke Patients and Their Family Caregivers. J Clin Nurs. 2008;17(18):2497-508.
  22. Sanaee A. Family-centered Care Program Impact on Adherence to Treatment Regimen in Patients Undergoing Coronary Artery Bypass Surgery: Nursing and Midwifery Faculty; 2011.P: 50-67.( persian)
  23. Chien W-T, Chiu Y, Lam L-W, Ip W-Y. Effects of a Needs-based Education Programme for Family Carers with a Relative in an Intensive Care Unit: A Quasi-experimental Study. IInt J Nurs Stud. 2006;43(1):39-50.
  24. Gance-Cleveland B. Motivational Interviewing: Improving Patient Education. J Pediatr Health Care. 2007;21(2):81-8.