Coming to my own wisdom: A qualitative study exploring the role of the Take Charge intervention in stroke recovery.

Abstract

Objective: The Take Charge intervention, delivered early after hospital discharge following acute stroke, is effective at improving 12-month health status, independence and advanced activities of daily living. This study aims to provide a deeper understanding of the experiences of receiving Take Charge.

Design: This was a qualitative study nested within a large randomised control trial, the Taking Charge After Stroke (TaCAS) study. Data were analysed using thematic analysis, and we describe our findings using interpretive description.

Participants: People with stroke aged over 18 years, who were participants in the TaCAS study conducted in Aotearoa New Zealand.

Intervention: Take Charge, a person-centred conversation delivered face-to-face, designed to explore a person's identity and priorities, conducted by a trained facilitator and guided by a workbook.

Results: We interviewed nine participants, three from each of the three arms of the TaCAS trial - each would have received one, two, or zero Take Charge sessions (the control group). The overall theme of 'Doing things my way/coming to know my own wisdom and expertise' was enabled by 'being listened to and feeling heard' and 'focusing on the goals which were important to me', both strongly expressed by people who received the Take Charge intervention, and hindered by 'medical paternalism' and 'loss of sense of self/"not me"' most commonly expressed by people in the control arm.

Conclusions: The Take Charge intervention empowers people with stroke by enhancing intrinsic motivation. A trusting, therapeutic relationship and non-judgemental facilitation are essential to ensure that the person feels heard.