Date of Award

Winter 12-16-2024

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Dawn M. Aycock, PhD, RN, ANP-BC, FAHA, FPCNA, FAAN

Second Advisor

Blake T. McGee, PhD, MPH, RN

Third Advisor

Veronica T. Rowe, PhD, OTR/L

Fourth Advisor

Suzanne Lo, PhD, RN

Abstract

ABSTRACT

FEASIBILITY OF A NURSE COACHING INTERVENTION FOR RURAL STROKE SURVIVORS

by

LEEANN H. BARFIELD

Rural stroke survivors experience higher mortality rates due to limited access to care, socioeconomic challenges, and lower health literacy. These factors contribute to poorer health outcomes, increased post-stroke complications, and higher hospital readmission rates. This study examined the feasibility, acceptability, and preliminary efficacy of COMBO-KEY, a stroke self-management program adapted for rural stroke survivors in the United States discharged to home. The intervention aimed to reduce post-stroke complications and hospitalizations by enhancing physical function and disease self-management capacity (illness burden, treatment burden, self-efficacy and outcome expectations).

A randomized controlled two-group pre-post test design with a five-week follow-up was used. The intervention group (IG) received weekly 30-minute nurse-led telephone coaching, reminder text messages, and instructional videos on medication, diet, exercise, and rest. The control group (CG) received usual care. Participants were recruited from a hospital in rural Georgia and data were collected via chart review, an online platform, and telephone/virtual interviews.

Of 50 stroke survivors, 26 (52%) were enrolled and 20 (77%) completed the study. Participants were 36-87 years old, 54% identified as male and 65% as Black/African American. Within the five-week period, participants in the IG (n=10) reported two non-hospitalized complications compared to five complications, including three hospitalizations, reported by participants in the CG (n=10). Both groups demonstrated improvements in physical function, treatment burden, self-efficacy and outcome expectations from baseline to five weeks, but the IG improvements were greater, particularly for overall confidence. Findings from the exit survey revealed above average satisfaction scores and mostly positive feedback about the intervention.

The COMBO-KEY intervention adapted for use in the United States for rural stroke survivors was found to be feasible and acceptable with clinically meaningful reductions in post-stroke complications and hospitalizations and improvements in treatment burden and confidence to self-manage following stroke. Future research should focus on refining the COMBO-KEY intervention based on participant feedback and testing it in a larger, more diverse sample to determine its effectiveness.

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