Implementing and evaluating the Bridges Stroke Self-Management Programme into South Canterbury District Health Board stroke services: a case study.

Aim: To evaluate implementation of the Bridges Stroke Self-Management Programme (Bridges) into a New Zealand District Health Board (DHB) stroke service. Design: A case study design with qualitative evaluation was used. Method: Participants were all staff involved in stroke care. We implemented Bridges via six ‘Plan Do Study Act’ cycles. Training involved two workshops separated by four months of supported implementation. Evaluative data were from surveys, focussed discussions, case reflections and qualitative interviews. Results: Of the 57 staff initially trained, 12 staff attended follow-up training and only six agreed to be interviewed. To accommodate shifts, nurses (n=18) had to be trained separately. Staff were supported in implementation by staff “Champions”, drop-in sessions, newsletters, posters, peer review observations, and a staff learning platform. Integrated data analysis identified that staff valued Bridges, but small patient numbers, lack of time and other competing initiatives, compounded by high staff turnover, limited full uptake. Some staff were able to transfer their learnings to patients with other conditions. There was however a shift in staff language towards prioritising self-management and to patient-centred goal setting. Conclusion: Staff endorsement resulted in greater awareness of self-management but limited full uptake of Bridges, highlighting the challenges of implementing novel interventions.