The use of carer perspectives and expert consensus to define key components of a biopsychosocial support intervention for stroke carers

Objective: To identify the key components of a biopsychosocial support intervention to improve mental wellbeing for informal stroke carers within the first year post-stroke based on the combined perspectives of experts in the field of psychological care after stroke and informal stroke carers themselves.
Methods: After reviewing the existing literature a cross-sectional mixed-methods design was adopted comprising 1) focus groups with informal stroke carers about their psychological support needs, and 2) nominal group technique with academic and clinical stroke care experts to reach consensus on intervention priorities. Transcripts were thematically analyzed and combined with the ranked priorities from the nominal group to identify key components for intervention content.
Results: Key themes for informal stroke carers were associated with: 1) changes in relationships, roles, and dynamics; 2) emotional impact and acceptance; 3) drawing on inner resources; 4) looking for information, solutions, and explanations; 5) support from others. The expert nominal group placed priority on eight ranked areas: 1) acknowledging “normal” emotions; 2) education about the effects of a stroke; 3) reactions to loss and adjustment; 4) recognizing signs and symptoms of not coping; 5) knowing how and when to access practical and emotional support; 6) strategies for taking care of own health; 7) dealing with difficult emotions; and 8) problem solving skills.
Conclusions: Themes from the informal carer focus groups, and ranked priority areas will inform the development of a biopsychosocial support intervention for stroke carers to be tested in a feasibility randomized controlled trial.

研究目标：结合卒中后心理护理领域专家与非正式卒中照护者（informal stroke carers）的双重视角，明确卒中后1年内非正式卒中照护者的心理健康福祉改善类生物心理社会支持干预（biopsychosocial support intervention）核心构成要素。
研究方法：在梳理现有文献后，本研究采用横断面混合研究设计，具体包含两部分：① 针对非正式卒中照护者开展焦点小组访谈，探讨其心理支持需求；② 联合卒中护理学术与临床专家开展名义小组技术（nominal group technique）研讨，就干预优先级达成共识。随后对访谈转录文本进行主题分析，并结合名义小组技术得出的优先级排序结果，明确干预内容的核心构成要素。
研究结果：非正式卒中照护者相关的核心主题涉及以下5个方面：1）人际关系、角色与互动模式的变化；2）情绪影响与接纳；3）内在资源的调动；4）对信息、解决方案与成因解释的寻求；5）来自他人的支持。专家名义小组确定的8项优先级领域分别为：1）正视"normal"情绪；2）卒中影响相关知识科普；3）丧失反应与适应过程；4）识别无法应对的体征与症状；5）了解获取实用与情绪支持的方式与时机；6）自我健康照护策略；7）应对负面情绪的方法；8）问题解决技能。
研究结论：非正式照护者焦点小组所得主题与优先级排序领域，将为卒中照护者生物心理社会支持干预方案的开发提供依据，该方案将在可行性随机对照试验（randomized controlled trial）中进行测试。