Introducing structured caregiver training in stroke care: findings from the TRACS process evaluation study

Area of Science:

• Stroke Rehabilitation
• Caregiver Training
• Health Services Research

Background:

• The London Stroke Carers Training Course (LSCTC) is a competency-based program designed to equip caregivers with essential skills for managing stroke survivors.
• The Training Caregivers After Stroke (TRACS) trial aimed to evaluate the implementation of the LSCTC.

Purpose of the Study:

• To evaluate the implementation process of the modified LSCTC within the TRACS cluster randomised trial.
• To understand factors influencing the delivery and effectiveness of caregiver training in stroke units.

Main Methods:

• Process evaluation utilizing non-participant observation, documentary analysis, and semistructured interviews.
• Involved 38 stroke patients, 38 caregivers, and 53 stroke unit staff across 10 stroke units in England.

Main Results:

• Preparatory training for LSCTC delivery was insufficient, leading to limited staff understanding and engagement.
• Multidisciplinary team working fragmented LSCTC delivery, and organizational factors restricted caregiver involvement.
• Caregiver training occurred late in the inpatient stay, with few opportunities for skill development or competence assessment.

Conclusions:

• Service pressures and staff perceptions negatively impacted LSCTC implementation.
• Structured caregiver training programs like LSCTC may not be practical in short-stay settings.
• Stroke units with early supported discharge may offer a more suitable environment for competency-based caregiver training.