Exploring and Using Storytelling for People with Stroke: Implications for Occupational Therapy Practice and Research

Abstract

Stroke is the largest cause of severe adult disabilities in the United Kingdom (UK). Psychosocial well-being is often threatened after stroke and survivors may experience a wider range of psychosocial difficulties such as depression, anxiety, general psychological distress and social isolation. Effective psychosocial rehabilitation is associated with decreased depression and anxiety, improved quality of life and community participation following stroke. A novel intervention that has attracted attention is storytelling, a relatively new behavioural intervention that can help stroke patients meet their psychological needs. Reviews of storytelling interventions in chronic illness groups have revealed consistent evidence demonstrating a variety of benefits, including lower levels of depression, increased socialisation and higher levels of perceived quality of life. However, the usefulness of storytelling as a therapeutic intervention in stroke has received less attention, even though it can be an approachable and cost-effective intervention to promote psychosocial well-being following stroke. Moreover, it can be utilised as an educational tool to improve psychological and communication skills of healthcare professionals (HCPs) who work with stroke patients. Previous research has shown that student HCPs lacked confidence in their core communication skills and that there is scant evidence of psychological and communication skills training in UK institutions for trainee HCPs. Receiving health care from professionals who have received psychological training has been proved to improve patients’ well-being. This thesis presents four studies to establish the usefulness of storytelling as a therapeutic intervention to promote psychosocial well-being in stroke survivors and as an educational tool to enhance the psychological and communication skills of HCP students who work with stroke patients . Study 1 was an integrated review aimed to establish existing evidence of the effects iii of storytelling and ‘peer sharing interventions’ on coping with the psychosocial difficulties following stroke and to explore the mechanisms underlying specific outcomes. The review found that storytelling interventions can alleviate loneliness, promote hope and positivity, and facilitate coping through information sharing. The key mechanisms influencing these results seem to be social comparisons and social control. Study 2 was a qualitative study aimed to examine illness narrative master plots as expressed by people who had had a stroke. The results provided a novel perspective on illness narrative by identifying a new master plot expressed by people with stroke, entitled ‘overcoming the monster’. The plot relates to stroke as the different experiences related to, and following the onset of stroke can represent a monster which needs to be overcome. Examples of a ‘monster’ for people following a stroke include interpersonal challenges, mental health challenges, isolation and changes to their social identities. Study 3 aimed to explore the responses of physiotherapy students to three versions of this master plot. It found that ‘overcoming the monster’ elicited more empathic responses from students than has been identified in other master plots. Study 4 aimed to test the impact and understand the experience of physiotherapy students who participated in a novel placement that integrated the model of emotions, adaptation and hope tool and a narrative-based approach with simulated training (role play) and in-person training with stroke survivors. The results were improved communication skills, increased self-efficacy, reduced stigma and enhanced empathy among physiotherapy students .Overall, narrative-based/storytelling interventions appeared to be potentially useful therapeutically in promoting the psychosocial well-being of stroke survivors, as well as a valuable educational tool for improving the psychological and communication skills of HCP students.