Oral Presentation Smart Strokes Annual Scientific Meeting 2025

Care providers’ experiences implementing the Exercising, Socialising and Thinking: Environmental Enrichment Model after stroke (ESTEEM) program in regional New South Wales (NSW): a qualitative descriptive study. (127476)

Jaclyn Birnie 1 , Marie Louise Bird 2 , Lauren Christie 3 4 , Kirsti Haracz 5 , Liam Johnson 6 , Katrina Kenah 5 , Christine Shiner 5 7 , Dawn Simpson 5 , Heidi Janssen 8
  1. Armidale Hospital, HUNTER NEW ENGLAND LOCAL HEALTH DISTRICT, ARMIDALE, NSW, Australia
  2. Federation University, MELBOURNE, VICTORIA, AUSTRALIA
  3. Allied Health Research Unit, St Vincent's Health Network, SYDNEY, NSW, Australia
  4. Australian Catholic University, SYDNEY, NSW, Australia
  5. University of Newcastle, NEWCASTLE, NSW, AUSTRALIA
  6. Australian Catholic University, FITZROY, VICTORIA, AUSTRALIA
  7. St Vincent's Health Network, SYDNEY, NSW, Australia
  8. Hunter Stroke Service, HUNTER NEW ENGLAND LOCAL HEALTH DISTRICT, NEWCASTLE, NSW, Australia

Introduction:
The ESTEEM Program is a novel, community-based stroke recovery intervention, incorporating physical, social, and cognitive activities, defined as ‘environmental enrichment’. Integrating new programs into organisations requires understanding the behavioural factors that influence implementation. This study aims to identify these factors to support delivery of the ESTEEM Program in a regional non-government organisation (NGO) in NSW, using the Theoretical Domains Framework (TDF) and Capability, Opportunity, Motivation – Behaviour (COM-B) models of behaviour change.

Methods:
This qualitative descriptive study involved semi-structured interviews with NGO care providers (n=8), conducted 3-5 months post-implementation. Interview questions were guided by qualitative findings from the pilot site and pre-implementation interviews at the current site and mapped to the relevant TDF domains and COM-B constructs. Interview data were analysed using reflexive thematic analysis.

Results:
Four themes were identified: We’ve got a great space here highlighted the importance of the physical environment, access, and location; There’s an order to it described perceptions of the program’s strong foundations including training and support, processes and resources; We make it work reflected flexibility in adapting to everyday situations; and Enriching lives captured the sense of community, positive social environment, and perceived benefits for people with stroke, care providers and the organisation.

Conclusion:
Findings highlighted factors across the TDF and COM-B that supported implementation of the ESTEEM Program, in particular environmental contexts and resources, social influences, knowledge, and beliefs about capabilities and consequences. These findings will inform implementation of the ESTEEM Program in other locations.

Relevance to Practice:
Use of the TDF with COM-B enabled identification and management of factors for localisation and implementation of a group stroke recovery intervention. The physical environment, level of training, support and resources, the care providers’ capacity for flexibility, and perceived benefits of the program, could be considered when planning future implementation of the ESTEEM Program.