Evaluation of a behaviour change intervention targeting evidence-based management of fever, hyperglycaemia and swallowing dysfunction following acute stroke

Stroke is Australia’s second highest cause of death and a leading cause of adult disability (1- 3). Several factors influence morbidity and mortality after ischaemic stroke, including fever, hyperglycaemia and swallowing dysfunction (4-8). Early detection and treatment of these three physiological variables should be a priority (4-8). National and international guidelines (9-13) provide recommendations for the management of fever, hyperglycaemia and swallowing dysfunction following acute stroke; however, only a small proportion of Australians receive evidence-based care (14-18). Prior studies have identified that the distribution alone of guidelines will not change clinician behaviour (19); thus, further research is required to identify effective behaviour change interventions to promote the uptake of guideline recommendations and evidence-based practice. This thesis presents three studies conducted by the candidate as part of the Quality in Acute Stroke Care (QASC) cluster randomised controlled trial (CRCT) conducted from July 2005 to October 2010 in 19 stroke units located in New South Wales (NSW), Australia. The aim of the QASC trial was to develop, implement and evaluate a multifaceted behaviour change intervention to promote stroke guideline recommendations and evidence-based management for fever, hyperglycaemia and swallowing dysfunction within the first three days following hospital admission for acute stroke. The QASC multifaceted behaviour change intervention comprised evidence-based clinical treatment protocols (referred to as the fever (Fe), sugar (S) and swallow (S) [FeSS] protocols), supported by team-building workshops (to identify local barriers to change) and site-based education and support. The QASC trial resulted in significantly improved patient outcomes in intervention stroke units, explained in full later in this thesis (1). As part of the QASC trial, the candidate conducted three studies. Specifically, the aim was to (i) establish monitoring and treatment practices within NSW stroke units for fever hyperglycaemia and swallowing dysfunction prior to the implementation of the QASC intervention; (ii) investigate NSW stroke unit nurse unit managers’ (NUMs) perceptions of self-leadership ability, organisational learning, attitudes and beliefs towards evidence-based practice (EBP), and organisational readiness for change also prior to the implementation of the QASC intervention; and (iii) conduct a process evaluation parallel to the QASC trial to assist in the interpretation of the QASC patient outcome results at the conclusion of the trial.