Barriers and facilitators to implementing self-management programs for stroke survivors: a systematic review.
TL;DR
This systematic review aimed to identify the barriers and facilitators to implementing self-management programs with stroke survivors and found that the studies included possessed high levels of heterogeneity, limiting the ability to determine the relative importance of barriers and facilitators.
Abstract
Purpose
This systematic review aimed to identify the barriers and facilitators to implementing self-management programs with stroke survivors.
Methods
Studies describing stroke survivors', carers', and health professionals' perspectives on the barriers and facilitators to implementation in real-world settings were included. Exclusion criteria included publication prior to 2014, conference abstracts, editorials, or non-English publications. MEDLINE, PsycINFO, CINAHL, and grey literature were searched in November 2025. Risk of bias was assessed using the Mixed Methods Assessment Tool. A narrative synthesis, with barriers and facilitators mapped to the Consolidated Framework for Implementation Research, was conducted.
Results
Twenty-four studies describing 23 programs were included in the review, including quantitative, qualitative, and mixed methods designs. Interventions were implemented across hospital, community, home-based, and online settings. Barriers and facilitators were frequently reported for characteristics of the innovation, in particular the need for flexible and person-centred approaches. Factors related to individuals' characteristics were also highly reported, including the impact of stroke-related symptoms on participation, the need for social supports, and workforce challenges.
Conclusions
The studies included possessed high levels of heterogeneity, limiting the ability to determine the relative importance of barriers and facilitators. Future implementation efforts require consideration of the challenges in sustaining self-management programs long-term.