Research On The Attributes Of Primary Caregiver Needs Of Post-stroke Patients Based On The Kano Model

ObjectiveThe purpose of this study is to analyze the primary caregiver needs of post-stroke patients based on the kano model,to define and prioritize the attributes of primary caregiver needs,to provide reference for meeting the needs of primary caregivers,and then to provide a reference basis for deepening quality care services.Methods(1)Five categories of primary caregiver needs and 29 need entries for post-stroke patients were initially derived using the literature review and focus group discussion methods.(2)The initial needs were revised through two rounds of Delphi expert consultation,deleted,merged and added the demand contents based on expert opinions,resulting in 5 categories and 31 needs for primary caregivers.(3)According to the structured questionnaire design method of the Kano model,positive and negative questions were asked about the 31 needs of the primary caregivers to form the Questionnaire on the Attributes of the Needs of Primary Caregivers of Poststroke Patients based on the Kano model,and the reliability and validity of the questionnaire were tested.(4)A cross-sectional study design was used to survey 349 primary caregivers of post-stroke patients,who met the inclusion and exclusion criteria by convenience sampling using the Kano model-based Primary Caregiver Needs Attributes Questionnaire for Post-stroke Patients in four tertiary care general hospitals in Lanzhou City from August 2022 to January 2023;data were entered using Excel and SPSS 26.0software was used for data analysis;descriptive statistics were used to analyze the general information of patients and primary caregivers,measures were expressed as mean ± standard deviation or median and interquartile spacing depending on whether they conformed to a normal distribution.,and frequency and percentage were used for count data;Based on Kano model theory,the "maximum frequency method" was used to define the attributes of the primary caregiver needs,and the two-dimensional matrix analysis and the average satisfaction coefficient(ASC)were used to prioritize the needs.Results(1)Results of the reliability test of the "Primary Caregiver Needs Attributes Questionnaire for Post-stroke Patients" based on the Kano model: Cronbach’s αreliability coefficient was used to evaluate the reliability of the questionnaire,and the overall Cronbach’s α reliability coefficients for the forward and reverse questions were0.902 and 0.923,respectively.KMO value was used to test the validity analysis,and the KMO values of forward and reverse problems were 0.878 and 0.913,respectively.(2)Results of defining the attributes of the main caregiver needs:The one-dimensional attributes include 8 needs(25.80%):: information on the signs of stroke and emergency treatment measures,information on common complications of stroke and daily preventive measures,guidance on the management of patients’ healthy life patterns(diet,exercise,smoking cessation,etc.),guidance on toileting techniques for patients with hemiplegia,guidance on rehabilitation training of patients’ swallowing function,getting enough rest,information on channels to seek professional help,guidance on ways to relieve their own psychological stress,etc.8(25.80%)needs;Must-be attributes include 10 needs(32.26%): informing about the causes and risk factors of stroke,informing about the use of commonly used drugs and precautions for medication,informing patients about the time and content of post-discharge review,instructing on how to properly and effortlessly transfer patients to beds and chairs,instructing on pressure injury care techniques,methods of lower limb massage for hemiplegic patients(to prevent venous thrombosis,muscle atrophy,etc.),instructing on methods to assist hemiplegic patients to effectively use assistive tools,instructing patients on limb rehabilitation training,coordinating their work,life and care tasks,and continuing to maintain their social interaction activities;The attractive attributes include 7 needs(22.58%): informing the clinical manifestations of the common sequelae of stroke(motor impairment,cognitive impairment,speech and swallowing disorders,etc.),guidance on the care techniques for turning and tapping the back of patients with pneumonia,guidance on measures to deal with choking and coughing,guidance on skills related to maintaining the psychological and social functions of post-stroke patients,regular lectures on the topic of stroke care,regular organization of caregiver exchange sessions,application for socio-economic assistance,and other seven needs;The indifferent attributes include 6 needs(19.35%): informing the characteristics of stroke course and typical clinical manifestations,guidance on dressing and undressing of patients,guidance on body cleaning of patients,guidance on oral care techniques,guidance on rehabilitation training of patients’ cognitive function,and provision of rehabilitation exercise sites and equipment in the community.(3)Primary caregiver needs project prioritization results:The top three primary caregiver needs in the one-dimensional attributes were:guidance on how to relieve psychological stress,information on the signs of stroke and emergency measures,and guidance on rehabilitation training of swallowing function;The top three primary caregiver needs in the attractive attributes were: information on the clinical manifestations of common sequelae of stroke(motor disorders,cognitive disorders,speech and swallowing disorders,etc.),guidance on the management of choking,and guidance on skills related to maintaining psychological and social functions of post-stroke patients,The top three needs of primary caregivers in the charismatic attribute were: clinical manifestations of common sequelae of stroke(motor impairment,cognitive impairment,speech and swallowing impairment,etc.),guidance on how to deal with choking and coughing,and guidance on skills related to maintaining psychological and social functions of patients after stroke;in the must-be attribute,The top three needs of primary caregivers were: guidance on how to assist patients with hemiplegia to use assistive devices effectively,guidance on physical rehabilitation training,and coordination of their work,life and care tasks;among the indifferent attributes,the top three needs of primary caregivers were,in order of priority,to be informed of the characteristics and typical clinical manifestations of stroke,to be instructed in dressing and undressing,and to be instructed in cognitive rehabilitation.Conclusion(1)The primary caregiver needs attribute questionnaire for post-stroke patients constructed in this study includes 5 dimensions and 31 items with good reliability and validity,which can be used as a survey tool for the primary caregiver needs of poststroke patients.(2)Among the 31 need items,8 needs are desired attributes,10 needs are essential attributes,7 needs are charming attributes,and 6 needs are non-differential attributes.Health care workers should combine the results of Kano model analysis to ensure the satisfaction of each need of the primary caregiver in order to enhance the satisfaction of the primary caregiver.(3)Health care workers should improve their services according to the priority order in which the needs of primary caregivers are met,allocate resources appropriately,and optimize services.