title: How is rehabilitation with and without an integrated self-management approach perceived by UK community-dwelling stroke survivors? A qualitative process evaluation to explore implementation and contextual variations.
abstract: Self-management programmes could support long-term needs after stroke and using methods integrated into rehabilitation is one option. To explore theoretical assumptions and possible mechanisms of implementation a process evaluation was delivered alongside a cluster trial which has demonstrated feasibility of an integrated self-management programme (Bridges SMP) in community-dwelling stroke survivors. This paper aims to show the extent to which experiences from stroke survivors receiving rehabilitation in control (usual care) and intervention (integrated self-management) sites reflected the differences in rehabilitation received and whether their understandings aligned with the self-management approach employed.
  
  
  
  Semistructured qualitative interviews carried out as part of a process evaluation analysed thematically.
  
  
  
  Study was based in South London; all interviews were carried out in participants' home setting.
  
  
  
  22 stroke participants recruited; 12 from integrated self-management sites and 10 from usual care sites.
  
  
  
  All participants revealed shared appreciation of knowledge and support from therapists but subtle differences emerged between sites in respect to perceptions about responsibility, control and how previous experiences were used. Accounts depicted a variance regarding who had structured and planned their rehabilitation, with greater flexibility about content and involvement perceived by participants from the integrated self-management sites. They also provided accounts and experiences which aligned with principles of the intervention, such as self-discovery and problem-solving.
  
  
  
  The findings reflect our theoretical assumptions and possible mechanisms of implementation that rehabilitation with a focus on supporting self-management is reflected in accounts and understandings of stroke survivors. Taken together with our previous research this justifies evaluating the effectiveness of Bridges SMP in a larger sample to further contribute to an understanding of the functioning of the intervention, implementation, contextual factors and mechanisms of impact.
  
  
  
  ISRCTN42534180; Post-results.
authors.affiliation: Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK.|National Institute for Health Research (NIHR), Collaboration for Leadership in Applied Health Research and Care South London, London, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Jones
authors.affiliation: National Institute for Health Research (NIHR), Collaboration for Leadership in Applied Health Research and Care South London, London, UK.|Division of Health & Social Care Research, Faculty of Life Sciences & Medicine, King's College London, London, UK.|National Institute for Health Research (NIHR), Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: McKevitt
authors.affiliation: Department of Psychology, Royal Holloway University of London, London, UK.
authors.forename: Afsane
authors.initials: A
authors.lastname: Riazi
authors.affiliation: Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK.|School of Science and Health, University of Western Sydney, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Liston
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D016022:Case-Control Studies; D005260:Female; D017144:Focus Groups; D006801:Humans; D057187:Independent Living; D008131:London; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D000073278:Self-Management / Q000379:methods*; D020521:Stroke / Q000628:therapy*; D000071939:Stroke Rehabilitation / Q000379:methods*; D017741:Survivors; D006113:United Kingdom
keywords: QUALITATIVE RESEARCH; rehabilitation; self-management