What is important in supporting self-management in community stroke rehabilitation? A Q methodology study

Figures & data

Figure 1. Q methodology study informing programme theory development and testing within the IMPETUS realist evaluation.

Four separate boxes are shown side by side indicating a process from left to right, starting with a literature search to Q methodology study to realist informed interviews and finally leading to finalised programme theories. Below these four boxes, two arrows show how this process moves from initial programme theories to testing and refining programme theories.

Table 1. Q set and factor scores.

#	Statement	Factor
		F1	F2	F3	F4
1	Being able to reflect on what works well and what doesn’t work well	2	−3**	3*	1
2	Addresses multiple health problems not just stroke	0	1	−2	−3
3	Power and decision making is shared equally between professionals and stroke survivors	−2**	1	2	2
4	Fosters hope	2**	−4**	−1	−2
5	Provides help to manage physical impact of stroke	−1*	3**	−2	−2
6	Working in partnership	−1	−2	0	−1
7	Understanding the person and their needs	2	3	−1**	3
8	Being able to get support from a wide range of local and community organisations	−2*	2*	4*	0*
9	Focuses on personally meaningful goals	4	0**	2	2
10	Provides help to manage emotional impact of stroke	3	3*	2	0**
11	Trusting, supportive relationship	1*	0	1	0
12	Being able to get support online	−4	−4	−1**	−4
13	Sharing and learning from each other	1	−2	1	−2
14	Having adequate resources	−2**	1	3**	1
15	A safe space to learn and practice what works and doesn’t work	−2	−2	1*	−1
16	Builds self-worth and self-belief	3**	0	0	2
17	Having dedicated time for self-management	−3	−3	3**	0**
18	Provision of support as and when it is needed	1**	−1	−2	4**
19	Feeling supported and cared for	0	4**	0	−1
20	Seeing how others in the same boat are doing	0*	−1	−2	−3*
21	Professionals decide what is best for the stroke survivor	−4	−2**	−4	−4
22	Support is tailored to the individuals needs	2*	−1	1	3*
23	Everyone has a clear role to play	−3	0	−4	−1
24	Being listened to	3**	4**	0**	1**
25	A leader or a champion	−3	−3	0**	−3
26	Support from family and friends	−1	2	−1	2
27	Professionals have the appropriate preparation and training for SSM	−1**	1	2	4**
28	Flexibility and freedom to decide what works best for me	0	2	−3**	0
29	Part of routine stroke care	1**	−1	4**	−2
30	SSM is valued and understood by everyone	0	0	−3**	3**
31	Ability to work in a different or creative way to overcome challenges	0	0	−3	0
32	Builds confidence in own abilities and skills	4**	2	0	1

Distinguishing statements marked with *significant at p < 0.05 ** significant at p < 0.01; Statements in italics are consensus statements that do not distinguish between any two pairs of factors at p < 0.05 level.

Figure 2. Q grid.

A grid containing 32 squares in a normal distribution shape with +4 most important on the furthest left number left to right 4 through 0 to −4 on the right for least important.

Table 2. Respondents' stakeholder group and factor association.

Participant	Stakeholder group	Factor 1	Factor 2	Factor 3	Factor 4
%exp var		16	10	6	14
NC2	Clinician	0.45	0.40	0.04	0.18
NC4	Clinician	0.27	0.25	0.16	0.59*
NC5	Clinician	0.47*	0.07	0.05	0.07
NC6	Clinician	0.64*	0.31	−0.09	0.29
NC7	Clinician	0.19	0.41	0.13	0.58*
EC1	Clinician	0.61*	0.18	−0.05	0.42
EC2	Clinician	0.63*	0.29	−0.09	0.34
EC3	Clinician	0.38*	0.15	0.03	0.12
EC4	Clinician	0.72*	0.03	0.20	0.01
EC5	Clinician	0.48	0.33	0.37	0.18
SC1	Clinician	0.25	−0.15	−0.01	0.67*
SC2	Clinician	0.75*	0.11	0.07	0.09
SC3	Clinician	0.62*	0.16	0.35	0.31
SC4	Clinician	0.22	0.47	0.52	0.13
SC5	Clinician	0.46	−0.17	0.07	0.57*
WC2	Clinician	0.62*	0.26	0.11	−0.02
WC4	Clinician	0.25	0.03	0.31	0.45
WC6	Clinician	−0.03	0.03	0.59*	0.19
WC7	Clinician	0.14	−0.02	0.35	0.44*
WC8	Clinician	0.26	0.09	−0.04	0.64*
NM1	Manager	0.49	0.38	0.30	0.28
NM2	Manager	0.13	0.05	−0.01	−0.04
EM1	Manager	0.32	−0.20	0.19	0.32
EM2	Manager	0.09	0.18	0.19	0.48
SM1	Manager	0.64*	−0.21	0.13	0.21
SM2	Manager	0.06	−0.20	0.64*	0.13
WM1	Manager	0.68*	−0.03	0.04	0.22
WM2	Manager	−0.31	−0.21	0.25	0.62*
NS1	Stroke survivor	0.55*	0.27	0.34	0.05
NS2	Stroke survivor	0.09	0.19	0.62*	0.06
NS3	Stroke survivor	0.42	0.25	−0.19	0.42
NS4	Stroke survivor	0.02	0.47	0.11	0.57*
NS5	Stroke survivor	0.02	0.75*	0.04	0.06
ES1	Stroke survivor	0.27	0.15	0.06	0.62*
ES2	Stroke survivor	0.01	0.36	0.07	0.61*
ES3	Stroke survivor	0.12	0.63*	0.14	−0.07
ES5	Stroke survivor	0.51	0.24	0.02	0.48
ES6	Stroke survivor	0.54	0.51	−0.08	0.22
SS1	Stroke survivor	0.18	0.56*	0.25	0.35
SS2	Stroke survivor	0.26	0.41	0.20	0.53
SS3	Stroke survivor	0.00	−0.03	0.02	0.17
SS4	Stroke survivor	0.44*	0.25	0.09	0.20
SS5	Stroke survivor	0.27	0.08	−0.09	−0.10
WS1	Stroke survivor	0.05	0.48*	−0.08	0.13
WS3	Stroke survivor	0.33	0.49	0.16	0.47
WS5	Stroke survivor	0.17	0.27	0.18	0.58*
WS6	Stroke survivor	0.25	0.61*	−0.19	−0.04
WS7	Stroke survivor	0.22	0.45	−0.25	0.41

%exp var: percentage of explained variance. The significance level for factor loadings is taken as 2.58 (SE). SE represents a standard error that is defined as 1/√N where N is the number of statements in the Q set. In this case then, 2.58 (SE) = 2.58 (1/√49) = 0.37. Significant loadings are shown in bold type. The automatic flagging procedure in PQ method software was used to identify defining sorts (*) according to the following rule: Flag loading a: if (1) a² > h²/2 (factor “explains” more than half of the common variance) and (2) a > 1.96/√(N items) (loading “significant at p < 0.05”).

Data availability statement

Consent was not obtained to share anonymised data for this project.