Developing a model of participation post-stroke: a mixed-methods approach

To develop and verify a model of participation post stroke, as a domain of health related quality of life.

An explanatory sequential mixed-methods design was selected. The quantitative phase developed a participation model with data
from an observational study of 453 participants at 12 months post-stroke, using structural equation modeling. The qualitative
phase followed to verify the model from the perspective of individuals post-stroke. Data was collected from two groups of
eight stroke survivors involved in a multicentre trial about participation in the community. Individuals took photographs
to describe participation; discussion of photographs was conducted over the course of three focus groups, and analysis identified
emergent categories related to the model.

The 12-month post stroke participation model consisted of latent variables: accomplishment, restricted roles, and health efficacy.
The model fit was reasonable: normed χ² = 2.95, RMSEA = 0.066(0.052; 0.079). The qualitative data verified the model; participants initiated photo-taking and discussion
of all aspects of the model. Concepts of social support, environment, and cognitive difficulties were also discussed in relation
to participation.

The participation model was developed and verified. Additions to future models are suggested. Theoretical, clinical, and research
implications are discussed.