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

PURPOSE: To develop and verify a model of participation post stroke, as a domain of health related quality of life. METHODS: 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. RESULTS: The 12-month post stroke participation model consisted of latent variables: accomplishment, restricted roles, and health efficacy. The model fit was reasonable: normed χ(2) = 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. CONCLUSIONS: The participation model was developed and verified. Additions to future models are suggested. Theoretical, clinical, and research implications are discussed.