{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T18:58:30Z","timestamp":1791313110762,"version":"4.3.1"},"reference-count":63,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2021,11,23]],"date-time":"2021-11-23T00:00:00Z","timestamp":1637625600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000364","name":"The Stroke Association","doi-asserted-by":"crossref","award":["SA PDF 19\\100011"],"award-info":[{"award-number":["SA PDF 19\\100011"]}],"id":[{"id":"10.13039\/501100000364","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Self-management is a promising approach to improve quality of life after stroke. However, evidence for the appropriateness and effectiveness of self-management for stroke survivors with aphasia is limited. This article reports on the process used to develop a supported self-management intervention for stroke survivors with aphasia (SSWA) using co-production and behaviour change theory. Preparatory research included systematic reviews, and qualitative interviews and focus groups with SSWA, family members and speech and language therapists (SLTs).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>We conducted six, 2 hour long intervention development workshops with key stakeholders. The workshops were informed by principles of co-production and the intervention development process outlined by the Behaviour Change Wheel (BCW). We also incorporated the findings of our preparatory research within workshops. Each workshop included an introduction, 1\u20132 co-production tasks and time for feedback at the end of the session. Data were analysed on an ongoing basis so that findings could be used to feed in to subsequent workshops and intervention development.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Workshop participants (n = 12) included; SSWA (n = 5), family members (n = 3) and SLTs (n = 4). Together, participants engaged with accessible and participatory co-production tasks which aligned with the BCW framework. Participants engaged in discussion to define self-management in behavioural terms (behavioural diagnosis) and to identify what needed to change to support self-management. Participant\u2019s co-produced solutions for supporting self-management and discussed options to implement these in practice. Prototype materials were generated by the research team and evaluated by participants. Intervention functions and behaviour change techniques (BCTs) were mapped to the solutions generated by participants by the research team, after the final workshop. A supported self-management intervention for SSWA was developed which will be delivered by SLTs through community stroke services.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>This paper reports the process we used to integrate co-production work with behaviour change theory to develop a complex self-management intervention. This is of relevance for researchers looking to harness the strengths of co-production methods and theory in intervention design. Future research will feasibility test the supported self-management intervention developed. This paper provides transparency to our intervention development process which will help others to better interpret the findings of our feasibility work.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0259103","type":"journal-article","created":{"date-parts":[[2021,11,23]],"date-time":"2021-11-23T20:14:49Z","timestamp":1637698489000},"page":"e0259103","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":26,"title":["Development of a self-management intervention for stroke survivors with aphasia using co-production and behaviour change theory: An outline of methods and processes"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9351-5019","authenticated-orcid":true,"given":"Faye","family":"Wray","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Clarke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeline","family":"Cruice","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Forster","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,11,23]]},"reference":[{"issue":"9913","key":"pone.0259103.ref001","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/S0140-6736(13)61953-4","article-title":"Global and regional burden of stroke during 1990\u20132010: findings from the Global Burden of Disease Study 2010","volume":"383","author":"VL Feigin","year":"2014","journal-title":"The Lancet"},{"issue":"12","key":"pone.0259103.ref002","doi-asserted-by":"crossref","first-page":"2188","DOI":"10.1016\/j.apmr.2016.03.006","article-title":"Poststroke aphasia frequency, recovery, and outcomes: a systematic review and meta-analysis","volume":"97","author":"HL Flowers","year":"2016","journal-title":"Archives of physical medicine and rehabilitation"},{"issue":"3","key":"pone.0259103.ref003","doi-asserted-by":"crossref","first-page":"211","DOI":"10.3109\/09638288.2010.508829","article-title":"The impact of stroke: are people with aphasia different to those without?","volume":"33","author":"K Hilari","year":"2011","journal-title":"Disability & Rehabilitation"},{"issue":"12","key":"pone.0259103.ref004","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1080\/02687030600790136","article-title":"Quantifying aphasic people\u2019s social lives in the context of non-aphasic peers","volume":"20","author":"M Cruice","year":"2006","journal-title":"Aphasiology"},{"issue":"6","key":"pone.0259103.ref005","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1159\/000016107","article-title":"Aphasia, depression, and non-verbal cognitive impairment in ischaemic stroke","volume":"10","author":"M-L Kauhanen","year":"2000","journal-title":"Cerebrovascular Diseases"},{"issue":"10","key":"pone.0259103.ref006","doi-asserted-by":"crossref","first-page":"e017944","DOI":"10.1136\/bmjopen-2017-017944","article-title":"Longer-term needs of stroke survivors with communication difficulties living in the community: a systematic review and thematic synthesis of qualitative studies","volume":"7","author":"F Wray","year":"2017","journal-title":"BMJ open"},{"issue":"1","key":"pone.0259103.ref007","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1186\/s13063-018-2669-5","article-title":"An intervention to support stroke survivors and their carers in the longer term (LoTS2Care): study protocol for a cluster randomised controlled feasibility trial","volume":"19","author":"A Forster","year":"2018","journal-title":"Trials"},{"issue":"8","key":"pone.0259103.ref008","doi-asserted-by":"crossref","first-page":"2212","DOI":"10.1161\/STROKEAHA.115.008585","article-title":"Cluster Randomized Controlled Trial Clinical and Cost-Effectiveness of a System of Longer-Term Stroke Care","volume":"46","author":"A Forster","year":"2015","journal-title":"Stroke"},{"key":"pone.0259103.ref009","first-page":"afp095","article-title":"Structured re-assessment system at 6 months after a disabling stroke: a randomised controlled trial with resource use and cost study","author":"A Forster","year":"2009","journal-title":"Age and ageing"},{"issue":"1","key":"pone.0259103.ref010","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1111\/j.1747-4949.2011.00722.x","article-title":"A cluster randomized controlled trial of a structured training programme for caregivers of inpatients after stroke (TRACS)","volume":"7","author":"A Forster","year":"2012","journal-title":"International Journal of Stroke"},{"issue":"2","key":"pone.0259103.ref011","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/S0738-3991(02)00032-0","article-title":"Self-management approaches for people with chronic conditions: a review","volume":"48","author":"J Barlow","year":"2002","journal-title":"Patient Educ Couns"},{"key":"pone.0259103.ref012","article-title":"Self management programmes for quality of life in people with stroke","volume":"8","author":"C Fryer","year":"2016","journal-title":"The Cochrane Library"},{"issue":"1","key":"pone.0259103.ref013","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1207\/S15324796ABM2601_01","article-title":"Self-management education: history, definition, outcomes, and mechanisms","volume":"26","author":"KR Lorig","year":"2003","journal-title":"Annals of behavioral medicine"},{"key":"pone.0259103.ref014","unstructured":"Department of Health. National Stroke Strategy2007 13th September 2017. http:\/\/webarchive.nationalarchives.gov.uk\/20130105121530\/http:\/\/www.dh.gov.uk\/en\/Publicationsandstatistics\/Publications\/PublicationsPolicyandguidance\/dh_081062."},{"key":"pone.0259103.ref015","volume-title":"National clinical guideline for stroke","year":"2016","edition":"5"},{"key":"pone.0259103.ref016","unstructured":"Stroke Foundation. (Australian) Clinical Guidelines for Stroke Management2017 6 August 2018. https:\/\/informme.org.au\/en\/Guidelines\/Clinical-Guidelines-for-Stroke-Management-2017."},{"issue":"6","key":"pone.0259103.ref017","doi-asserted-by":"crossref","first-page":"e98","DOI":"10.1161\/STR.0000000000000098","article-title":"Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"47","author":"CJ Winstein","year":"2016","journal-title":"Stroke"},{"issue":"4","key":"pone.0259103.ref018","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1177\/1747493016643553","article-title":"Canadian stroke best practice recommendations: stroke rehabilitation practice guidelines, update 2015","volume":"11","author":"D Hebert","year":"2016","journal-title":"International Journal of Stroke"},{"issue":"11","key":"pone.0259103.ref019","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1080\/09638288.2017.1294206","article-title":"Post-stroke self-management interventions: a systematic review of effectiveness and investigation of the inclusion of stroke survivors with aphasia","volume":"40","author":"F Wray","year":"2018","journal-title":"Disability and rehabilitation"},{"issue":"8","key":"pone.0259103.ref020","first-page":"e029954","volume":"9","author":"A O\u2019Cathain","year":"2019","journal-title":"Guidance on how to develop complex interventions to improve health and healthcare"},{"issue":"1","key":"pone.0259103.ref021","first-page":"41","volume":"5","author":"A O\u2019Cathain","year":"2019","journal-title":"Taxonomy of approaches to developing interventions to improve health: a systematic methods overview"},{"issue":"1","key":"pone.0259103.ref022","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s13012-017-0553-4","article-title":"Intervention planning for a digital intervention for self-management of hypertension: a theory-, evidence- and person-based approach","volume":"12","author":"R Band","year":"2017","journal-title":"Implementation Science"},{"issue":"11","key":"pone.0259103.ref023","doi-asserted-by":"crossref","first-page":"e003534","DOI":"10.1136\/bmjopen-2013-003534","article-title":"Pain management for chronic musculoskeletal conditions: the development of an evidence-based and theory-informed pain self-management course","volume":"3","author":"D Carnes","year":"2013","journal-title":"BMJ open"},{"issue":"1","key":"pone.0259103.ref024","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13012-016-0418-2","article-title":"Using intervention mapping to develop a theory-driven, group-based complex intervention to support self-management of osteoarthritis and low back pain (SOLAS)","volume":"11","author":"DA Hurley","year":"2015","journal-title":"Implementation Science"},{"issue":"5","key":"pone.0259103.ref025","first-page":"472","volume":"12","author":"MF Walker","year":"2017","journal-title":"Improving the development, monitoring and reporting of stroke rehabilitation research: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable"},{"issue":"9","key":"pone.0259103.ref026","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1080\/14719037.2014.930505","article-title":"A systematic review of co-creation and co-production: Embarking on the social innovation journey","volume":"17","author":"WH Voorberg","year":"2015","journal-title":"Public Management Review"},{"key":"pone.0259103.ref027","unstructured":"SCIE. Co-production in social care: What it is and how to do it2015 07 August 2020. https:\/\/www.scie.org.uk\/publications\/guides\/guide51\/."},{"key":"pone.0259103.ref028","volume-title":"The behaviour change wheel: a guide to designing interventions","author":"S Michie","year":"2014"},{"issue":"1","key":"pone.0259103.ref029","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/1748-5908-6-42","article-title":"The behaviour change wheel: a new method for characterising and designing behaviour change interventions","volume":"6","author":"S Michie","year":"2011","journal-title":"Implementation science"},{"issue":"1","key":"pone.0259103.ref030","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1037\/a0016939","article-title":"Are interventions theory-based? Development of a theory coding scheme","volume":"29","author":"S Michie","year":"2010","journal-title":"Health psychology"},{"key":"pone.0259103.ref031","doi-asserted-by":"crossref","first-page":"h1258","DOI":"10.1136\/bmj.h1258","article-title":"Process evaluation of complex interventions: Medical Research Council guidance","volume":"350","author":"GF Moore","year":"2015","journal-title":"bmj"},{"key":"pone.0259103.ref032","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1136\/bmjqs-2015-004315","article-title":"Coproduction of healthcare services","volume":"25","author":"M Batalden","year":"2015","journal-title":"BMJ Quality & Safety"},{"issue":"5","key":"pone.0259103.ref033","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1136\/qshc.2005.016527","article-title":"Experience-based design: from redesigning the system around the patient to co-designing services with the patient","volume":"15","author":"P Bate","year":"2006","journal-title":"BMJ Quality & Safety"},{"key":"pone.0259103.ref034","unstructured":"MRC. Developing and evaluating complex interventions: new guidance2008 17th July 2015. www.mrc.ac.uk\/documents\/pdf\/complex-interventions-guidance\/."},{"key":"pone.0259103.ref035","article-title":"How do stroke survivors with communication difficulties manage life after stroke in the first year? A qualitative study","author":"F Wray","year":"2019","journal-title":"International Journal of Language & Communication Disorders"},{"key":"pone.0259103.ref036","first-page":"1","article-title":"\u201cGuiding them to take responsibility\u201d: exploring UK speech and language therapists\u2019 views of supporting self-management of aphasia","author":"F Wray","year":"2019","journal-title":"Aphasiology"},{"issue":"1","key":"pone.0259103.ref037","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1186\/s40814-020-00667-1","article-title":"A co-production approach guided by the behaviour change wheel to develop an intervention for reducing sedentary behaviour after stroke","volume":"6","author":"J Hall","year":"2020","journal-title":"Pilot and Feasibility Studies"},{"issue":"5","key":"pone.0259103.ref038","first-page":"639","article-title":"Co-production and the co-creation of value in public services: a suitable case for treatment?","volume":"18","author":"SP Osborne","year":"2016","journal-title":"Pmr"},{"issue":"1","key":"pone.0259103.ref039","first-page":"20","article-title":"Collaborative research and the co-production of knowledge for practice: an illustrative case study","volume":"11","author":"J Heaton","year":"2015","journal-title":"IS"},{"issue":"1","key":"pone.0259103.ref040","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1186\/s12889-017-4695-8","article-title":"Development of a framework for the co-production and prototyping of public health interventions","volume":"17","author":"J Hawkins","year":"2017","journal-title":"BMC public health"},{"key":"pone.0259103.ref041","volume-title":"Frenchay Aphasia Screening Test","author":"P Enderby","year":"2013","edition":"3"},{"issue":"12","key":"pone.0259103.ref042","first-page":"1083","article-title":"Development of a reliable self-report outcome measure for pragmatic trials of communication therapy following stroke: the Communication Outcome after Stroke (COAST) scale","volume":"22","author":"A Long","year":"2008","journal-title":"CR"},{"key":"pone.0259103.ref043","unstructured":"Stroke Association. Accessible Information Guidelines. London: Stroke Association; 2012. https:\/\/www.stroke.org.uk\/shop\/product\/accessible-information-guidelines."},{"key":"pone.0259103.ref044","unstructured":"Chest Heart & Stroke Scotland. Allan in the street: YouTube; 2015 [03 March 2021]. https:\/\/www.youtube.com\/watch?v=sghniTVIY8s."},{"key":"pone.0259103.ref045","unstructured":"Clark E. What is self-management? Watch this video and see. Twitter2017 [cited 2021 03 March 2021]. https:\/\/twitter.com\/clark_ev\/status\/826028658141888512?s=03."},{"key":"pone.0259103.ref046","unstructured":"The Stroke Association. Rebuilding Lives: Alisha\u2019s story 2019 [03 March 2021]. https:\/\/www.stroke.org.uk\/rebuilding-lives\/alisha."},{"issue":"10","key":"pone.0259103.ref047","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1177\/0269215509337197","article-title":"Facilitating the participation of people with aphasia in research: a description of strategies","volume":"23","author":"R Dalemans","year":"2009","journal-title":"Clinical Rehabilitation"},{"issue":"2","key":"pone.0259103.ref048","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1080\/02687030601065470","article-title":"Interviewing people with aphasia: Insights into method adjustments from a pilot study","volume":"21","author":"AM Luck","year":"2007","journal-title":"Aphasiology"},{"issue":"02\u201304","key":"pone.0259103.ref049","first-page":"327","volume":"20","author":"C Croteau","year":"2006","journal-title":"Overprotection, \u201cspeaking for\u201d, and conversational participation: A study of couples with aphasia"},{"issue":"4","key":"pone.0259103.ref050","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1080\/02687030344000616","article-title":"\u201cSpeaking for\u201d behaviours in spouses of people with aphasia: A descriptive study of six couples in an interview situation","volume":"18","author":"C Croteau","year":"2004","journal-title":"Aphasiology"},{"key":"pone.0259103.ref051","unstructured":"BCT taxonomy. BCT taxonomy v1 online training: British Websites; 2021 [02 March 2021]. https:\/\/www.bct-taxonomy.com\/."},{"issue":"1","key":"pone.0259103.ref052","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1080\/15710882.2015.1020316","article-title":"Codesign with people living with cognitive or sensory impairments: a case for method stories and uniqueness","volume":"11","author":"N Hendriks","year":"2015","journal-title":"CoDesign"},{"issue":"1","key":"pone.0259103.ref053","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1080\/15710882.2014.997744","article-title":"Codesign for people with aphasia through tangible design languages","volume":"11","author":"S Wilson","year":"2015","journal-title":"CoDesign"},{"issue":"1","key":"pone.0259103.ref054","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1080\/15710882.2014.888183","article-title":"Probes, toolkits and prototypes: three approaches to making in codesigning","volume":"10","author":"EB-N Sanders","year":"2014","journal-title":"CoDesign"},{"issue":"3","key":"pone.0259103.ref055","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1080\/17437199.2016.1190291","article-title":"Celebrating variability and a call to limit systematisation: the example of the Behaviour Change Technique Taxonomy and the Behaviour Change Wheel","volume":"10","author":"J Ogden","year":"2016","journal-title":"Health psychology review"},{"key":"pone.0259103.ref056","unstructured":"Iriss. Co-production project planner 2020 [cited 2021 05 Feb]. https:\/\/www.iriss.org.uk\/resources\/tools\/co-production-project-planner."},{"key":"pone.0259103.ref057","unstructured":"North East Social Enteprise Partnership. Introduction to the Principles of Participatory Appraisal 2014 [5 Feb 2021]. https:\/\/www.northumberlandcva.org.uk\/files\/NESEP_Participatory_Appraisal_Handbook_2014.pdf."},{"issue":"7","key":"pone.0259103.ref058","doi-asserted-by":"crossref","first-page":"e014650","DOI":"10.1136\/bmjopen-2016-014650","article-title":"What outcomes are associated with developing and implementing co-produced interventions in acute healthcare settings? A rapid evidence synthesis","volume":"7","author":"D Clarke","year":"2017","journal-title":"BMJ open"},{"issue":"5","key":"pone.0259103.ref059","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1080\/02687038.2018.1431830","article-title":"Combating social isolation for people with severe chronic aphasia through community aphasia groups: consumer views on getting it right and wrong","volume":"32","author":"L Lanyon","year":"2018","journal-title":"Aphasiology"},{"issue":"1","key":"pone.0259103.ref060","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1080\/02687030701521786","article-title":"Informed consent and aphasia: Evidence of pitfalls in the process","volume":"23","author":"C Penn","year":"2009","journal-title":"Aphasiology"},{"key":"pone.0259103.ref061","doi-asserted-by":"crossref","first-page":"g1687","DOI":"10.1136\/bmj.g1687","article-title":"Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide","volume":"348","author":"TC Hoffmann","year":"2014","journal-title":"Bmj"},{"issue":"53","key":"pone.0259103.ref062","doi-asserted-by":"crossref","DOI":"10.3310\/hsdr02530","article-title":"A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS\u2013Practical systematic Review of Self-Management Support for long-term conditions","volume":"2","author":"SJ Taylor","year":"2014","journal-title":"Health services and delivery research"},{"issue":"10","key":"pone.0259103.ref063","doi-asserted-by":"crossref","first-page":"797","DOI":"10.3109\/09638288.2010.511415","article-title":"Self-efficacy and self-management after stroke: A systematic review","volume":"33","author":"F Jones","year":"2011","journal-title":"Disability and Rehabilitation: An International, Multidisciplinary Journal"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0259103","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,23]],"date-time":"2021-11-23T20:15:57Z","timestamp":1637698557000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0259103"}},"subtitle":[],"editor":[{"given":"Andrew","family":"Soundy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,11,23]]},"references-count":63,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0259103","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,23]]}}}