Table 2.

Developing the theoretical foundation of the ‘Back on Track’ intervention

Aim	Means	Mechanisms of change
To promote resilience after stroke	Enhance resilience practices by means of a group peer support intervention	Social learning, meaning‐making, helping others, social comparison
Objective	Means	Evidence of mechanisms of change
To provide an opportunity to give and receive emotional, appraisal, informational and instrumental support between peers.	Formal and informal exchange of information, knowledge and understanding between stroke survivors	Helping others increases self‐esteem in adults with cancer (Hoey et al. 2008). Downward social comparisons improves perceptions of well‐being in older adults (Beaumont & Kenealy 2004). Group‐based peer support interventions based on social learning theory (peer‐to‐peer learning, modelling behaviours and coping strategies, problem‐solving and goal setting) improves socialisation, healthy coping and role attainment in stroke survivors (Muller et al. 2004), and self‐efficacy, health behaviours and health status for people with heart or lung disease, or diabetes (Lorig et al. 2003).
To foster practical and mental coping strategies for managing life after stroke.		Older stroke survivors use a range of practical and mental coping strategies to promote resilience (our qualitative research) and adjustment after stroke (Sarre et al. 2014) Our qualitative research found that older stroke survivors identified peer support as a factor promoting resilience to aid adjustment after stroke (through peer‐to‐peer learning, sharing experiences, and modelling behaviours).
To provide an opportunity to make sense of stroke and its consequences in a social context.	Stroke survivors sharing experiences with others.	Meaning‐making through sharing experiences with others promotes adjustment to chronic illness (Hydén 1997, Greenhalgh 2006, Newbould et al. 2007). Older stroke survivors use meaning‐making strategies to promote adjustment after stroke (Sarre et al. 2014)
To help people to identify personally valued social activities and roles.	Facilitating reflection and problem‐solving; sharing information and experiences between peers.	Group‐based peer support interventions based on social learning theory (peer‐to‐peer learning, modelling behaviours and coping strategies, problem‐solving and goal setting) improves socialisation, healthy coping and role attainment in stroke survivors (Muller et al. 2004), and self‐efficacy, health behaviours and health status for people with heart or lung disease, or diabetes (Lorig et al. 2003)
To provide information tailored to individual needs.	Providing information on local services, practical support for relevant information, sharing of information between peers, and referral to local services.	Lack of information tailored to meet individual needs and lack of access to services hinders adjustment after stroke (Sarre et al. 2014) (and our qualitative research).