Table 3.

Outline and description of the stages involved in the study

Phase	Stage	Methods
Phase 1a Aim: To identify and describe initial programme theories and underpinning CMOs	1. Initial ideas on ‘what’ supported self-management in stroke is and ‘how’ it is expected to work	Drawn from research team’s previous research Discussions with PPI group, stroke practitioners and researchers working in the field of stroke and self-management research respectively Review of Blogs, Twitter, opinion pieces
	2. Develop and run a preliminary ‘parent’ search of the literature on self-management +stroke	Literature review of primary and secondary data on supported self-management in stroke table 4
	3. Describe specific context, mechanism and outcome configurations sitting underneath each programme theory	Review of relevant papers that meet the inclusion criteria and appear to offer nuggets of information to help unpack the programme theories into CMOs
	4. Initial appraisal (for relevance and rigour) and data extraction	Journaling (writing a description of the paper, how it helps to inform or refine the programme theories/CMOs, its overall quality in the sense of contributing to the developing programme theories) by way of appraisal of the relevance and rigour of the paper Extraction of nuggets of data and evidence relevant to developing programme theories, thematic analysis
	5 Iterative and purposive searches, ongoing appraisal, journaling and data extraction in line with developing theories	Additional, purposive searches of specific bodies of literature that align directly with the programme theories to help develop these further (plus stage 4).
Phase 1b Aim: To describe the components, structure, organisation and contexts of delivery of supported self-management approaches	Scoping and mapping of the implementation of SSM in each case study site	Bespoke proforma created to capture relevant information on structure, organisation and delivery of SSM in each site
Phase 1c Aim: To validate, prioritise and begin refining the initial theories and CMOs	Q-methodology study	Q-sort statements Factor analysis Qualitative follow-up interview comments
Phase 2a Aim: To test and consolidate the programme theories to produce robust, evidence-based explanatory framework	Qualitative realist informed study	Realist informed interviews Realist informed focus groups Framework analysis
Phase 2b Aim: To identify common patterns across the programme theories and provide an explanatory pathway of how SSM works	Seeking out and synthesis of middle range theories	Middle range theory consolidation (apply MRTs based on relevance to explanatory power of programme theories) Programme theory consolidation (confirm, refute or refine) Additional literature search and synthesis (where relevant) Narrative synthesis of evidence for which MRTs can be used to explain the programme theories.

CMO, context, mechanism and outcome; MRT, Mid-Range Theory; PPI, Patient and Public Involvement; SSM, Supported Self-Management.