How important are working relationships for stroke self-management? A qualitative study with healthcare professionals in community stroke teams

ObjectiveTo understand healthcare professionals' experiences of developing therapeutic alliances (working relationships) with stroke survivors, and their views on how alliance relates to self-management in community settings.DesignQualitative study.SettingCommunity.ParticipantsHealthcare professionals recruited purposively from four National Health Service community stroke teams in England.Main measuresSemi-structured, one-to-one qualitative interviews, transcribed verbatim and analysed using Braun and Clarke's reflexive thematic analysis.ResultsNineteen clinicians (six physiotherapists, four occupational therapists, two speech and language therapists, two nurses, one psychologist and four people in assistant/trainee roles) were included in the study. Three main themes were developed from the data. (1) <i>The team can't come forever</i>: alliances were shaped by the time-limited nature of community rehabilitation and relied on trust, buy-in, and clearly defined roles and expectations. (2) <i>Therapeutic alliances help and hinder</i>: whilst alliances supported motivation and engagement, complicated power dynamics sometimes undermined self-management. (3) <i>Confusion about what self-management is</i>: participants often equated self-management with self-directed rehabilitation and described a lack of clarity, confidence and training in supporting emotional and long-term adjustment needs. Strong alliances were viewed as essential for self-management, but formal support strategies were rarely used.ConclusionsCommunity-based healthcare professionals consider therapeutic alliance to be the foundation for stroke self-management in the community. However, a limited understanding of self-management among clinicians, combined with unbalanced power dynamics, may restrict patient autonomy. Relationship-based training (e.g. Bridges) and the development of self-management champion roles within organisations may enhance clinicians' confidence and consistency in delivering self-management support in the community.