What does confidence mean to people who have had a stroke? A qualitative interview study.

Objective: To explore the meaning of confidence to stroke patients after stroke in order to inform the development of a measurement tool.

Design: Qualitative interview study using interpretative phenomenological analysis (IPA).

Methods: Ten stroke survivors were purposively selected from those participating in a multi-centre randomised trial of outdoor mobility rehabilitation. Interviews about confidence were conducted in participants' homes, audio recorded and transcribed verbatim.

Results: Six themes emerged from the analysis. These were loss of identity, fear, social confidence, role confidence, mastering skill and attitudes and beliefs. Loss of identity was particularly evident in the early stages of stroke recovery. Fear was a barrier to regaining confidence and was associated with avoidance behaviours. Lack of social confidence was a common problem which appeared difficult to resolve. Life roles motivated participants to re-engage in daily life activities. Personal attitudes and beliefs, combined with the attitudes of significant others, contributed to personal feelings of competence.

Conclusion: This study provides a coherent definition of the meaning of confidence through the experiences of stroke survivors. Being successful in gradually re-engaging in activities, including social activities and life roles helped to establish a positive self-belief. The influence of others, such as family and friends reinforce self-beliefs. Confidence and self-efficacy appear to be a similar construct. However, participants in this study also identified a relationship between confidence and self-esteem. The findings indicate that all six themes need to be included in a confidence measure to encompass the meaning of confidence as described by participants with stroke.