1. The Southampton Stroke Self-Management Questionnaire (SSSMQ)
Development of a new patient-reported outcome measure (PROM) for self- management:
The Southampton Stroke Self-Management Questionnaire (SSSMQ)
Dr. Emma Boger* (Snr Research Fellow, Dr. Matthew Hankins (Biostatistician), Dr. Sara Demain (NIHR Post-doc research fellow), Prof. Sue Latter (Professor of Nursing)
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Introduction – Self-management interventions (SMIs) are important to the long-term health and well-being of people following stroke1,2. However, (the) assessment of how effective SMIs are is limited by measures that are inappropriate or of variable quality 3. Here we report upon the development of a new patient-report outcome measure (PROM) of self-management competency following stroke: the Southampton Stroke Self-Management Questionnaire (SSSMQ).
Method - A mixed methods paradigm with three phases was adopted (Figure 1). Focus groups were conducted (n=28) to identify the factors influencing self-management from the perspectives of people following stroke to inform the preliminary item content of a PROM4. Cognitive Interviewing (n=11) was next employed to ensure item acceptability. Finally, a nationally derived convenience sample of people with stroke (n=87) completed the SSSMQ, Stroke Self-Efficacy Questionnaire and Stroke Impact Scale to assess reliability and validity. Scaling properties were assessed using Mokken Scale Analysis5.
Qualitative investigation (n=28)
Development of preliminary items
Cognitive interviewing (n=11))
Mokken Scale analysis
(n=87)
Reliability and validity testing
Figure 1. Development process of the SSSMQ
Results –Mokken analysis refined the preliminary items from 44 to 28 scalable items. All hypothesised correlations with the SEQ and SIS were significant and held in the expected direction (Pearsons’ r , p<0.01), demonstrating good evidence for preliminary construct validity (range . Internal consistency reliability (Mokken r=0.89) and test-retest reliability (ICC=0.928) were excellent.
Conclusion –The Southampton Stroke Self-Management Questionnaire (SSSMQ) consists of 28 items that form a unidimensional scale measuring self-management competency and which demonstrates excellent reliability and good evidence of validity. The SSSMQ is useful for the evaluation of self-management competency following stroke, and may be useful for guiding the content of new SMIs.
Figure 2. Example items from the SSSMQ
1. Jones, F, Riazi, A and Norris, M (2013) Self-management after stroke: time for some more questions? Disability and Rehabilitation, 35(3):
2. Lennon, S, McKenna, S, Jones, F (2013) Self-management programmes for people post stroke: a systematic review. Clinical Rehabilitation, 27(10):
3. Boger, EJ, Demain, D, Latter S (2013) Self-management: a systematic review of outcome measures adopted in self-management interventions for stroke. Disability and Rehabilitation, 35(16-17): 1415–1428
4. Boger, E., Demain, S. & Latter, S. Stroke self-management: A focus group study to identify the factors influencing self-management following stroke. International Journal of Nursing Studies, early online. DOI:
5. Mokken, R (1971). The theory and procedure of scale analysis with applications in political research, New York: Walter de Gruyter, Mouton