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Background: Stroke rehabilitation increasingly takes place at home, where individuals are expected to take a more active role in managing life after stroke. Internationally, self-management support has gained attention as an approach to strengthening confidence, autonomy and participation. However, in Sweden, this is not yet an established part of stroke rehabilitation and knowledge remains limited regarding how it is understood, experienced, implemented and evaluated in this context.

Aim: The overall aim of this thesis was to expand knowledge of self-management after stroke and to explore how self-management support can be understood, implemented and measured in Swedish stroke rehabilitation.

Methods: This thesis comprise four studies using multiple methods. Study I explored how people with stroke experienced and practised self-management in everyday life after discharge. Study II reviewed barriers and enablers related to implementing self-management support in stroke rehabilitation. Study III described the translation and cross-cultural adaptation of the Stroke Self-Efficacy Questionnaire into Swedish, including preliminary assessments of content and face validity. Study IV evaluated the implementation of the Bridges self-management programme in two Swedish stroke sites, using qualitative and quantitative data to examine the implementation process.

Results: Self-management after stroke was shaped by confidence, readiness, relationships, and context. Across the studies, self-management support emerged as relational and context-dependent rather than as an isolated individual activity. In Swedish stroke rehabilitation, introducing self-management support required not only changes in practice, but also conceptual clarification, since healthcare practitioners and people with stroke expressed varied understandings of self-management. The implementation of Bridges increased awareness among healthcare practitioners and contributed to small shifts in communication with patients, but patient-level impact remained limited. Implementation was influenced by leadership support, team engagement, organisational stability, and available time and resources. The Swedish version of the Stroke Self-Efficacy Questionnaire provided a culturally adapted instrument for future research and clinical evaluation.

Conclusions: The findings suggest that developing self-management support in Swedish stroke rehabilitation requires not only changes in practice, but also conceptual clarity, recognition of the relational and contextual nature of self-management, appropriate ways of evaluation and organisational support over time.