Factors influencing stroke survivors' reintegration into a rural community: Perspectives from a municipality in Limpopo Province, South Africa

Abstract

Background:  Stroke incidence remains high in South Africa.  Access to rehabilitation services is critical for stroke survivors to successfully reintegrate back into the community.  This study aimed to explore the factors that influence stroke survivors' reintegration into the community to inform contextually relevant rural rehabilitation processes.

Methods:  A sequential, explanatory mixed-method research design was used.  Quantitative data were collected through a file audit of 15 participants.  The qualitative data were sourced through semi-structured interviews with 15 purposively selected  stroke survivors and three rehabilitation team members.  The five themes identified were stroke survivors' meaningful occupations, enablers for community reintegration, barriers to community reintegration, stroke survivors' and caregivers' perceptions on rehabilitation processes for improved stroke rehabilitation.  Work was the most affected occupation reported, followed by socialisation and the least affected was Basic Activities of Living (BADL) and Instrumental Activities of Daily Living (IADL).  Facilitators included accessibility to assistive devices, positive attitude and community support of the rehabilitation team.  Main barriers were residual impairments and limited hospital resources.

Conclusion:  Early intervention, provision of assistive devices and continued community interventions strengthen the stroke survivors' reintegration into the community.

Implications for practice:

• Work is the most affected occupation in stroke survivors, followed by socialisation and the least affected were BADLs and IADLs
• Continued support to the stroke survivors and caregivers through support groups in the community is needed to increase awareness of stroke sequelae, caregiver relief and fostering social participation
• Return to work rehabilitation for stroke survivors should include a routine vocational rehabilitation programme that is individually structured to assist the stroke survivors to adapt to the work routine
• Occupational therapist should also initiate vocational training such as entrepreneurial skills and subsistence agriculture in collaboration with other sectors such as the Department of Agriculture, to assist the stroke survivors and their caregivers to support their families.