Contextual experiences of Maltese stroke survivors during their rehabilitation journey : an interpretative phenomenological study using status passage theory

Abstract

Introduction: The adjustment period of stroke survivors can be very individualised, as they experience the changes in their lives during rehabilitation, and also when discharged into the community. Understanding the meaning behind stroke survivors’ lived experience of rehabilitation during this process is crucial. On discharge back home, reintegration into the relationships and roles within their familial and societal networks is important to explore, as it is the expression of the status of the ‘stroke patient’ as a person, within their individual cultural context. Exploring contextual lived experience of persons following stroke is therefore essential in the implementation of person-centred care. Methodology: This study aimed to explore Maltese stroke survivors’ lived experience following rehabilitation, on discharge to the community. Participants were interviewed 3 months, 6 months, and 9 months following discharge into the community. Interviews were audiotaped and transcribed verbatim. Interpretative Phenomenological Analysis (IPA) was used to analyse the findings. A specific theory, Status Passage Theory (SPT), was also used in a second analysis of these transcribed interviews to deepen the exploration of the lived experience of stroke survivors during the rehabilitation process. This analysis was done using the five properties of SPT: Reversibility, Desirability, Temporality, Shaping of Status Passage and Multiplicity. Findings: Group Experiential Themes (GETs) constructed from the IPA included the engagement and understanding of rehabilitation during their in-patient stay, limited active participation in the discharge process from the rehabilitation hospital into the community, the meaning of home and family for the Maltese stroke survivor, the diversity of levels of health literacy within participants, and the influence of Maltese familial networks on stroke survivors’ experiences. A matrix constructed from the codes generated from the analysis using SPT indicated that they were aligned with the GETs. The GETs were also displayed in a matrix using a ‘best-fit’ framework approach method, and this matrix showed that they did fit in the five properties of Status Passage, in more than one property of this theory. In this way, this alignment of the properties of the SPT brought out different aspects of the GETs constructed within the IPA, not only at a static point in time, but related to periods of transition across time. It also indicated how some aspects of the GETs constructed from the IPA were influential in the shaping of the status passage of the participants, as stroke survivors during the rehabilitation process. Conclusion: The findings in this study highlighted specific aspects related to active participation, knowledge and understanding required for the contextual management of Maltese stroke survivors within Maltese healthcare systems and within the Maltese sociocultural context. Stroke survivors within this context may benefit from an increase in shared clinical decision-making in the management of their healthcare, including the discharge process, with assistance where necessary. The support of familial networks appears to be a crucial component of their process of recovery whilst back in the community. This vital component may need to be supplemented by the involvement of health care professionals in stroke survivors where this social capital and cohesion are not present, to enable discharge into the community. This individualised approach is an important component of person-centred care.