Determining and comparing the activity requirements and participation experiences of Xhosa Women with stroke in relation to life roles in rural and urban environments

[摘要] ENGLISH SUMMARY : Introduction: Stroke impacts on a person's body function, performance in meaningful activities and participation in life roles. The complex health transition in South Africa has seen a rise in the incidences of stroke in a younger population.Objectives: The aim of this study is to describe and compare the activity requirements and personal experiences of Xhosa women with stroke in relation to performance of their life roles in rural and urban settings.Methods: This descriptive, cross-sectional study uses a convergent mixed method design. Quantitative and qualitative data was obtained from 11 participants in the rural setting of the Eastern Cape and 9 participants in the Western Cape of South Africa.The quantitative data was obtained using the Barthel Index, EuroQol five-dimension questionnaire (EQ-5D). A self-developed questionnaire was used to gather information on participants' demographic and environmental information. The qualitative data was obtained by doing individual semi-structured interviews. The quantitative data was analysed using summative and descriptive statistics in MS Excel and STATA 14 software. The qualitative data was analysed using deductive and inductive analysis in Atlas.ti version 7 software. Complementary data from different data sources were triangulated.Results: The median age for the rural participants was 42 years (28-72) and 56 years (31-65) for urban participants. In the rural setting, most participants reported that they relied on natural water sources and has poor access to sanitation services.The total median BI score was 80 for rural (40-95) and urban (10-100) participants. The median scores for rural participants were higher in bathing and mobility, while urban participants score higher in feeding and transfers. The median EQ-5D VAS score was 50 (30-80) in rural and 55 (20-90) in urban participants. The rural participants reported less problems associated with HRQoL state dimensions for self-care and, anxiety and dimension.The deductive analysis of the qualitative data described the life roles of Xhosa women as self-care role, being a provider, caregiver and community members. These role responsibilities and how environmental factors shaped activities and task requirements were described and compared between both setting. The inductive findings of the qualitative data described the personal experiences of Xhosa women with stroke within three emerging themes namely: theme 1 – 'I struggle with nothing, they do so much for me, theme 2 – 'I still like looking smart and theme 3 – 'Dead, but alive. These themes associated with participants' perception of family support and their drive to strategize in order to participate in life roles.Conclusion: This study found that life roles for women with stroke in rural and urban settings were similar. However, the activity requirements of role responsibilities were shaped by the environmental factors in rural and urban setting, leading to additional task requirements to overcome barriers. Participants' participation experiences were similar in rural and urban settings as perception of their social support contributed to their perceived HRQoL. The overlapping of data sources in this study highlighted the limitation of the BI in addressing the contextual factors influencing activities of daily living and comparing scores between populations in different settings or cultures.

[发布机构] Stellenbosch University