Caregivers' perceived enablers of and barriers to adherence to home exercise programmes in stroke survivors

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Science in Physiotherapy Johannesburg, 2017This was a qualitative study design using in-depth caregiver interviews. Ethical clearance was applied for at the University of the Witwatersrand and permission was also obtained from hospital management where the study took place before the commencement of the research project. Interviews were conducted with the caregivers of patients discharged from the hospital where the study took place, who met the inclusion criteria. The interviews took place at the hospital three months post discharge. Verbal and written consent was obtained from all the stroke survivors and caregivers for participation and audio recording of the interviews. The researcher collected all the demographic data from the stroke survivors including BI score. The in-depth interview was conducted by the researcher using an interview schedule. The interview was informal, with open- ended questions, carried out in a conversational style in the participants’ choice of language Afrikaans, English or Setswana. Initially the interview started with structured questions and probing questions followed as necessary for more information or clarification thereof. Audio records and field notes were made during the interview by the researcher. The audio records were transcribed and translated word for word afterwards by the researcher. The data was analysed by the researcher and a second analyser using the general inductive approach and consisted of five main steps. Results: Seven interviews were conducted. The average age of the stroke survivors was 55.8 (±15.03) years, four were female and three were male, five had right sided strokes and two left sided. The average BI score was 47.1%. The average age of the caregivers was 47.8 years (±13.96) years, five were female and two were male all of them were closely related family members. Three were unemployed, two self-employed, one employed and one a pensioner. The most common enablers of adherence to home exercise programmes are: self –motivation, external motivation from friends and family, daily routine, spirituality, carers’ ‘attitudes and desire’ and knowledge. The most common barriers of adherence to home exercise programmes are: general health issues, other responsibilities, lack of family and social support, caregiver burden and stress, low self-efficacy and mood, and fear of falling. Conclusion: It is evident from this study that adherence to home exercise programmes is multifactorial and does not only relate to the stroke survivor alone. Caregivers have a lot of responsibilities and experience emotional strain and burden and this has an influence on stroke survivors’ adherence to home exercise programmes as they rely upon caregivers for assistance. When addressing adherence both the stroke survivor and the caregivers needs to be considered. Being aware of the potential enablers and barriers of adherence to home exercise programmes can give health care professionals insight in how to optimise adherence and possibly improve functional ability and the quality of life of stroke survivors.MT201