Experiences and needs of the caregivers of stroke survivors in Malaysia-A phenomenological exploration

Explaining the multifaceted experiences of family caregivers of stroke survivors: a qualitative study in Iran

OBJECTIVES

As the family caregivers of stroke survivors are typically subjected to care burden, spirituality has been advocated to protect them from its negative effects. The purpose of this study was to describe the caregiving experiences of family caregivers of stroke survivors.

DESIGN

This qualitative study was conducted from December 2023 to June 2024 in Iran. Data were analysed using the conventional content analysis method.

SETTING

The study was conducted in the neurology wards of two referral hospitals affiliated with Shahid Beheshti University of Medical Sciences in Tehran, Iran.

PARTICIPANTS

After meeting the inclusion criteria, a total of 17 family caregivers of stroke survivors were recruited using the purposive sampling technique with maximum variation. Data were then collected through 17 in-depth semistructured interviews, each lasting 30-60 min.

RESULTS

Four themes emerged from the study participants' statements: (1) 'challenges and struggles', (2) 'religious coping strategies', (3) 'psychological coping strategies' and (4) 'social and relational dynamics'. The core concept of 'balancing hope and hardship' was then introduced.

CONCLUSION

The study findings highlight the need to develop comprehensive support programmes for family caregivers of stroke survivors to minimise their caregiving burden. Healthcare planners and providers are encouraged to use these findings to improve the health outcomes of these families and reduce the burden of caregiving.

Knowledge, Attitudes and Practice of Informal Caregivers of People Living With Stroke: A Scoping Review of Recent Literature

AIMS

The study aimed to explore the recent scientific literature regarding the knowledge, attitudes and practices of informal caregivers towards supporting a person with astroke.

DESIGN

This study was a scoping review that followed the Joanna Briggs Institute (JBI) methodology and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Scoping Review extension) guidelines.

DATA SOURCES

Searches were conducted across Medline, CINAHL, PsycINFO, EMBASE, Cochrane, SCOPUS and Web of Science from January 2009 to January 2024.

REVIEW METHODS

The search results from the various database sources were collated in EndNote 20 and duplicates were removed. Following the removal of duplicates, the studies were imported to Covidence and filtered based on the well-defined eligibility criteria. Three reviewers independently conducted screening and data extraction, and any conflicts were resolved through discussion.

RESULTS

The analysis included a total of 37 studies that focused on the knowledge, attitudes and practices related to stroke caregiving. Of these, 15 studies addressed knowledge, 24 studies examined attitudes and 33 studies looked at caregiver practices.

CONCLUSION

This scoping review finds that lack of knowledge impacts the attitudes and practices of informal stroke caregivers. With the increasing incidence of stroke and the growing number of caregivers, there is an urgent need for targeted, individualised interventions accompanied by comprehensive evaluation.

IMPACT

Caregivers of people with stroke are often unprepared to provide care. Further research is needed to support these individuals, ensuring improved quality of life and better health outcomes for both the caregiver and the person with stroke.

PATIENT OR PUBLIC CONTRIBUTION

Not applicable.

The supportive care needs of stroke patients: A scoping review

The aims of the current review were to identify the current supportive care needs of stroke patients, categorize those needs according to the supportive care needs framework (SCNF), and to form a SCNF of stroke patients. Preferred Reporting Items for Systematic Reviews and Meta-Extension for Scoping Reviews (PRISMA-ScR) and Guidance for conducting systematic scoping reviews were followed. Ten databases were searched, including six English databases: PubMed, Embase, Web of Science, Cumulative Index to Nursing Allied Health Literature, Cochrane Library, and PsycINFO, and four Chinese databases: China National Knowledge Infrastructure, Wan Fang, China Biology Medicine Database and Chongqing VIP. The search period covers from the establishment of the database to December 31, 2022. Three thousand twenty-nine hits were screened resulting in the inclusion of 34 articles in the final literature review. The greatest need identified by stroke patients was information, followed by psychological, social, rehabilitation, practical, physical, emotional, and spiritual needs. The supportive care needs of stroke patients were identified. A preliminary SCNF of stroke patients was developed according to Fitch's SCNF. The multitude of existing needs of stroke patients need to be addressed. This review may represent the first time that SCNF for stroke patients has been developed. This work may lay the foundation for future research on the supportive care needs of stroke patients and provide a framework for the implementation of supportive care in clinical stroke units.

The experience of mutual support during hospitalization of co-morbid couples with recurrent older stroke survivors - A descriptive phenomenological study

The phenomenon of the experiences of mutual support of co-morbid couples of recurrent older stroke survivors during hospitalization is receiving increased interest from nursing scholars. However, little is known about how they support each other. The aim of this study was to explore the experiences of co-morbid couples of older stroke survivors with recurrent stroke who support each other during hospitalization. A descriptive phenomenology study was employed. 21 co-morbid couples with recurrent older stroke survivors were recruited. The interviews were analyzed with Colaizzi's descriptive analysis framework. Three themes emerged from the data analysis: (1) maintaining the couple's relationship through mutual support, (2) mutual support so as not to drag the children down, and (3) providing support while struggling between ideals and reality. It is crucial to provide them with individualized, tailored support and interventions that can help these couples achieve a more optimal balance in their mutual support.

Technology Use for Home-Based Stroke Rehabilitation in Switzerland From the Perspectives of Persons Living With Stroke, Informal Caregivers, and Therapists: Qualitative Interview and Focus Group Study

BACKGROUND

Stroke is a leading cause for long-term disability, requiring both inpatient and outpatient rehabilitation and self-training in the home environment. Technology-based tools are gradually gaining acceptance as additional and suitable options for extending the rehabilitation process. While the experiences of persons living with stroke, therapists, and informal caregivers with respect to technology use have already been investigated in other countries, this topic is underexplored in the Swiss context.

OBJECTIVE

We aimed to explore the experiences and needs of persons living with stroke, informal caregivers, and therapists in using technology-based tools in a home environment for stroke rehabilitation in Switzerland.

METHODS

This study followed a qualitative descriptive methodology, including semistructured interviews and focus group discussions. We applied a deductive template analysis alongside the accessibility, adaptability, accountability, and engagement framework to analyze the qualitative data sets for technology-assisted solutions for poststroke rehabilitation.

RESULTS

We collected the experiences and needs of persons living with stroke (7/23, 30%), informal caregivers (4/23, 17%), and therapists (occupational and physical therapists; 12/23, 52%). The 4 categories we used to organize the analysis and results were accessibility to quality rehabilitation, adaptability to patient differences, accountability or compliance with rehabilitation, and engagement with rehabilitation. Persons living with stroke stated that they use various tools within their rehabilitation process depending on their specific needs. They felt that there is a plethora of tools available but sometimes felt overwhelmed with the selection process. Informal caregivers indicated that they generally felt underserved and insufficiently informed throughout the rehabilitation process. They reported that they use technology-based tools to support their relatives affected by stroke in becoming more independent. Therapists appreciate the numerous possible applications of technology-based tools in rehabilitation. At the same time, however, they express dissatisfaction with the lack of clarity in Switzerland regarding cost coverage, recommendations, and training opportunities.

CONCLUSIONS

Persons living with stroke, informal caregivers, and therapists in Switzerland reported varied and unique experiences and needs with the use of technology-based tools in outpatient stroke rehabilitation. Written recommendations, the assumption of financial costs, and the provision of information and education could foster increased confidence in the use of technology-based tools for patients and therapists.

Fear of disease progression, self-management efficacy, and family functioning in patients with breast cancer: a cross-sectional relationship study

Introduction

Fear of disease progression (FoP) has been identified as one of the most prevalent unmet needs among breast cancer patients in recent years. The aim of this study was to examine FoP in patients with breast cancer and explore its associations with demographic and clinical characteristics, self-management efficacy, and family functioning. We also aimed to create a clinically-relevant prediction model based off of these factors (i.e., a "nomogram") to help identify patients' probability of experiencing high FoP.

Methods

A cross-sectional survey of breast cancer in patients at the Affiliated Hospital of Jiangnan University was conducted from June 2023 to February 2024. The study included the Demographic and Clinical Characteristics Questionnaire, the Fear of Disease Progression Scale (FoP-Q-SF), the Chinese Self-Management Efficacy Scale for Cancer Patients (C-SUPPH), and the Family Care Index Questionnaire (APGAR). Data analysis included descriptive statistics, independent-samples t-test, one-way ANOVA, Pearson correlation analysis, and multiple regression analysis. A nomogram was constructed based on multiple regression results and the model performance was evaluated.

Results

A total of 151 breast cancer patients were enrolled in the study. The mean (standard deviation) FoP score of the patients was 35.87 ± 9.24. The average score of C-SUPPH was 96.97 ± 17.29, and the average score of APGAR was 6.74 ± 2.98. Pearson correlation analysis showed that FoP was negatively correlated with self-management efficacy (r = -0.544, p < 0.01) and family functioning (r = -0.730, p < 0.01). Multiple regression analysis showed that age (B = -4.038), self-management efficacy (B = -0.085) and family functioning (B = -1.972) were significantly related to FoP, and together explained 36% of FoP variation (R 2 = 0.360, F = 20.50, p < 0.001). The nomogram of these variables showed satisfactory prediction performance [the Bootstrap Correction Consistency Index (C-index) = 0.872]. According to previous studies, a C-index of >0.70 indicates that the model is acceptable.

Conclusion

We found that greater fear of cancer progression (FoP) was associated with younger age, lower self-management efficacy and poorer family functioning in breast cancer patients. Based on these variables, our exploratory prediction model should be further investigated in order to help identify breast cancer patients who may be at highest risk of experiencing high FoP.

Developmental trajectory of care dependency in older stroke patients

Background

Stroke is the leading cause of death in China. Older stroke survivors often have other chronic conditions, not only musculoskeletal deterioration due to age, but also changes in body image that can be brought on by stroke and other diseases, making them unable to take good care of themselves and dependent on others. The degree of dependency affects the rehabilitation progress of stroke survivors and shows dynamic changes that need to be recognized.

Objectives

This study investigates the trajectory of dependency changes in older stroke patients with comorbidities and analyze the influencing factors.

Methods

Grounded in the Chronic Illness Trajectory Framework (CITF), a longitudinal study was conducted from February 2023 to October 2023, tracking 312 older stroke patients with comorbidities admitted to two tertiary hospitals in Guangzhou. Care dependency levels were assessed using Care Dependency Scale on admission day 5 (T0), at discharge (T1), 1 month post-discharge (T2), and 3 months post-discharge (T3). Growth Mixture Model were utilized to identify trajectory categories, and both univariate analysis and multivariate logistic regression methods were employed to explore factors associated with different developmental trajectories.

Results

A total of four developmental trajectories were fitted, C1 (high independence-slow increased group, 52.0%), C2 (moderate independence-rapid increased group, 13.0%), C3 (moderate independence-slow increased group, 25.0%), and C4 (low independence-increased and decreased group, 10.0%). Length of hospital stay, place of residence, level of social support, residual functional impairments, NIHSS score, and BI index independently influence the trajectory categories.

Conclusion

There is heterogeneity in care dependency among older stroke patients with comorbidities. Most patients gradually reduce their dependency and become more independent, but others remain dependent for an extended period of time. It is recommended to focus on patients who live in rural areas, have low social support, have high admission NIHSS scores and have residual functional impairment, and provide them with personalized continuity of care and rehabilitation services in order to reduce care dependency and the burden of care, and to improve patients' quality of life.

A mixed-methods study on the implementation of a mobile health application (mHealth app) for stroke caregivers in Malaysia: healthcare providers' perspective

INTRODUCTION

Recognizing the burden experienced by caregivers of stroke survivors, an intervention using mobile health applications (mHealth apps) has been proposed to support and empower stroke caregivers. This study aimed to assess the acceptability and expectations of healthcare providers, who play a vital role as gatekeepers in the healthcare system, to ensure the effectiveness and sustainability of the intervention.

METHODS

This was a concurrent mixed-method study design, with healthcare providers involved in stroke care management in the northeast regions of Malaysia as study participants. The qualitative component of the study was conducted using a phenomenological approach that involved in-depth interviews to explore the acceptability and expectations of healthcare providers regarding the adoption of mHealth apps in the context of stroke caregiving. The study was complemented by quantitative data collected through an online survey using an adjusted version of the technology acceptance model tool.

RESULTS

In total, 239 participants from diverse backgrounds and professions were enrolled in the study, with 12 in the qualitative component and 227 in the quantitative component. The findings from the quantitative survey showed that over 80% of the participants expressed their intention to use mHealth apps. The qualitative component generated two themes related to the acceptability and expectations of mHealth apps, which were integrated with the quantitative findings. Additionally, in-depth interviews revealed a new theme, namely the key features of mHealth, with three sub-themes: availability of services for caregivers, provision of knowledge skills, and supporting caregivers in managing stroke patients.

CONCLUSION

Healthcare providers demonstrated excellent acceptability of this mHealth intervention as part of caregiving assistance, particularly with the inclusion of essential key features. However, future investigations are necessary to establish the feasibility of integrating the mHealth app into the healthcare system and to ensure its long-term sustainability.

The Unmet Needs of Caregiving Skills, Support, Emotions, and Finances of Stroke Caregivers: A Multicenter Study

​​​​​​Background Informal stroke caregivers in Malaysia play an important role in supporting stroke survivors following acute care. Nevertheless, there is a lack of available data to inform the sufficiency of help and resources available to address the needs of local stroke caregivers. This study aimed to determine the unmet needs in caregiving skills, support, emotions, and finances as well as the associated factors of stroke caregivers in Malaysia. Methodology This multicenter, cross-sectional study used a self-administered survey developed and validated for the Malaysian population. It was prepared in paper-based and web-based formats, and it was distributed via direct contact with the respondents, post, and email. Respondents were recruited from different sites in Malaysia. In this study, unmet needs were defined as "help that was needed more or was not provided to assist caregivers and address their specific needs." This article only presents the quantitative data of this study. Data were analyzed using descriptive analysis and logistic regression to determine factors associated with unmet needs. Results Almost all study respondents (91%) reported having unmet needs. Unmet needs ranged from 1 to 10, while the mean unmet needs was 5. The highest unmet need was related to financial support (72.5%), followed by support from professionals to address their own needs (59.2%), skills to care for stroke survivors, i.e., skills in caring for stroke survivors with their daily activities (57.9%), and skills in supporting stroke survivors to perform rehabilitation at home (53.1%). The lowest unmet need was related to support in transporting stroke survivors from place to place (45.3%). Additionally, this study did not identify an association between the reported unmet needs and gender, age, ethnicity, duration of caregiving, and site of participation. Conclusions This study reported a range of unmet needs perceived by stroke caregivers in Malaysia. Further research is warranted to understand the gaps in supporting local stroke caregivers to inform future post-stroke support and services in the country.