A Community-Based Study of Stroke Survivors in a Semi-urban Community in South East (SE) Nigeria Using a Mixed Methodology

Background: Stroke is the leading cause of death and the root of long-term disability worldwide; this has become an international concern. Studies have identified a 42% decrease in stroke incidences in high-income countries (HICs) but 100% increase in LMICs –such as in Nigeria.

Objectives: The purpose of this study was to investigate the impact of stroke on the quality of life (QOL) of stroke survivors in the SE communities of Nigeria by utilising the health-related quality of life in stroke patients’ questionnaires. The secondary objective was to investigate the perceptions, attitudes, and cultural approaches of stroke survivors to provide evidence of the variables and determinants that predict the impact of stroke on QOL from the perspective of the survivors.

Methods: The research employed an explanatory sequential mixed methodological strategy involving two phases. Quantitative phase 1 utilised a cross-sectional design with convenience sampling, administering a robust HRQOLISP questionnaire to 101 people, 53 male and 48 female (who were spread over 4 medical institutions) over over two years. Qualitative phase 2 combined a phenomenological approach with purposive sampling. This entailed conducting ten semi-structured interviews (6 male and 4 particpants) over a two-year period and analysing them using an interpretative phenomenological methodology.

Results: The results had a twofold effect on the QOL of the stroke survivors: positive and negative. In quantitative phase 1, HRQOLISP descriptive statistics indicated that the category with the lowest score, showing a negative impact on QOL, was the physical domain (mean = 2.52, SD = 0.76). In contrast, the spiritual domain had the greatest positive influence on QOL (mean = 3.70, SD = 0.50).The results also revealed the significance of the relationships between the HRQOLISP which demonstrated a significant positive relationship between the emotional dimension and the intellectual and soul dimensions. Qualitative phase 2 indicated that the physical dimension – portrayed by an unknown self, which includes (physical and psychological)– was the most negatively affected, while the spiritual dimension – reflecting reconstruction of the embodied self, was positively affected mainly by the spiritual interaction of one’s faith.

Conclusion: The most affected HRQOL domains in this study were physical and spiritual. The findings emphasise the importance of rehabilitation, which should involve a holistic multidimensional approach within the community that will address not only the physical aspect of rehab but equally the psychological circumstances and existential issues. A simple form of partnership between rehabilitation clinics or hospital-based stroke rehabilitation centres and faith-based organisations and traditional healers is recommended.