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

Enright, Marlie (2017-03)

Thesis (MScPhysio)--Stellenbosch University, 2017.

Thesis

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.

AFRIKAANSE OPSOMMING : Inleiding: Beroerte affekteer en beperk ‘n persoon se liggaamsfunksies, die uitvoering van betekenisvolle aktiwiteite en vervulling van lewensrolle. In die gekompliseerde gesondheidsverandering in Suid Afrika is daar ’n beduidende voorkoms van beroerte onder die jonger geslag. Doel van die Studie: Die doel van die studie is om die aktiwiteitsvereistes, lewensrolle en persoonlike ervarings van Xhosa vroue met beroerte in stedelike en landelike omgewings te vergelyk en te beskryf. Metodologie: Die beskrywende dwarssnitstudie gebruik ‘n konkurrente gemengde metode. Kwantitatiewe en kwalitatiewe inligting is van 11 deelnemers in die landelike omgewing in die Oos-Kaap en 9 deelnemers in die Wes-Kaap provinsies van Suid- Afrika ingesamel. Die kwantitatiewe inligting is met die Barthel Indeks, EuroQol vyf-demensie vraelys (EQ-5D) ingesamel. ‘n Vraelys is opgestel om inligting van deelnemers se demografie en omgewing in te samel. ‘n Gedeeltelike gestruktureerde vraelys en onderhoude is gebruik om kwalitatiewe inligting te verkry. Die kwantitatiewe inligting is deur die gebruik van opsommende en beskrywende statistieke ontleed. Die kwalitatiewe inligting is deur die gebruik van deduktiewe en induktiewe ontledings verwerk. Inligting van verskillende bronne is getrianguleer. Resultate: Die mediaan ouderdom van landelike deelnemers was 42 jaar (40-95) en deelnemers in die stedelike gebied was 56 jaar (31-65). Die meeste deelnemers in die landelike gebied het terugvoering gegee dat hulle afhanklik is van natuurlike waterbronne en swak sanitasie dienste ondervind. Die totale mediaan Bl telling vir die landelike (40-95) en stedelike (10-100) deelnemers was 80. Die mediaan telling vir bad en mobiliteit van landelike deelnemers was hoer terwyl stedelike deelnemers ‘n hoer telling vir voeding en vervoer gehad het. Die tussengemiddelde EQ-5D VAS telling was 50 (30-80) by landelike deelnemers en 55 (20-90) by stedelike deelnemers. Die landelike deelnemers het minder probleme geopper wat met HRQoL status verband hou gegewe die omvang van selfversorging sowel as angs en dimensie. Die deduktiewe ontleding van die kwalitatiewe inligting beskryf die lewensrolle van Xhosa vroue as selfversorging, voorsiener, versorger en gemeenskapslid. Die rolverantwoordelikhede en hoe omgewingsfaktore die aktwiteite en take beinvloed, is beskryf en tussen die studie-gebiede vergelyk. Die induktiewe bevindings van die kwalitatiewe inligting beskryf die persoonlike ervarings van Xhosa vroue met beroerte in drie opkomende temas naamlik: tema 1 – “ Ek sukkel met niks nie, ander doen so baie vir my”, tema 2 – “Ek hou daarvan om nog mooi te lyk” en tema 3 – ‘Dood, maar lewendig”. Hierdie temas gee die deelnemers se persepsie mee van familie ondersteuning sowel as eie motivering en herbeplanning om in lewensrolle deel te neem. Gevolgtrekking: Die studie vind dat lewensrolle dieselfde is in landelike en stedelike gebiede. Omgewingsfaktore beinvloed egter die aktiwiteitsvereistes van rolverantwoordelikhede wat addisionele aanpassings verg om struikelblokke te oorkom. Deelnemers se persoonlike ervarings in beide gebiede is dieselfde en hul persepsie van sosiale ondersteuning was ‘n bydraende faktor van hulle siening van HRQoL. Die oorvleueling van inligtingsbronne in hierdie studie beklemtoon die beperking van die Bl om die verbandhoudende faktore wat aktiwiteite daaglikse lewe aan te spreek en vergelykende tellings tussen bevolkings in verskillende omgewings of kulture te beskryf.

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