Barriers to Adherence to Post-stroke Exercise Program: A Qualitative Study into the Experiences of Patients with Stroke


  • Dara Abdulla Al-Banna Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq.
  • Sadea Ahmed Khuder Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq.



Adherence, Barriers, Post-stroke patients, Qualitative research


Background and objective: Approximately one-third of stroke patients remain disabled and post-stroke rehabilitation is required. Adherence to an exercise rehabilitation program is considered an important area of interest in the wake of optimizing long-term participation in physical activities after stroke. This study aims to explore the barriers to adherence to exercise program among post-stroke patients.
Methods: A qualitative study was conducted in the Physiotherapy units of Hawler and Rizgary Teaching Hospitals, Erbil, the Kurdistan Region of Iraq including twelve post-stroke participants with limited/ inadequate adherence to a post-stroke exercise program schedule from March to December 2018. Data was collected through face-to-face interviews. All of the interviews were conducted at a time and place that was the most convenient for the participants. Within two months, the categories emerging from the analysis of the inter-views began to repeat, and no new categories emerged, leading to an enrollment of 14 participants. One month after the first interview, the second interview was conducted which included 12 participants. This was done to confirm their previous answers and ensuring that there were no new concepts about this limited adherence. Software for Qualitative Data Analysis was used for managing the data.
Results: More than half of the participants were over 70 years old, male, illiterate, married, and housekeepers from urban areas. Most of the participants had an ischemic stroke for more than four weeks. The barriers to adherence to post-stroke exercise program were categorized into the four main categories of the barriers related to environment and facility, personal (physical and psychological) factors, organizational policies, and contents of exercise program.
Conclusion: Barriers to adherence are different in nature. Environmental barriers and lack of facilities show that a well-organized rehabilitation program in health care system at directorate of health-Erbil is very important to improve and facilitate adherence...


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Author Biography

Dara Abdulla Al-Banna, Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq.

Dara Abdulla Al-Banna has MSc degree in Medical-Surgical Adult Nursing from Hawler Medical University (PhD Student). He is an assistant lecturer of nursing at Hawler Medical University, Erbil, Iraq. He teaches different courses including Medical-Surgical Adult Nursing Theory, Lab, and Clinic, Fundamental of Nursing, Basic Life Support (First Aid), Global Health Care, Hospital Management, Professional Ethics, Research Methodology, and Biostatistics. He has more than 15 publications. His current research work is mainly related to Stroke Rehabilitation and Health Administration research. Before pursuing the academic career, he established seven years of experience in the Nursing Care in Emergency Center, Laboratory Responsibility at Conservative department in College of Dentistry at Hawler Medical University, and the Private Clinic. His work involved in establishing the Gasha Medical Institute, Erbil, in Iraqi Kurdistan Region and International Rescue Committee IRC projects in Erbil Displacement Camps. It has more than 20 Awards and Prices.

A Board Member of Erbil Journal of Nursing and Midwifery (EJNM)

A Reviewer in Eastern Mediterranean Journal of Health Sciences (WHO)

A Reviewer in Advances in Science, Technology and Engineering Systems Journal (ASTESJ)


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How to Cite

Al-Banna DA, Khuder SA. Barriers to Adherence to Post-stroke Exercise Program: A Qualitative Study into the Experiences of Patients with Stroke. Erbil j. nurs. midwifery [Internet]. 2019 Nov. 30 [cited 2024 Apr. 14];2(2):132-43. Available from:



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