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. http://orcid.org/0000-0003-1514-6590
  • Sadea Ahmed Khuder Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq.
Keywords: Adherence, Barriers, Post-stroke patients, Qualitative research

Abstract

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...

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)

References

[1] Attwood S, Morton K, Mitchell J, Van Emmenis M, Sutton S, VBI Programme Team. Reasons for non-participation in a primary care-based physical activity trial: a qualita-tive study. British Medical Journal Open.2016;23;6(5):e011577. doi: 10.1136/bmjopen-2016-011577.[PubMed: 27217288].
[2] Bengtsson M. How to plan and perform a qualitative study using content analysis. Nursing Plus Open. 2016;2. doi: 10.1016/j.npls.2016.01.001.
[3] Dobkin B, Dorsch A. New evidence for therapies in stroke rehabilitation. Current Atherosclerosis Reports. 2013; 15(6): 331. doi: 10.1007/s11883-013-0331-y.
[4] Frich JC, Russell D. Stroke-a new epoch. Tidsskr Nor Laegeforen. 2007;127(6):719. [PubMed: 17363980].
[5] Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measure to achieve trust-worthiness Nurse Education Today. Nurse Education Today. 2004 Feb;24(2):105-12. doi: 10.1016/j.nedt.2003.10.001. [PubMed: 14769454].
[6] Ivey FM, Hafer-Macko CE, Macko RF. Exercise rehabilitation after stroke. Neuro Therapeutics (NeuroRx). 2006;3(4):439–50. doi: 10.1016/j.nurx.2006.07.011. [PubMed: 17012057].
[7] Lees FD, Clarkr PG, Nigg CR, Newman P. Barriers to exercise behavior among older adults: a focus-group study. Journal of Ag-ing and Physical Activity. 2005 Jan;13(1):23-33. [PubMed: 15677833].
[8] Lincoln YS, Guba EG. Naturalistic Inquiry. Newbury Park, CA: Sage Publications. 1985. ISBN-13: 978-0803924314. ISBN-10: 0803924313.
[9] Polit DF, Beck CT. Essentials of nursing research: Appraising evidence for nursing practice. Lippincott Williams & Wilkins 2009.
[10] Rimmer JH, Rubin SS, Braddock D. Barriers to exercise in African American women with physical disabilities. Archives of Physical Medicine and Rehabilitation. 2000;81(2):182–88. [PubMed: 10668772].
[11] Elo S, Kyngas H. The qualitative content analysis process. Journal of Advanced Nursing. 2008;62:107–15.
[12] Barbara DiCicco, Bloom-Benjamin F Crab-tree.The qualitative research interview.Medical Education 2006;40: 314–321.
[13] Rimmer JH, Wang E, Smith D. Barriers associated with exercise and community access for individuals with stroke. Journal of Rehabilitation Research & Development. 2008;45(2):315-22. [PubMed: 18566948].
[14] Rimmer JH, Wang E. Aerobic exercise training in stroke survivors. Topics Stroke Rehabilitation journal. 2005;12(1):17–30. doi: 10.1310/L6HG-8X8N-QC9Q-HHM [PubMed: 15735998].
[15] Shaughnessy M, Resnick BM, Macko RF. Testing a model of post-stroke exercise behaviour. Rehabilitation Nursing Journal.2006;31(1):15–21. [PubMed: 16422040].
[16] World Health Organizations. Global status report on noncommunicable diseases. Stroke, Cerebrovascular accident. 2014. ISBN: 978 92 4 156485 4.
[17] Eldred C, Sykes C. Psychosocial interventions for carers of survivors of stroke: A systematic review of interventions based on psychological principles and theoretical frameworks. British Journal of Health Psychology. 2008; 13(3):565–581.
[18] Creasy KR, Lutz BJ, Young ME, Ford A, Martz C. The impact of interactions with providers on stroke caregivers’ needs. Rehabilitation Nursing. 2013; 38(2):88–98. [PubMed: 23529947].
[19] Amreen Mahmood, Pradeepa Nayak, Gerjo Kok, Coralie English, Natarajan Manikandan. Factors influencing adherence to home-based exercises among community-dwelling stroke survivors in India: a qualitative study. European Journal of Physiotherapy. 2019; 1(7). doi: 10.1080/21679169.2019.1635641.
Published
2019-11-30
How to Cite
Al-Banna, D., & Khuder, S. (2019). Barriers to Adherence to Post-stroke Exercise Program: A Qualitative Study into the Experiences of Patients with Stroke. Erbil Journal of Nursing and Midwifery, 2(2), 132 - 143. https://doi.org/10.15218/ejnm.2019.17
Section
Original Articles