Abstract
Introduction: Stroke is a leading cause of disability in New Zealand, disproportionately affecting Pacific populations, including Sāmoans, who experience higher incidence rates and earlier onset compared to New Zealand Europeans. Stroke impacts physical, psychological and social wellbeing. Physical activity (PA) plays a pivotal role post stroke, enhancing recovery by improving mental health, physical function, and mitigating the risk of secondary conditions. While PA is incorporated throughout the stroke care journey most research on post-stroke PA has predominantly focused on non-Pacific populations. Cultural, environmental, and psychosocial factors significantly mediate PA participation, yet the specific experiences of Sāmoan stroke survivors remain underexplored. This thesis addressed this gap by exploring the meaning and value of PA for Sāmoan stroke survivors in New Zealand.
Methods: This study used Talanoa, a Pacific research methodology, to qualitatively explore the lived experiences of Sāmoan stroke survivors regarding PA. Talanoa sessions were conducted face-to-face or via Zoom, with transcripts transcribed and translated for analysis. Reflexive thematic analysis (RTA) was used to analyse the data inductively, focusing on reflexivity, researcher positionality, and participant-centred interpretation. Ethical considerations included ensuring participant confidentiality, informed consent, and participant autonomy throughout the research process.
Results: Eight Sāmoan stroke survivors and with a mean age of 60.75 years and mean Modified Rankin Score of 1.9 participated in this study, along with three ‘āiga (family) members. Three themes were constructed from participants’ talanoaga (discussions), namely 1) Physical activity is holistic, 2) Sāmoan caregiving, health beliefs, and physical activity, and 3) A call to action – advice for health professionals. The themes explain that participants find personal meaning and value in PA, appreciating how it connects them to their bodies and relationships. Living with stroke in the context of Sāmoan values and caregiving was complex, with ‘āiga providing strong support, though sometimes overprotective. Participants expressed clear preferences for PA programs and cultural support groups, emphasising the importance of health professionals (HPs) involving ‘āiga and promoting stroke knowledge. Participants believed HPs could enhance the quality of life for Sāmoan stroke survivors by facilitating communication with ‘āiga and supporting overall wellbeing.
Conclusion: For Sāmoan stroke survivors, PA has strong links to, and is underpinned by, the concepts of holistic wellbeing and relationality. PA was valued as a way to nurture their relationships with their ‘āiga, community, and faith, playing a significant role in recovery and maintaining their sense of self. PA was not only about improving physical health; it enabled stroke survivors to contribute to their ‘āiga, participate in community activities, and fulfil cultural responsibilities. Participation in PA allowed individuals to maintain their roles within their ‘āiga and church; central pillars of Sāmoan culture.
The value of PA also extended to enhancing a sense of purpose and agency. Participants viewed PA as an essential part of re-engaging with life, especially in terms of fulfilling relational and cultural obligations. The recommendations for HPs stress the importance of understanding these cultural perspectives. HPs should adopt an ‘āiga-centred and holistic approach to rehabilitation, recognising the collective nature of recovery in Sāmoan culture. PA interventions should incorporate culturally relevant practices and consider the role of traditional healing methods. Additionally, overcoming environmental barriers, such as providing access to culturally meaningful spaces and community programs, is critical to supporting Sāmoan stroke survivors in maintaining their PA and overall wellbeing.
Further research is needed to explore the specific cultural practices and community-based interventions that can enhance PA participation among Sāmoan stroke survivors, the family dynamic and caregiving practices of Sāmoan families affected by stroke, as well as the role of spirituality and traditional healing in their rehabilitation journey.