Access to physical activity for men following stroke

Abstract

Background Stroke sequelae can negatively affect a stroke survivor’s independence, social participation, and identity. Although men acknowledge the health benefits of physical activity, most remain inactive. This is true for both non-disabled men and men after stroke. Current strategies to promote behaviour change towards physical activity in men after stroke are clearly ineffective. This is of concern to health professionals. Objective The purpose of this thesis was to explore factors that influence community dwelling male stroke survivors to access and participate in physical activity (primarily at fitness centres) in the province of Canterbury, in New Zealand (NZ). Methodology The thesis is situated in a transformative worldview and is underpinned by disability theory and social cognitive theory. A three strand mixed methods explanatory sequential design, within a social ecological conceptual framework, was used. Methods Strand 1 systematically reviewed fitness centre accessibility quantitatively. Using a participatory action research (PAR) approach, Strand 2 explored the user-friendliness of fitness centres with seven male stroke survivors. The final strand of inquiry (Strand 3) explored the attitudes of 13 support persons of male stroke survivors towards encouraging access to and participation in physical activity, also using a PAR approach. Qualitative data were analysed inductively for themes. Mixing of the methods occurred through a synthesis of the themes. Inferences were developed from the data analysis of each strand independently. These inferences were then synthesised into meta-inferences, thus mixing the methods. Findings Two meta-inferences arose from the inquiry. First, all levels of the social ecological framework influenced access to and participation in physical activity by male stroke survivors. Second, PAR could be an effective model for health professionals to use in practice because it is a collaborative and inclusive way of empowering individuals to create change across multiple levels of the social ecological framework. Discussion Access and participation in physical activity at fitness centres by male stroke survivors are influenced by personal factors (i.e., self-efficacy), built environment accessibility, and societal attitudes of non-disabled individuals. Societal attitudes appear to have a powerful influence on male stroke survivors’ participation in physical activity, social engagement, and re-establishing identity. Although attitudes are difficult to change, it seems possible that physiotherapists (and other health professionals) who use a collaborative PAR approach together with stroke survivors and other stakeholders, may be well placed to act as change agents across all levels of the social ecological framework. Conclusions Genuine collaborative practice with male stroke survivors requires physiotherapists to extend rehabilitative practice beyond that of retraining function, to the restoration of social participation and identity. Physiotherapists should consider including the primary support person as an equal member of the rehabilitation team and offer support to enhance their confidence in their caregiving role. Collaboration at the organisational, community and social policy levels of the social ecological framework is challenging. It requires a collective and educative approach from health professionals, organisational leaders, disability advocates, and most importantly, end-users to change non-disabled individuals attitudes.