Study aim and objectives:
This thesis reports on a study that develops a novel explanatory theory around the family context of stroke recovery. This was developed from the perspectives of the evidence base for family interventions, the experiences of stroke couples over time, and the experiences of generalist and specialist staff. The thesis culminates in a realist (contingent) programme theory which melds these perspectives with extant theory to explain how health and social care professionals can better support couples through the aftermath of stroke.
Methods:
Realist principles are employed to generate a better understanding of the mechanisms and contexts that lead to outcomes (CMOs) for couples following a stroke. After a critical literature review, a realist synthesis was completed on eleven systematic reviews examining interventions supporting stroke survivors and their family carers. Coterminous with the synthesis, in-depth dyadic interviews were carried out with six stroke couples. Three stroke couples agreed to follow-up longitudinal interviews over a two-year period. Four stroke service provider focus groups were conducted (2 in Wales, and 2 in England), as well as a focus group with RELATE counsellors completed data collection.
Findings:
Four conjectured CMOs were developed and refined through the longitudinal couple interviews and service provider focus groups. The study has shown that interventions need to focus on the stroke survivor and the main family carer as a dyad whose interactions affect stroke outcomes, both physically and emotionally. Centring on the relationship between the stroke dyad is a key aspect of supporting longer-term stroke rehabilitation that limits the psychological damage for both stroke survivor and family carer. An attachment theoretical perspective on social support between spousal couples emerged from the findings to show how enhancing positive and reciprocal interactions develops resiliency that improves their quality of life. Use of technology can help maintain longer-term communication between the stroke family and professional support, enabling a partnership that tailors interventions to their needs.
Recommendations:
The theoretical propositions uncovered in this study could inform research, policy and practice through recognising and centralising the dyadic nature of stroke rehabilitation in the community. To date, interventions to help stroke families have been ‘patient-centred’ and have consistently shown limited efficacy in combatting psychological distress. Taking a relational perspective can enhance both stroke survivor and family carer coping skills throughout the stroke trajectory. Practitioners need organisational commitment to develop their skills in family assessment and given the time to foster a relational focus on care, prioritising relationship dynamics over functional therapy.