Interpretations of self-rated health in stroke survivors from a semi-rural community in South East Asia

ABSTRACT

Purpose: Stroke survivors report poorer self-rated health (SRH) compared to the general population but there is limited understanding on what contributes to SRH. This ethnographic study examined the individual and contextual factors that shape stroke survivors’ SRH in a rural middle income country situated in South East Asia. Methods: Ethnographic methods which encompasses various data collection methods from different data sources were used in this study to describe the socio-cultural context of 16 stroke survivors living in a rural village. Within this context, the experiences of these participants were then interpreted in terms of what contributed to their perception of health and recovery, juxtaposed with objectively measure physical and cognitive states. Results: SRH reflected the post stroke adjustment of stroke survivors. Better SRH was influenced by good post-stroke adjustment that was achieved by a combination of physical functioning, cognitive functioning, emotional well-being and family support. Poorer SRH appear to reflect poor post-stroke adjustment regardless of the objective physical and cognitive states of the stroke survivors. It was also observed that cognitive deficits, though its presence was acknowledged by participants, were usually not taken into account when rating SRH. However, while physical functioning was perceived by participants to directly impact SRH, the presence of cognitive deficits (often in tandem with depressive symptoms) indirectly complicated the recovery of physical functions treasured by participants. Conclusion: Stroke survivors reporting poorer SRH warrant further attention and intervention from health practitioners supporting the longer-term needs of stroke survivors in similar settings.

KEYWORDS:

• Stroke
• cognitive impairment
• self-rated health
• ethnography
• older adults

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Australian Research Council [DP140101995].

Notes on contributors

Kwong Hsia Yap

Kwong Hsia Yap, MPH, is a Global Public Health PhD candidate at the School of Medicine and Health Sciences, Monash University (Malaysia). Her research focuses on health in aging communities.

Narelle Warren

Narelle Warren, PhD, is a senior lecturer in Anthropology and Sociology in Monash University (Australia). Her research is concerned with everyday experiences of chronic conditions and disability, including how care is arranged, negotiated, and deployed in practice.

Daniel D. Reidpath

Daniel D. Reidpath, PhD, is a Professor of Population Health at the School of Medicine and Health Sciences, Monash University (Malaysia). He is the Director of the South East Asia Community Observatory (SEACO) Research Platform in Segamat, Johor. His research has focused on the measurement of population health, social stigma and health equity.

Pascale Allotey

Pascale Allotey, PhD, is the Director of the United Nations University International Institute for Global Health (UNU-IIGH). Her research has focused on health equity, health and human rights, gender and social determinants of health, forced migration and marginalisation, sexual and reproductive health, infectious diseases, and non-communicable diseases