Understandings of stroke in rural Malaysia: ethnographic insights

Abstract

Background

Stroke is a public health concern in Malaysia but local beliefs and lay understandings of stroke have not been examined before. Explanatory models provide a way for people to make sense of their illness and influence health seeking behaviors, in a locally relevant way.

Methods

Drawing on ethnographic research from rural Malaysia, this descriptive article explores ethnic Malaysian-Chinese stroke survivors’ lay understandings of stroke. Eighteen community-dwelling stroke survivors aged 50–83 took part in the study.

Results

Causation of stroke was derived from cultural, biomedical and social sources. Participants also drew simultaneously from both biomedical and traditional explanations of stroke to develop their own understanding of etiology. Similarities with biomedical causation and other studies from different cultures were found. Participants’ typically focused on the more immediate effects of stroke and often do not attribute causation and association with their comorbid conditions which are also risk factors of stroke.

Conclusion

Lack of knowledge about stroke and its symptoms was evident in participants’ account. Findings emphasize the importance of knowledge based health interventions, especially in health education strategies for stroke survivors to reduce delays to diagnosis and potentially improve health outcomes post-stroke.

Implications for rehabilitation

• Stroke survivors often form explanatory models of stroke that draw from both biomedical and traditional explanations of stroke.

• Understanding how people derive lay understandings of stroke can contribute towards developing the goals and activities that facilitate recovery and rehabilitation in similar settings.

• Health practitioners in the community should strengthen communication regarding the identification, etiology and risk factors of stroke with stroke survivors and their carers to improve compliance to medication, exercise and diet for better recovery. Sustained health education which is culturally relevant is recommended.

• Communication should also include non-physical impact of stroke (such as cognitive deficits and emotional difficulties) as the stroke survivors were unlikely to relate such symptoms to stroke.

Keywords:

• Stroke
• ethnography
• lay models
• explanatory models
• older adults

Disclosure statement

No potential conflict of interest was reported by the authors.

Acknowledgements

Data collection was undertaken at the Monash SEACO HDSS technology research platform. The Authors would like to express their appreciation to the SEACO Field Team and members of the SEACO Scientific Advisory Group from the Malaysian Ministry of Health. SEACO is funded by the Monash University Malaysia Campus; the Office of the Vice Provost Research, Monash University Australia; the office of the Deputy Dean Research, Faculty of Medicine, Nursing and Health Sciences, Monash University Australia; The Faculty of Arts, Monash University Australia, and the Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia. SEACO is an associate member of the INDEPTH Network.

Notes

1 Official romanization system for Standard Chinese

Additional information

Funding

The study was funded through the Australian Research Council [Discovery Project Scheme, project number DP140101995].