Social identity and stroke: ‘they don't make me feel like, there's something wrong with me’

Abstract

Over 85% of the people survive stroke; and of those, over 80% are discharged to the community. However, the majority do not recover completely. Loss of identity is a commonly reported experience after stroke. Studies focus on the individual survivors' use of their own cognitive resources to adapt to change, rather than examining the effects of social interactions on stroke survivors' identities. Social relationships are the foundation upon which survivors rebuild skills to engage with the world, yet little is known about the ways in which families, friends and neighbours provide a context for the recreation of a sense of self and activities after stroke. This article draws on situational analysis grounded theory analysis of in-depth individual interviews with nine middle-aged survivors of stroke. In situational analysis, the original grounded theory methods proposed by Glaser and Strauss are used; however, the situational context, and how environments and relationships influence actions, is explicitly analysed. Our objective was to understand the ways in which family, social, and community resources might enhance stroke survivors' participation in personally meaningful activities over the long term. The qualitative accounts of these survivors reveal how social support helped them maintain or more importantly regain a position in society. Following any life-changing event, people's sense of self is fluid. A relevant social position entitles stroke survivors to become actively involved in setting their own goals and maintaining a positive identity. However, as these participants attested, stroke impaired their social position and resources to reject an imposed social position. It was difficult for these survivors to construct a valued social identity without the support of other people. Future studies should explore the consequences of social interactions with others and how social attitudes about stroke disability affects individual's activity options, professional practice, and ultimately development of a positive poststroke identity.

Roles of Changing Physical Function and Caregiver Burden on Quality of Life in Stroke

“…This lack of improvement in social QOL has previously been observed in the literature. 37,38 After a stroke, relationships with friends and colleagues decline, resulting in stroke survivors living more isolated lives than before the stroke. Similarly, environmental QOL, which focuses on issues regarding living conditions, are unlikely to vary for most stroke survivors and may in fact be amplified because of the stroke.…”

Gaining perspectives of people with stroke, to inform development of a group exercise programme: A qualitative study

“…Third, social interaction was highlighted throughout our data and the findings suggest that being part of a social network, finding a sense of community and belonging in a positive and supportive environment will in turn lead to increased/sustained attendance. This is supported by Anderson and Whitfield (2013) who argued that social relationships are the foundation on which stroke-survivors rebuild their skills to engage with the world. Other studies have also confirmed that social support in group sessions is important in sustaining commitment by participants (Desrosiers et al 2008).…”

“…A social group, where participants are treated as 'us' rather than the individual, provides attendees with a sense of belonging and purpose (Anderson and Whitfield 2013). Five of the six participants in this study preferred to exercise in a group setting rather than one-on-one with their therapist.…”

“…Several studies have demonstrated that group-based programmes lead to positive outcomes for people with stroke, including psychosocial gain, positive impact on confidence, and functional improvement (Graham et al 2008, Schouten et al 2011, Song et al 2015. Depression is also commonly seen in people after stroke and several studies have indicated that group-based classes may increase confidence and hope with a consequent reduction in depression (Anderson andWhitfield 2013, Townend et al 2010). However, people with moderate to severe stroke are frequently excluded from studies investigating group-based rehabilitation due to their limited ability to participate without assistance, so little is known about its potential use in this population.…”

The experiences of everyday activities post-stroke

“…With more people experiencing stroke, the need for rehabilitation services that enable stroke survivors and their families to transition back to healthy community living will also increase. Currently, 80% of survivors of stroke are discharged to the community [2]. However, as stroke survivors return home after medical care, they find themselves confronted by their physical and social limitations [3].…”