Background: Stroke is a major cause of long-term disability and loss of quality of life. People living with stroke face enormous challenges particularly after discharge from acute care adjusting to a new life. Stroke self-care is an important element in preventing stroke recurrence by direct survivors’ attention to stroke secondary prevention. Self-care helps survivors to recapture or learn new skills to manage their daily activities. However, several factors hinder the self-care and interfere with healthcare behaviors. Therefore, identifying the barriers and facilitators for stroke self-care is the key element for improving stroke self-care
Purposes: To analyze the state of the science in regard to the barriers and facilitators for self-care
Methods: The electronic databases PubMed, Cumulative Index to Nursing and Allied Health Literature , and PsycInfo were searched. Inclusion criteria included: peer reviewed primary English studies; self-care or self-management as the primary outcome; adult stroke survivors; and published after 2005. The integrative review guidelines were used for analysis.
Results: From an original of 794 studies identified, 23 met the inclusion criteria and were reviewed. Self-care and self-management concepts were used interchangeably. The barriers to stroke self-care were classified into three categories: individual factors, psychological factors, social and environmental factors. The individual factors were lack of knowledge, decrease individual capacity such as lack of self-confidence and learning capabilities, lack of self-efficacy and motivation, non-adherence to medication, and physical impairment. The psychosocial factors included depression, anxiety, and cognitive impairment. Social and environmental factors were lack of family and social support, lack of professional support, lack of trust in healthcare providers, lack of transportation, low socioeconomic status, and lack of the resources. The facilitators were motivation and social support.
Conclusions: Overall, quality of the studies was limited by small sample sizes in the intervention studies. Managing healthcare behaviors through understanding the barriers and facilitators will help nurses and stroke survivors in improving self-care.