The Influence of a Low-Income and Linguistic Minority Context on Post-Stroke Participation

Abstract

Following a stroke, the majority of survivors experience challenges returning to participation, also known as “involvement in life situations” in the International Classification of Functioning, Health, and Disability. Contextual factors, such as low income and linguistic minority status, have been shown to have an impact on participation post stroke; however, the process by which this occurs is poorly understood. The aim of this research was to increase our understanding of how low income and official minority language status influence the experience of return to participation following a stroke.

A qualitative multiple case study approach was used with eight francophone stroke survivors living in a low-income situation in eastern Ontario (Canada). Data was collected from several sources: semi-structured interviews with the stroke survivors and with their care partners, participant observations, four measures, and chart reviews. Data was categorised, and patterns that furthered understanding of the experience of return to participation were identified during intra and cross-case analyses.

The stroke survivors were all able to access healthcare and social services in both official languages, and the findings suggest that official language minority status had limited influence on the experience of return to participation. Low income, however, influenced precursors to participation by limiting the stroke survivors’ ability to afford housing, goods (e.g., medication, equipment), and services (e.g., transportation, private therapy).

Certain personal and environmental factors modulated the experience of return to participation – specifically, age, knowledge of the healthcare and social service systems, support of family and friends, the built environment, and health literacy. The healthcare and social policies of the macro environment, which regulates the healthcare and social services, had a critical influence on the experience of return to participation for these stroke survivors, irrespective of their individual situations, unless wealth or financial support was available.