The process of adjustment over time following stroke: A longitudinal qualitative study.

Understanding how people adjust following stroke is essential to optimise recovery and ensure services are responsive to people's needs. This study aimed to explore people's experiences over the first three years post-stroke and identify what helped or hindered recovery. As part of a longitudinal, qualitative descriptive study, 55 people and 27 significant others purposefully selected from a population-based stroke incidence study were interviewed 6, 12, 24 and 36 months post-stroke. Interviews were audio taped and transcribed verbatim. Participants described an ongoing process of shock, disruption, and fear, making sense of what happened, needing to fit in with what's offered, finding what works for them and evolving a new normal, whilst managing the ups and downs of life. This process needed to be re-negotiated over time, as people experienced changes in their recovery, comorbidities and/or wider circumstances. The adjustment process continued over the three years post-stroke, even for those who perceived that they were recovering well. Rehabilitation services need to support patients to make sense of their stroke, navigate the health system, address individual concerns and priorities and to know what, when and how much to challenge themselves. Rehabilitation plans need to be revised as circumstances change to facilitate adjustment following a stroke.

Capturing the stories behind the numbers: the Auckland Regional Community Stroke Study (ARCOS IV), a qualitative study.

BACKGROUND: Qualitative data can add value and understanding to more traditional epidemiological studies. This study was designed to complement the quantitative data from the incidence study the Auckland Regional Community Stroke Study or ARCOS-IV by using qualitative methods to uncover the richer detail of life as a stroke survivor, thereby extending our understanding of the impact of stroke. AIMS: The aims of the study were to identify how the experience of recovery and adaptation changes over time after stroke; and to elicit the strategies people with stroke and their whanau/family use and find helpful in living life after stroke. The aim of this paper is to describe the methodology and also the challenges and advantages of embedding qualitative research into a large epidemiological study. METHODS: Longitudinal study utilizing a Qualitative Description design in a subset of those taking part in the incidence study. Participants will be interviewed at 6, 12, 24, and 36 months after stroke. Semistructured interviews will explore three key areas: (1) issues of importance to people following a stroke and their whanau/family; (2) the perceived impact on people's sense of recovery, adaptation, and hopes; and (3) key strategies that people with stroke and their whanau/family use and find most helpful in living life after stroke. Thematic analysis will be conducted using iterative constant comparative methods. CONCLUSIONS: This methodology paper demonstrates the application of mixed methods in epidemiology. It also considers some of the practical and methodological issues that have emerged and may provide a useful framework for other qualitative projects in population-based studies.

The role of hope in adjustment to acquired hearing loss.

This study investigated the relationship between individual and disability characteristics and adjustment to acquired hearing loss, and the role hope has in that relationship. A sample of 114 adults with sensorineural hearing loss who had accessed hearing therapy services participated in the study. The mean age of the participants was 67 years. A survey of individual and disability characteristics, hope and adjustment was conducted. Multiple regression analyses were applied to examine possible moderating and mediating models. The results indicate that the degree of loss was the only statistically significant individual and disability characteristic related to adjustment. The trait of hope was found to serve as a mechanism by which the degree of loss affects adjustment. Hearing loss affects hope which in turn affects adjustment. Hope was found to account for 45% of the relationship between the degree of loss and adjustment. Additionally, the study found that self-efficacy and personal meaning may influence hope and despair dimensions in different ways. Discussion centres on the implication of these findings for intervention strategies used in rehabilitation programmes for those with a significant hearing loss.

They only see it when the sun shines in my ears: exploring perceptions of adolescent hearing aid users.

Hard-of-hearing (HOH) young people may encounter multiple challenges to their educational, social, and emotional development. The benefits of wearing hearing aids to enhance communication may be countered by negative stigma associated with hearing aids. This study explored the experience of 16 bilaterally, moderately to severely HOH adolescents in mainstream education to understand their perceptions of using hearing aids. A core category of "normality" emerged from the data, which captures the predominant issue for these young people. The sense of being normal may be situationally determined, but those who are able to perceive their use of hearing aids in a given context as normal most frequently use them. Regardless of the age of diagnosis or length of time since fitting, if use of hearing aids is perceived as not normal then their use is disguised or negated. The perceptions of the young people indicate that psychosocial supports focused on promoting their identity as HOH young people and normalizing the use of hearing aids should be a key feature of interventions.