Health-related quality of life in ethnically diverse Black prostate cancer survivors: a convergent parallel mixed-methods approach.

PURPOSE: This study examined the health-related quality of life (HRQoL) among ethnically diverse Black men (BM) with prostate cancer (CaP) in the United States. METHODS: A convergent parallel mixed-methods design, employing both qualitative and quantitative research, involved recruiting Black CaP survivors through multiple channels. The target population was native-born BM (NBBM), African-born BM (ABBM), and Caribbean-born BM (CBBM). QoL for all men was assessed using The Functional Assessment Cancer Therapy-Prostate (FACT-P) measure, which includes five domains: physical- (PWB), emotional- (EWB), social-(SWB), and functional-wellbeing (FWB), and a CaP subscale (PCS). A subset of men completed qualitative interviews. Demographic and clinical characteristics were also collected. RESULTS: Black CaP survivors aged 49-85 participated in the study (n = 108), with a subset (n = 31) completing a qualitative interview. Participants were mainly NBBM (72.2%) and treated with radiotherapy (51.9%). The FACT-P scale total mean score (± SD) was 114 ± 24.1 (theoretical range 0-156), with lower scores reported on the SWB, FWB, and EWB domains. The mixed-methods findings approach included meta-inferences derived from integrating the corresponding quantitative and qualitative data, covering all the domains within the FACT-P. CONCLUSION: Black CaP survivors experienced significant burdens that impacted their overall HRQoL. The analysis revealed impacts on physical, social, and emotional well-being, with variations among ethnic groups suggesting the need for culturally tailored interventions. EWB was also profoundly impacted by CaP treatment, with universal emotional burdens emphasized across all groups. Healthcare providers must recognize and address these multifaceted needs to promote better outcomes and HRQoL for Black CaP survivors.

Voices of Black men: reflecting on prostate cancer survivorship care plans.

PURPOSE: This study addresses the critical issue of survivorship care for Black prostate cancer survivors. The aim was to explore their awareness of survivorship care plans to improve prostate cancer care and survivorship within this high-risk group. METHODS: Utilizing a thematic analysis approach, we conducted in-depth interviews focused on analyzing post-treatment experiences of Black prostate cancer survivors by applying interpretive explanations to data collected from participants. RESULTS: Participants reported a significant gap in survivorship care plan communication post-treatment, as these plans were seldom discussed. Survivors highlighted the adoption of post-treatment strategies and self-education as means to enhance their comprehension of the survivorship process. Black survivors demonstrated an intrinsic motivation, after feeling "discarded," to find suitable resources to enhance their survivorship care for a better quality of life. CONCLUSION: The prioritization of post-treatment care for Black prostate cancer survivors is important. By offering comprehensive post-treatment education, improving symptom transparency, and establishing safe spaces for open discussion, the quality of life of Black survivors may be substantially improved. IMPLICATIONS FOR CANCER SURVIVORS: There is a pressing need for dynamic post-treatment care coordination tailored to Black prostate cancer survivors. A lack of crucial post-treatment education for this population that experiences disproportionate burden of prostate cancer may exacerbate cancer health disparities. Addressing this care coordination gap may improve support systems, survivor well-being, and better cancer outcomes.

Quality of life assessment among ethnically diverse Black prostate cancer survivors: a constructivist grounded theory approach.

PURPOSE: Prostate cancer (CaP) is the most common cancer in Black men (BM), and the number of Black CaP survivors is rapidly increasing. Although Black immigrants are among the fastest-growing and most heterogeneous ethnic groups in the USA, limited data exist regarding their CaP experiences. Therefore, this study aimed to explore and model the experiences of ethnically diverse Black men with CaP. METHODS: In-depth interviews were conducted with 34 participants: native-born BM (NBBM) (n = 17), African-born BM (ABBM) (n = 11), and Caribbean-born BM (CBBM) (n = 6) CaP survivors recruited through QR code-embedded flyers posted in Black businesses, clinics, social media platforms, and existing research networks within the USA. Guided by Charmaz's constructivist grounded theory methodology, the interviews were analyzed using constant comparison following key stages of initial, focused, and theoretical coding using Atlas.ti v23. RESULTS: Participants were thirty-four men aged 49-84 years (mean ± SD, 66 ± 8). Most were married (77%), likely to be diagnosed at stage I (35%), and treated with radiotherapy (56%). Our study findings explored the complex trajectory of Black prostate cancer (CaP) survivors, unveiling a comprehensive model termed "Journeying through Unfamiliar Terrain." Comprising three phases and 11 sub-phases, this model uniquely captures the pre-diagnosis awareness and post-treatment adaptation among survivors. CONCLUSION: The resulting theoretical model delineates the entire CaP survivorship process among BM, providing contextual and conceptual understanding for developing interventions and enhancing patient-centered care for ethnically diverse CaP survivors, pivotal in bridging the gaps in survivorship research and healthcare practices. IMPLICATIONS FOR CANCER SURVIVORS: Black CAP survivors experience significant burdens and challenges that impact their overall quality of life. Understanding the factors that impact the complex survivorship journey can inform design and implementation of interventions to address the multiple challenges and thus improve quality of life.

Quality of Life Assessment Among Ethnically Diverse Black Prostate Cancer Survivors: A Constructivist Grounded Theory Approach.

Purpose: Prostate cancer (CaP) is the most common cancer in Black men (BM), and the number of Black CaP survivors is rapidly increasing. Although Black immigrants are among the fastest-growing and most heterogeneous ethnic groups in the US, limited data exist regarding their CaP experiences. Therefore, this study aimed to explore and model the experiences of ethnically diverse Black men with CaP. Methods: In-depth interviews were conducted with 34 participants: Native-born BM (NBBM) (n=17), African-born BM (ABBM) (n=11), and Caribbean-born BM (CBBM) (n=6) CaP survivors recruited through QR-code embedded flyers posted in Black businesses, clinics, social media platforms, and existing research networks within the US. Guided by Charmaz's constructivist grounded theory methodology, the interviews were analyzed using constant comparison following key stages of initial, focused, and theoretical coding using Atlas.ti v23. Results: Participants were thirty-four men aged 49-84 years (mean±SD, 66±8). Most were married (77%), likely to be diagnosed at Stage I (35%), and treated with radiotherapy (56%). Our study findings explored the complex trajectory of Black prostate cancer (CaP) survivors, unveiling a comprehensive model termed "Journeying through Unfamiliar Terrain." Comprising three phases and 11 sub-phases, this model uniquely captures the pre-diagnosis awareness and post-treatment adaptation among survivors. Conclusion: The resulting theoretical model delineates the entire CaP survivorship process among BM, providing contextual and conceptual understanding for developing interventions and enhancing patient-centered care for ethnically diverse CaP survivors, pivotal in bridging the gaps in survivorship research and healthcare practices.

Development of a Minority Prostate Cancer Research Digest: Communication Strategy Statement for Black Men.

Since prostate cancer incidence, prevalence and mortality are still highest among Black men in the United States, it is important to effectively address the factors that contribute to prostate cancer disparities in this at-risk population as well as their low participation in biomedical research/clinical trials. An effective communication strategy that can be used to disseminate information with high public health impact to Black men is one way to combat prostate cancer disparities. The objective of this study was to develop a Minority Prostate Cancer (MiCaP) research communication strategy using focus group methodology and expert in-depth interviews. The communication strategy statement developed in this study provides a guide for message concepts and materials for Black men, including communication content, source, channel, and location. Specifically, it provides recommendations on how to deliver information, how to choose the language and relevant images, how to gain attention, who is preferred to deliver messages, and other ways to engage Black men in health communication strategies. The communication strategy statement was used to develop the MiCaP Research Digest, a research communication program that is currently being tested in Orange County, Duval County, Leon County, Gadsden County, and the Tampa Bay area of Florida.

Sex Trafficking in the United States: A Scoping Review.

PURPOSE: Human trafficking is a public health social work issue. This review aimed to present the current state (nature and extent) of sex trafficking research, categorize best practices, and identify recommendations for professionals. METHODS: Comprehensive literature searches of online databases were conducted to identify eligible articles from January 2000 to March 2019. RESULTS: The search yielded 467 studies, 87 met the predetermined criteria for inclusion. Seven themes identified: awareness, identification, at-risk populations, health issues, implementation of trafficking legislation, service and program implementation, and exploiters. DISCUSSION AND IMPLICATIONS FOR PRACTICE: Findings indicate the need for additional research to determine the most effective practices to increase awareness and identification, widespread TVPA implementation, reduce risk factors and resulting health disparities, offer services to survivors and prevention of potential victims. CONCLUSION: There should be significant efforts to enhance all sex trafficking research in the United States to implement effective, sustainable and evidence-based interdisciplinary interventions.

Driving Outside the Wire: Examining Factors Impacting Veterans' Postdeployment Driving.

Combat Veterans (CVs) deployed to Iraq or Afghanistan experience driving difficulty, based on medical conditions and/or deployment exposures, elevating their risk of motor vehicle crash-related injury or death. To address grounded theory rigor and incorporate constructs such as the Person Environment Occupation Performance model, we revised the Hannold et al. (2013) conceptual framework. We conducted two focus groups with seven CVs. Conceptual framework revisions were based on an iterative process and thematic analysis. We elicited CVs' perspectives on deployment training, driving pre- and postdeployment, strategies, and intervention preferences. Personal, environmental, and task factors underpinned CVs' driving. Participants described triggers (e.g., stressful stimuli), use of environmental (e.g., car controls) or personal (e.g., avoiding traffic) strategies, and outcomes of appropriate or risky driving. Findings illustrated CVs' driving difficulty and informed development of a Veteran-centric driving intervention. Improving driving fitness has implications for Veterans' participation and community integration.

Perception of Older Adults Toward Smartwatch Technology for Assessing Pain and Related Patient-Reported Outcomes: Pilot Study.

BACKGROUND: Chronic pain, including arthritis, affects about 100 million adults in the United States. Complexity and diversity of the pain experience across time and people and its fluctuations across and within days show the need for valid pain reports that do not rely on patient's long-term recall capability. Smartwatches can be used as digital ecological momentary assessment (EMA) tools for real-time collection of pain scores. Smartwatches are generally less expensive than smartphones, are highly portable, and have a simpler user interface, providing an excellent medium for continuous data collection and enabling a higher compliance rate. OBJECTIVE: The aim of this study was to explore the attitudes and perceptions of older adults towards design and technological aspects of a smartwatch framework for measuring patient report outcomes (PRO) as an EMA tool. METHODS: A focus group session was conducted to explore the perception of participants towards smartwatch technology and its utility for PRO assessment. Participants included older adults (age 65+), with unilateral or bilateral symptomatic knee osteoarthritis. A preliminary user interface with server communication capability was developed and deployed on 10 Samsung Gear S3 smartwatches and provided to the users during the focus group. Pain was designated as the main PRO, while fatigue, mood, and sleep quality were included as auxiliary PROs. Pre-planned topics included participants' attitude towards the smartwatch technology, usability of the custom-designed app interface, and suitability of the smartwatch technology for PRO assessment. Discussions were transcribed, and content analysis with theme characterization was performed to identify and code the major themes. RESULTS: We recruited 19 participants (age 65+) who consented to take part in the focus group study. The overall attitude of the participants toward the smartwatch technology was positive. They showed interest in the direct phone-call capability, availability of extra apps such as the weather apps and sensors for tracking health and wellness such as accelerometer and heart rate sensor. Nearly three-quarters of participants showed willingness to participate in a one-year study to wear the watch daily. Concerns were raised regarding usability, including accessibility (larger icons), notification customization, and intuitive interface design (unambiguous icons and assessment scales). Participants expressed interest in using smartwatch technology for PRO assessment and the availability of methods for sharing data with health care providers. CONCLUSIONS: All participants had overall positive views of the smartwatch technology for measuring PROs to facilitate patient-provider communications and to provide more targeted treatments and interventions in the future. Usability concerns were the major issues that will require special consideration in future smartwatch PRO user interface designs, especially accessibility issues, notification design, and use of intuitive assessment scales.

The Role and Influence of Prostate Cancer Caregivers Across the Care Continuum.

BACKGROUND: Black men endure a disproportionate burden of morbidity and mortality related to prostate cancer (CaP). Increasingly family members are assuming the role of providing care and support to family members with chronic disease. Understanding the role and influence of the caregiver is a necessary part of developing resources to assist individuals learning to provide care. AIM: The analysis aimed to explore CaP survivors' perceptions of the role and influence of family caregivers to better understand existing opportunities for improving experiences and outcomes for both the caregiver and the care receiver. DESIGN: Secondary analysis of qualitative interview transcripts. Data were analyzed to explore new inquiries related to CaP survivors' perceptions of family caregivers' role and influence at each stage of care. Content analysis was used to group data into established categories. DATA SOURCE: Data included qualitative interview transcripts with 32 CaP survivors from the Florida Prostate Cancer Care and Survivorship Project. RESULTS: The role of the family caregiver is complex. Caregivers in this community seem to have a significant influence on behavior modification and cues to action for Black men with prostate cancer. According to the men in this group, caregivers functioned as normalizing agents, coordinating care and creating a new normal, throughout the various stages of care and survivorship. CONCLUSIONS: Findings inform areas for future research to develop culturally tailored health promotion programs designed to improve outcomes and address the needs of both the family caregiver and the care receiver across the care continuum.

More than a job: Career development of individuals with cystic fibrosis.

BACKGROUND: Cystic fibrosis and its employment corollaries have received little attention despite the fact that complications of CF represent numerous theorized barriers to optimal career outcomes. OBJECTIVES: The objective of the study was to conduct grounded theory research that results in an understanding of the employment experiences of people with CF and ultimately a substantive grounded theory of career development applicable to individuals with this disease. METHODS: This study utilized the grounded theory method of qualitative inquiry. A purposive sample of ten young adults with CF participated in in-depth semi-structured qualitative interviews. Analysis of the interview transcripts followed the constant comparative approach to coding, which identified core themes and sub-themes and culminated in a conceptual framework of variables influencing employment and career development. RESULTS: An ecologically-based grounded theory of career development was developed. Major themes that influenced employment and career development were illness appraisal, occupational compromise, persistence, and altruism. Two patterns of career development outcomes emerged - the uninterrupted and the interrupted. CONCLUSIONS: A complicated interaction of numerous ecological variables (individual characteristics, personal contextual factors, mediating factors, and the environment) collectively influenced career development. The presence of CF alone did not guarantee negative effects on career development.

Prostate Cancer Screening Perception, Beliefs, and Practices Among Men in Bamenda, Cameroon.

Prostate Cancer (CaP) is the most commonly diagnosed cancer among Cameroonian men. Due to inadequate infrastructure, record keeping, and resources, little is known about its true burden on the population. There are rural/urban disparities with regards to awareness, screening, treatment, and survivorship. Furthermore, use of traditional medicine and homeopathic remedies is widespread, and some men delay seeking conventional medical treatment until advanced stages of CaP. This study examined the perceptions, beliefs, and practices of men in Cameroon regarding late stage CaP diagnoses; identified factors that influence screening decision; and ascertained how men decided between traditional or conventional medicine for CaP diagnosis and treatment. Semistructured focus groups were used to collect data from men in Bamenda, Cameroon. Qualitative data analysis was used to analyze transcripts for emerging themes and constructs using a socio-ecological framework. Twenty-five men participated in the study, with an average age of 59. Most of the participants had never received a prostate screening recommendation. Socioeconomic status, local beliefs, knowledge levels, awareness of CaP and screening methods, and stigma were prominent themes. A significant number of Cameroonian men receive late stage CaP diagnosis due to lack of awareness, attitudes, cultural beliefs, self-medication, and economic limitation. To effectively address these contributing factors to late stage CaP diagnosis, a contextually based health education program is warranted and should be tailored to fill knowledge gaps about the disease, dispel misconceptions, and focus on reducing barriers to utilization of health services.

Improving Stroke Caregiver Readiness for Transition From Inpatient Rehabilitation to Home.

Purpose: As the population ages, older adults are more often living with functional limitations from chronic illnesses, such as stroke, and require assistance. Because stroke occurs suddenly, many stroke family caregivers in the United States are unprepared to assume caregiving responsibilities post-discharge. Research is limited on how family members become ready to assume the caregiving role. In this study, we developed a theoretical model for improving stroke caregiver readiness and identifying gaps in caregiver preparation. Design and Methods: We interviewed 40 stroke family caregivers caring for 33 stroke survivors during inpatient rehabilitation and within 6 months post-discharge for this grounded theory study. Data were analyzed using dimensional analysis and constant comparative techniques. Results: Caregivers identified critical areas where they felt unprepared to assume the caregiving role after discharge from inpatient rehabilitation. Steps to improve preparation include (a) conducting a risk assessment of the patient and caregiver; (b) identifying and prioritizing gaps between the patient's needs and caregiver's commitment and capacity; and (c) developing a plan for improving caregiver readiness. Implications: The model presented provides a family-centered approach for identifying needs and facilitating caregiver preparation. Given recent focus on improving care coordination, care transitions, and patient-centered care to help improve patient safety and reduce readmissions in this population, this research provides a new approach to enhance these outcomes among stroke survivors with family caregivers.

Social networks and participation with others for youth with learning, attention, and autism spectrum disorders.

BACKGROUND: Social participation involves activities and roles providing interactions with others, including those within their social networks. PURPOSE: This study sought to characterize social networks and participation with others for 36 youth, ages 11 to 16 years, with (n = 19) and without (n = 17) learning disability, attention disorder, or high-functioning autism. METHOD: Social networks were measured using methods of personal network analysis. The Children's Assessment of Participation and Enjoyment With Whom dimension scores were used to measure participation with others. Youth from the clinical group were interviewed regarding their experiences within their social networks. FINDINGS: Group differences were observed for six social network variables and in the proportion of overall, physical, recreational, social, and informal activities engaged with family and/or friends. Qualitative findings explicated strategies used in building, shaping, and maintaining social networks. IMPLICATIONS: Social network factors should be considered when seeking to understand social participation.

Evaluation of a newly developed tobacco cessation program for people with disabilities.

BACKGROUND: Tobacco use is the single most preventable cause of morbidity and mortality, accounting for at least 480,000 deaths in the United States annually. People with disabilities smoke at a rate 1.5 times greater than the able-bodied population. Higher incidence of tobacco use among people with disabilities has been directly related to both unique and universal cessation barriers. Despite increased prevalence of tobacco use and cessation obstacles, evidence is lacking on the development of successful interventions targeting people with disabilities. OBJECTIVE: We aimed to assess the feasibility, acceptability, and potential effectiveness of a cessation intervention tailored to people with disabilities. METHODS: Eighteen tobacco users with disabilities (56% African American, 64% male) participated in a 4-week, 8-session tobacco cessation program consisting of group sessions on managing addiction, relapse, and lifestyle changes specific to people with disabilities. Semi-structured interviews were conducted at the conclusion of the program. A follow-up measure of smoking status, triggers, and nicotine replacement therapy usage was completed at 4 weeks and 6 months. RESULTS: Sixteen participants completed the intervention (89%), with participants on average attending 86% of sessions. Most participants rated the program as excellent (83%) or good (8%). Qualitative interviews revealed participants value social support, accessibility, and a tailored program. Four participants (22%) reported abstinence at six months, which is greater than the standard quit rate. CONCLUSION: This study suggests tailoring a cessation program to the characteristics unique to people with disabilities may be critical in delivering meaningful and effective cessation interventions among this population.

Mixed-Method Exploration of Social Network Links to Participation.

The people who regularly interact with an adolescent form that youth's social network (SN), which may impact participation. We investigated the relationship of SNs to participation using personal network analysis and individual interviews. The sample included 36 youth, aged 11 to 16 years. Nineteen had diagnoses of learning disability, attention disorder, or high-functioning autism, and 17 were typically developing. Network analysis yielded 10 network variables, of which 8 measured network composition and 2 measured network structure, with significant links to at least I measure of participation using the Children's Assessment of Participation and Enjoyment (CAPE). Interviews from youth in the clinical group yielded description of strategies used to negotiate social interactions, as well as processes and reasoning used to remain engaged within SNs. Findings contribute to understanding the ways SNs are linked to youth participation and suggest the potential of SN factors for predicting rehabilitation outcomes.

Perspectives of linkage to care among people diagnosed with HIV.

Timely linkage to HIV care and treatment has led to improved individual and population benefits; however, 25%-31% of people diagnosed with HIV do not engage in care. Most linkage to care research has focused on larger metropolitan areas, but smaller metropolitan and rural areas encounter unique challenges to linkage to care. Our purpose was to examine factors influencing the decision to seek care by 27 people infected with HIV living in smaller metropolitan and rural areas of Florida. We used grounded theory methods to develop a theoretical model describing the decision-making process and participant recommendations within the context of stigma. Participants described support, defining care, activating care, conflicting messages of care, and pivotal events influencing the care decision. Findings highlight the complexities of HIV care and suggest a client-centered approach to address the multifaceted social and structural challenges people with HIV face in the journey from infection to care.

Clinical Implications of Family-Centered Care in Stroke Rehabilitation.

PURPOSE: Most stroke survivors will be cared for at home by family caregivers with limited training. Families actively involved in rehabilitation feel more prepared for the new responsibilities of caring for the stroke survivor. The focus of this article is to highlight the relevant concepts of a family-centered model of care and provide general guidance on how integrating a family-centered mindset may be clinically applicable. DESIGN: Concept Analysis. METHODS: Synthesis of literature on family-centered care and its application in for rehabilitation nurses. FINDINGS: Family-centered care is a model of collaborative healthcare that encourages collaboration and partnership among patients, families, and providers with respect to the planning, delivery, and evaluation of health care. Care provided within such a model can expand providers' knowledge of the impact of illness and any issues that may affect eventual transition back home. CONCLUSION: Rehabilitation nurses should view stroke patients and family caregivers as a unit. Using family-centered strategies can help nurses provide appropriate, individualized care during rehabilitation.

A comprehensive assessment of family caregivers of stroke survivors during inpatient rehabilitation.

PURPOSE: Stroke caregivers have been identified as a group at high risk for poor outcomes as a result of the suddenness of stroke and a potentially high level of care needed due to significant functional limitations of the patient. However, there is little research on the assessment of family members who will assume the caregiving role prior to patient discharge from rehabilitation. The purpose of this article is to delineate critical assessment domains identified by a subset of spousal stroke caregivers. METHODS: Semi-structured interviews were conducted pre- and post-discharge from rehabilitation as part of a larger study that focused on identifying caregiver and stroke survivor needs as they transitioned home from inpatient rehabilitation. For this study, two semi-structured interviews with 14 spousal caregivers were analyzed using grounded theory methods. RESULTS: Long-term stroke survivor outcomes were dependent upon the commitment, capacity and preparedness of the family caregiver. Twelve domains of assessment were identified and presented. CONCLUSIONS: A comprehensive, systematic caregiver assessment to understand the caregiver's concerns about stroke should be conducted during rehabilitation to help the team to develop a plan to address unmet needs and better prepare family caregivers to take on the caregiving role. IMPLICATIONS FOR REHABILITATION: Stroke is a sudden event that often leaves stroke survivors and their families in crisis. The needs of stroke family caregivers are not often systematically assessed as part of inpatient rehabilitation. Long-term stroke survivor outcomes are dependent upon the commitment, capacity and preparedness of the family caregiver. Stroke caregiver assessment should include the commitment, capacity and preparedness to provide care, and the overall impact of stroke in order to develop discharge plans that will adequately address the needs of the stroke survivor/caregiver dyad.

Creating a Tobacco Cessation Program for People with Disabilities: A Community Based Participatory Research Approach.

Introduction: Smoking is the single most preventable cause of morbidity and mortality, accountable for one out of every five fatalities in the United States annually. Fifty million Americans (22%) suffer from some form of disability, with evidence suggesting that smoking rates within the disabled community are double that of the general population. Methods: The purpose of this study was to develop a tobacco cessation program designed by and for people with disabilities (PWD). Limited research data regarding tobacco interventions suggest that both adapting treatment methods and developing novel approaches may be effective in establishing cessation programs for low-income populations. Community-Based Participatory Research (CBPR) was conducted to develop a tobacco cessation group treatment program for PWD. Consumers with disabilities who use tobacco were recruited from a large population of PWD utilizing services at multiple centers for independent living (CIL) within North Central Florida. Results: Following qualitative interviews, multiple Community Advisory Board (CAB) meetings, and expert panel review, the tobacco cessation program was modified across several areas including: updating epidemiological data, decreasing text density, adding personal vignettes from PWD, adjusting for person-first language, adding disability-specific issues, and incorporating appropriate counseling strategies. Conclusions: Study findings suggest that CBPR-based methods are useful when developing tobacco cessation programs for persons with disability. Forty-two changes were recommended for the resulting LIFT Curriculum. Next steps include pilot testing the curriculum among individuals with disability and comparing results to a standard tobacco cessation curriculum.

The impact of interactions with providers on stroke caregivers' needs.

PURPOSE: Preparation for caregiving is improved through engaged interactions between stroke family caregivers and healthcare providers throughout the care trajectory. We explored caregivers' perceptions about interactions with providers in rehabilitation, and how these experiences affected caregiver preparation. DESIGN: Seventeen caregivers, included in this grounded theory study, were interviewed during a rehabilitation stay and postdischarge. Data were analyzed using dimensional and comparative analysis. FINDINGS: Caregivers described interactions with providers on a continuum from collaborative to disconnected, and a range of strategies to enhance interactions. CONCLUSIONS: Caregivers want to be actively engaged with providers during inpatient rehabilitation and collaborative interactions enhance preparedness and care satisfaction. RELEVANCE: Family members should be assessed for caregiving capacity and interactions between providers and caregivers should be individualized to specific needs. Providers must also be aware that many caregivers are not active information seekers. They must engage caregivers who may not even know what questions to ask.