POST-STROKE HEALTH-RELATED QUALITY OF LIFE AND RETURN TO WORK IN SOUTHWESTERN ETHIOPIA: A MIXED-METHODS STUDY
Author(s)
Mastewal H. Samuel, MSc1, Getahun M. Asmamaw, MSc2;
1Wachemo University, Pharmacy, Hosanna, Ethiopia, 2Arba Minch University, Pharmacy, Arba Minch, Ethiopia
1Wachemo University, Pharmacy, Hosanna, Ethiopia, 2Arba Minch University, Pharmacy, Arba Minch, Ethiopia
OBJECTIVES: This study aimed to assess the determinants of Health Related Quality of Life (HRQoL) and explain the lived experiences of Returning to Work (RTW) among stroke survivors at Jimma Medical Center, Ethiopia.
METHODS: This study implemented a sequential explanatory mixed-methods design. A cross-sectional survey employed the EQ-5D-5L and other validated tools. Descriptive and inferential statistical analyses were used to present the findings. Multivariate logistic regression identified factors associated with each HRQoL dimension (p<0.05). Subsequently, in-depth interviews were conducted and thematic analysis was used to explore the RTW experience.
RESULTS: The mean EQ-5D-5L index and visual analog scale scores were 0.48 and 50.32, respectively. Among the five HRQoL dimensions, mobility (n=147; 53.2%) and pain/discomfort (n = 171; 61.9%) were the most severely affected. Aphasia was a dominant predictor significantly associated with all HRQoL dimensions, accounting problems in mobility (AOR=6.26, p=0.005), self-care (AOR=22.58; p<0.001), usual activities (AOR=6.12; p<0.001), pain/discomfort (AOR=14.92; p=0.003), and anxiety/depression (AOR=8.84; p<0.001). Failure to RTW predicted problems in mobility (AOR=8.47; p=0.029), self-care (AOR=4.31; p=0.004), and pain/discomfort (AOR=4.39; p=0.027). Other significant factors included low physical activity, high malnutrition risk, low medication adherence, advanced age, and lack of health insurance. Qualitatively, key themes were: 1) loss of identity; 2) a "treatment-subsistence dilemma" from economic insecurity; 3) internalized shame; and 4) "social death" from broken financial networks.
CONCLUSIONS: In this study, barriers to recovery after stroke extend far beyond physical impairment. The association between socioeconomic, clinical and functional status and failed to return to work creates a self-perpetuating cycle of disability and poverty. The lived experiences of survivors reveal that this cycle is reinforced by the loss of identity, economic insecurity, internalized shame, and ruptured social networks.
METHODS: This study implemented a sequential explanatory mixed-methods design. A cross-sectional survey employed the EQ-5D-5L and other validated tools. Descriptive and inferential statistical analyses were used to present the findings. Multivariate logistic regression identified factors associated with each HRQoL dimension (p<0.05). Subsequently, in-depth interviews were conducted and thematic analysis was used to explore the RTW experience.
RESULTS: The mean EQ-5D-5L index and visual analog scale scores were 0.48 and 50.32, respectively. Among the five HRQoL dimensions, mobility (n=147; 53.2%) and pain/discomfort (n = 171; 61.9%) were the most severely affected. Aphasia was a dominant predictor significantly associated with all HRQoL dimensions, accounting problems in mobility (AOR=6.26, p=0.005), self-care (AOR=22.58; p<0.001), usual activities (AOR=6.12; p<0.001), pain/discomfort (AOR=14.92; p=0.003), and anxiety/depression (AOR=8.84; p<0.001). Failure to RTW predicted problems in mobility (AOR=8.47; p=0.029), self-care (AOR=4.31; p=0.004), and pain/discomfort (AOR=4.39; p=0.027). Other significant factors included low physical activity, high malnutrition risk, low medication adherence, advanced age, and lack of health insurance. Qualitatively, key themes were: 1) loss of identity; 2) a "treatment-subsistence dilemma" from economic insecurity; 3) internalized shame; and 4) "social death" from broken financial networks.
CONCLUSIONS: In this study, barriers to recovery after stroke extend far beyond physical impairment. The association between socioeconomic, clinical and functional status and failed to return to work creates a self-perpetuating cycle of disability and poverty. The lived experiences of survivors reveal that this cycle is reinforced by the loss of identity, economic insecurity, internalized shame, and ruptured social networks.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
CO126
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment, Relating Intermediate to Long-term Outcomes
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)