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Participation sociale et représentations de l’Accident Vasculaire Cérébral (AVC) chez des patients suite à un AVC

Abstract : Stroke is a frequent and serious disease, constituting the first cause of acquired disability in adults. The impact of stroke on patients’ daily lives is multiple due to the polymorphic nature of post-stroke sequelae, this can have dramatic consequences on people’s lives. Patients often find themselves alone and powerlessness when they return home and have to readapt to daily life by adjusting to their new condition. Faced with stroke and its consequences, patients will develop representations of stroke that influence their self-management behaviours and the adoption of health behaviours favorable to health. The objective of the thesis was to identify, through a systematic literature review and a quantitative study, contextual factors associated with social participation of stroke patients. Contextual factors are both patient-related (socio-behavioural, psychosocial, socio-demographic characteristics) and related to people's living environment. Additionally, we used a qualitative approach to better understand the experience of stroke and in particular to understand individual representations of stroke. The literature review showed the importance of socio-behavioural and psychosocial factors (self-esteem, motivation, acceptance) and also the influence of environmental factors (social support, attitudes of others towards the patient, physical environment, access to care and services) on social participation of stroke patients. The quantitative study (TYBRA-quanti) further showed that gender, coping strategies and patient reported life environment satisfaction were independent determinants of the stroke patient's social participation. In an embedded design, the qualitative study (TYBRA-quali) provided additional information about the experience of stroke, including individual representations developed by patients without major disabilities (mRs ≤ 2). All reported problems in constructing an identity around stroke in both the acute and chronic phases. They had difficulty recognizing that lifestyle risk factors (tobacco, alcohol and diet) could play a role in the occurrence of stroke. Lack of information or information provided at an inappropriate time by health professionals resulted in poor knowledge about medications, and in poor perceived control over the risk of stroke recurrence causing anxiety and fear. Patients who considered stroke as a chronic disease reported more difficulty managing the consequences on daily life. Satisfaction with support from family and health professionals was a major facilitator of the recovery process and of the adoption of health-behaviors favorable to health. The objective of this research work was to better understand the impact of stroke on patients' daily lives and how people cope with it. Based on 3 distinct research methodologies, this thesis led to the production of knowledge on the rehabilitation process of people after stroke. This thesis paves the way for future research and clinical approaches to improving patient support during the rehabilitation phase. In addition to the management of patients' functional and cognitive deficits, providing support focused on psychosocial, socio-behavioural and ecological processes inherent to patients would allow the rehabilitation process to be optimized (in particular by improving social participation and self-management skills)
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Submitted on : Tuesday, May 19, 2020 - 6:42:13 AM
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Claire Della Vecchia. Participation sociale et représentations de l’Accident Vasculaire Cérébral (AVC) chez des patients suite à un AVC. Santé. Université de Lyon, 2020. Français. ⟨NNT : 2020LYSE1011⟩. ⟨tel-02612227⟩

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