An ecological approach to activity after stroke: it takes a community

Biopsychosocial recovery from stroke is remarkable for some individuals, but the majority of stroke survivors have difficulty resuming activities. Even survivors with mild disability become disengaged.

Situational analysis grounded theory and ecological models were used to examine the barriers and facilitators to choice of everyday activities of stroke survivors aged 50 to 64 years.

Resuming activities was an iterative process of scaffolding small tasks into activities through bargaining for access to practical support and inclusion into social situations. Although participants geared up to manage their condition and access activities, for the most part they were not in charge of the services and supports they required. They had little control over who was accepted to rehabilitation, for which services they qualified or disability policies.

There are layers of interactions between individuals and multiple factors in their environments that influence participation. Low poststroke activity levels may be amenable to intervention. Further research should consider the following: (1) participation in activities through the lens of all levels of the socioecological model; (2) the impact of disability and aging-related stigma; (3) the results of ad hoc community navigation; and (4) the effects of restrictive health and disability policies on meaningful activity.