Author ORCID Identifier

https://orcid.org/0009-0009-8079-3963

Date of Award

Summer 8-31-2025

Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Lingling Zhang

Second Advisor

Michelle D.S. Boakye

Third Advisor

Priscilla K. Gazarian

Abstract

Stroke rates have surged globally, severely impacting low-income countries like Ghana, where mortality remains high. Effective self-management is crucial for improving outcomes, yet many stroke survivors and families lack the necessary skills. Healthcare providers are key to bridging this gap, but limited knowledge and the absence of a standardized framework hinder effective support. This dissertation had two primary aims: (1) to clarify the role of healthcare providers in supporting stroke survivors’ self-management after discharge, and (2) to explore the experiences and perceptions of healthcare providers, survivors, and caregivers regarding self-management support (SMS) practices in Ghana. The study was conducted in two phases using Rodgers’ evolutionary concept analysis and Thorne’s Interpretive Description framework. Phase 1, presented in the first manuscript, clarified the attributes, antecedents, and consequences of provider-facilitated SMS. Phase 2, covered in the second and third manuscripts, involved semi-structured interviews with 48 participants from the Kwame Nkrumah University of Science and Technology Hospital, including 15 healthcare providers, 15 stroke survivors, 15 caregivers, and 3 hospital administrators. Individual interviews with providers and administrators are detailed in the second manuscript, while the third manuscript focuses on dyadic interviews with survivor–caregiver pairs. The concept analysis identified three antecedents, eight attributes, and six consequences of provider-facilitated SMS. Qualitative findings revealed five overarching themes, three from providers and administrators, and two from survivor–caregiver dyads. Across both phases, findings consistently showed that SMS was often insufficient, inconsistent, and misaligned with the Chronic Care Model. Survivors and caregivers typically received only basic information, lacking comprehensive, culturally sensitive, and collaborative support. Key SMS components like collaborative goal setting, emotional support, and discussions around sexual health were notably absent. Fragmented care, poor provider coordination, and systemic barriers, including a lack of supportive policies, staff shortages, inadequate SMS training, low literacy, and cultural beliefs, further undermined effective self-management. These findings highlight critical gaps and challenges in Ghana’s SMS practices, negatively affecting survivors’ health outcomes and quality of life. Addressing these deficiencies through policy development, workforce training, and culturally tailored interventions is urgently needed to improve the long-term well-being of stroke survivors and their caregivers.

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