Post-stroke care in the community: A qualitative study exploring perspectives of stroke survivors, family caregivers, and nurses in Northeast Thailand

Juthamart Khotchakhote; Patcharaporn  Kerdmongkol; Kwanjai  Amnatsatsue; Plernpit  Boonyamalik

Authors

Juthamart Khotchakhote -
Patcharaporn Kerdmongkol Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand
Kwanjai Amnatsatsue Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand
Plernpit Boonyamalik Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand

Keywords:

Cerebrovascular disease, Community stroke care, Intermediate care, Stroke service system

Abstract

Background: Stroke remains a formidable global health challenge and is recognized as the second-leading cause of death and the primary cause of long-term disability worldwide including Thailand. Objective: This qualitative descriptive study explored the experiences, challenges, and service expectations related to post-stroke care among stroke survivors, family caregivers, and community nurses in Mahasarakham Province, Northeastern Thailand. Methods: A purposive sample of 28 participants—10 stroke survivors, 8 family caregivers, and 10 community nurses—was recruited from primary care units in Kantharawichai District. Data were collected between June and September 2024 through 18 individual in-depth interviews, 2 focus group discussions, and 10 participatory observation sessions. Qualitative data were analyzed using Braun and Clarke's reflexive thematic analysis. Results: Three themes emerged: (1) inadequate knowledge and preparedness, reflecting gaps in rehabilitation skills and barriers to accessing credible information among caregivers; (2) insufficient and overburdened stroke care personnel, reflecting a shortage of specialized professionals and the need for intermediate care (IMC) guideline and monitoring tools for community nurses; and (3) psycho-cultural services, highlighting the role of spiritual beliefs (karma) in coping and the need for professional reassurance through home visits and financial support. Conclusion: The findings suggest a linkage between national IMC policy and its implementation at the community level. Although families demonstrated culturally grounded resilience, the transition to home care was hindered by systemic gaps and financial strain. These context-specific findings suggest that community stroke care may be strengthened through competency development for community nurses, IMC guideline, and culturally congruent care that integrates spiritual and psychosocial support with clinical rehabilitation.

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