Stroke survivors' and carers' experiences of nutritional care after stroke: a qualitative study.

Abstract

Impaired nutritional status is commonly reported following stroke and is associated with poor clinical outcomes. More than 60% of stroke survivors in the UK are supported by informal, unpaid carers who commonly report one or more unmet care needs. This qualitative study explores stroke survivors' and informal carers' experiences of nutritional care across the pathway of stroke rehabilitation and recovery. Twelve stroke survivors and 12 informal carers were recruited via voluntary stroke organizations. Twelve participants were male. Thirteen were aged 18-34, five were aged 35-54, six were aged 55-74. Ten were of Black British ethnicity, nine White British, two Black other, two Asian and one mixed ethnicity. Median time since stroke was 2 years (range: 4 months to >10 years). Individual, online, semi-structured interviews explored the impact of stroke on nutrition, perceptions of nutritional care received, and suggested improvements. Interviews were transcribed and analyzed using reflexive thematic analysis within a critical realist framework. Four themes were generated from the data: (1) "overlooked stroke-specific and co-morbid challenges," recognizing the clinical complexity of post-stroke nutrition (2) "the case for personalized, context-sensitive nutrition," highlighting the importance of personalized nutrition and consideration of cultural factors (3) "preparedness for discharge home," which recognizes the importance of the multidisciplinary team in preparing stroke survivors and carers for returning home, (4) "a lack of nutritional information and support," articulating a strong desire for nutritional information and lack of consistent dietetic support after discharge. Findings highlight the importance of preparing stroke survivors and carers effectively prior to discharge through improved access to personalized, culturally sensitive nutrition information, and more consistent dietetic support. Six recommendations are made for improved nutritional care across the stroke pathway. Strategies are needed to identify and address unmet need in relation to post-stroke nutrition and support recovery of stroke survivors.