| Summary: | 碩士 === 國立成功大學 === 職能治療學系碩博士班 === 101 === Purpose: The purpose of this study is to examine how middle and older stroke survivors adapt through occupational choices. The influences of primary adult child’s caregiving values and expectations on the process of decision making about the use of occupational strategies are also investigated.
Methods: This study purposively recruited 5 stroke survivors and 7 primary adult child caregivers from second-year participants of a NSC project. Semi-structured interviews and participant observations were conducted for data collection. All interviews were audio recorded and transcribed verbatim. Field notes were completed after each observation and interview. The analysis was supplemented with the transcripts and the field notes from the previous year of NSC project. Grounded theory approach was adopted as a framework to analyze the data.
Results: The adaptive strategies those 5 stroke survivors used in their daily occupations are “limit or cease participation in activities that may contribute to negative outcomes or impose burdens on primary adult child caregiver,” “emphasize activities that maintain or improve physical health and function,” “maximize participation in the activities or tasks with which they are competent,” “ask for the assistance of foreign domestic helpers,” and “maintain regular daily routines.” Adult child caregivers’ expectations influenced the strategy the older adults chose. They expected that stroke survivors to have conditional independence. They also emphasized safety concerns, maintenance or improvement of physical function and health, and a harmonious relationship between stroke survivors and foreign domestic helpers.
Discussion: The research findings can be further examined with the perspectives of selection, optimization and compensation model (SOC model) and transactionalism. “Limit or cease participation in activities that may contribute to negative outcomes or post burdens on primary adult child caregiver,” and “emphasize activities that can maintain or improve physical health and function” are the use of selection strategy; “maximize participation in activities or tasks they are competent with” is the use of optimization strategy; and “ask for the assistance of foreign domestic helpers” is the use of compensation strategy. Transactionalism is an emerging theoretical perspective to understand occupations in occupational science. The results support that occupations are contextualized, and embedded with interactions between individuals and contexts. In addition, occupations also act as the transaction medium. The selection and organization of occupations contribute to stroke survivors’ adaptation.
Conclusion: This research explores the changes in the occupational participation of stroke survivors from the perspective of adaptation. The primary adult child’s caregiving values and strategies are also investigated. The research findings advocate for involving family members in adult rehabilitation in Taiwan, and integrating concepts of selection, optimization, and compensation model in occupation-based clinical practice.
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