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Table 6 Partially met and unmet needs with respect to environmental factors

From: Rehabilitation needs for older adults with stroke living at home: perceptions of four populations

Environmental Factors No. of iterations reported by Themes
  Caregivers Health Professionals Healthcare Managers Patients  
Political economic factors      
Medical care (socio-health system) 33 30 24 32 ▪ Information on existing services
▪ Access to services (delays and disparities)
▪ Follow-up and transfer of files between establishments
▪ Respite services for caregivers: lodging, sitting
▪ Long-term follow-up by CLSC1
▪ Information on medication
▪ Follow-up on taking medication
Rehabilitation (socio-health system) 64 63 17 39 Rehabilitation:
▪ Multi-disciplinary care for patients: speech therapist, neuropsychologist, psychologist, nutritionist
▪ Evaluation of care dependent on budget and services offered rather than on patient's needs
▪ Personalized approach: length of stay, competency of staff with respect to aphasia, knowledge of patient's file, feeding, alternative therapy, intensity of interventions, services limited in some disciplines (speech therapy), attitude of staff with respect to overprotection, staff rotation versus counselling
▪ Access to services (delays): assistive technology, adaptation of home and vehicle
▪ Disparities between services offered in different CLSC territories
▪ Obtaining AT and support for care process: AT for the bathroom, clamp, electric bed, portable hoists, AT feeding, grab bars, emergency call button
▪ Home adaptation, support for care process: door frames, bathroom, access ramps, lift on rails, stairs, exiting the home
▪ Vehicle adaptation
▪ Follow-up on attribution of AT and home adaptation
▪ Support and means to find resources in the community (social worker, doctor)
▪ Psychosocial support offered to the family at start and end of stay
▪ Meeting with family at start and end of stay
Social assistance (socio-health system) 15 12 10 4 ▪ Information on existing services
▪ Discussion group and support for caregivers
▪ Discussion group for patients
▪ Sitting or respite services
▪ Day centre
▪ Temporary lodgings
▪ Support service for meeting with volunteers
▪ Voluntary support and partnership: life project
▪ Who does what: meetings, voluntary work, services, care...
Other types of instruction (education system) 14 23 10 19 ▪ Direct instruction to caregivers/family by health professionals (bathroom hygiene with AT, practising walking, preventing falls, medication, aphasia, exercises, state of health, nutrition, feeding and nourishment, basic care such as using the toilet)
▪ Integration of caregivers/family in vivo during care interventions (gym, therapy, services plan, day hospital)
▪ Prevention of falls (information meeting, video)
Momentum for communicating information to patient and caregiver
▪ Education on consequences and impacts at home (preparing for return home)
▪ Education on mourning process
▪ Equip caregivers with tools to find services for the patients, answers to their questions and support resources
Public infrastructures 4 2 3 10 ▪ Adapted/accessible transportation or paratransit
Community organizations 1 9 2 2 ▪ Information on existing services, directories
▪ Community services for stroke survivors
▪ Transport by community organizations
▪ Promotion and education by certain community organizations relating to consequences of stroke (values, attitudes)
Sociocultural factors      
Social Network 6 6 1 7 ▪ Family: availability and relationships
▪ Friends: social climate
Physical factors      
Architecture; National and regional development 2 0 0 7 ▪ Circulation space in public places (walking frame, wheelchair): sidewalks, ramps, stairs
▪ Parking spaces
▪ Rest areas: public benches
▪ Use of doors
Technology 0 2 2 6 ▪ Access to mobility aids for shopping (wheelchair, walking frame, tripod cane)
▪ Access to special needs equipment (pool, treadmill, rails...)
  1. 1 : center of local community services