Date of Award

1-1-2013

Document Type

Open Access Dissertation

Department

Exercise Science

First Advisor

Stacy L Fritz

Abstract

A study found that racial differences exist in stroke rehabilitation care and outcomes between African Americans (AAs) and Caucasian Americans (CAs). In addition to health status, the rehabilitation care of AAs with stroke (AAwS) may be influenced by cultural and or racial similarities or differences that exist between themselves and their physical therapists (PTs). Distorted perceptions of culture and race in the patient-PT relationship may contribute to disparities in stroke rehabilitation care and outcomes for AAwS. Current stroke rehabilitation literature lacks qualitative research that examines racialized differences in treatment. The purpose of this qualitative exploratory research study was to investigate the perspectives of: (1) AAwS regarding the ways in which culture and race may have influenced their physical therapy experiences during inpatient rehabilitation, and (2) PTs regarding how culture, race, and health status (latter two evidenced in literature) contribute to the disparities in rehabilitation care and outcomes for persons with stroke. Semistructured individual and paired interviews were conducted with a purposeful criterion sample of five AAwS. Semistructured focus group interviews were conducted with a purposeful criterion sample of PTs. Interviews were digitally recorded, transcribed verbatim, and content analyzed. Data analysis revealed six themes for AAwS: (1) self-acknowledgement, (2) shift in barriers to optimal health, (3) health cultured inferiority or subordination, (4) health outcome investment with a subtheme, culturally-relevant and functional activities, (5) issues of trust, and (6) race role interaction. Six themes emerged for PTs: (1) justice and equality, (2) family capacity, (3) patient-PT relationship, (4) health outcome investment, with a subtheme of physical therapy intensity, (5) systematic healthcare limitations, and (6) patient social health attributes. The diversity of these themes demonstrates the complexities involved in providing equitable care related to culture, race, and health status. Also, culture and race of the patient and PT are characteristics that factor into the patient-PT relationship in physical therapy practice. Future qualitative studies should interview and observe patient-PT dyads to investigate how physical therapy practice and the patient-PT relationship can accommodate the factors of culture, race, and health status to eliminate disparities in stroke rehabilitation care and outcomes between AAs and CAs.

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