Environmental determinants for participation among stroke survivors in Africa, a scoping review.
Yohannes Awoke Assefa, Zelalem Dessalegn Demeke, Sara Wolde and 1 others
PMID 37288455WHAT IT FOUND
Stroke survivors in Africa faced severe environmental barriers to participation.
Inaccessible transport, buildings, and homes restricted mobility and therapy access. While family support was often positive, societal stigma and lack of assistive devices hindered reintegration. These factors drove survivors to self-imposed isolation.
Key findings
01Inaccessible transport and public buildings were major barriers, with 100% of participants in one study reporting transport as a barrier and 65% of public buildings found inaccessible.
02Support from immediate family was generally positive, but societal attitudes and stigma created significant barriers to community participation.
03A lack of access to assistive devices beyond basic mobility aids, such as bathroom modifications and orthoses, restricted daily independence.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The review only included articles published in English, potentially missing relevant studies from non-English speaking African countries. No methodological appraisal was conducted on the included studies, so the quality of the evidence is unknown. The studies were heterogeneous in design and location, with the majority conducted in South Africa, limiting generalizability to other African regions. Information on services, systems, and policies was scarce, preventing a comprehensive analysis of systemic barriers.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not interpret the findings as evidence that specific interventions improve participation. This review identifies barriers and facilitators but does not test the efficacy of any treatment or policy change.