Relations sociales à trois pendant la prise en charge des soins et de l'aide à domicile après la réadaptation à la suite d'un accident vasculaire cérébral

The aim of this exploratory type qualitative research based on case study is to understand the process of “social relations alteration” or “conflicts” between the care giving main actors and the responsible of home care and assistance, in order to better detect, understand and prevent them. The subject of this study is the organization of the home care management. The main question that guided us in this research, is thus formulated: how the elderly, their caregivers and stakeholders organize the management of care and assistance at home after rehabilitation following a stroke? While this research question leads us to the description of the facts and their measurement, its purpose is to explain, analyze and understand the nature of relationships between the actors and the problems they are facing and then understand conflict relationships that appear to be problematic in the management of care and support at home after rehabilitation following a stroke. This thesis is part of a transdisciplinary research approach including sociology, anthropology, social psychology, human ecology and rehabilitation sciences. Such an approach has led us to combine the first corpus around three poles: a pole covering theoretical models and theories, a pole on the collection of empirical data and a pole on methodological approaches and techniques related to the collection and data analysis. For this, a conceptual framework was built from the theoretical and conceptual foundations from human ecology and sociology of translation. This conceptual framework gives us eight levels of analysis that are used to describe and interpret the nature of social relations between actors. So, there is in this centering (center action), a background that enables Applied Human Sciences to capture, analyze and interpret the organization of the management of care and support at home after rehabilitation from a rich array of data. To arrive at the methodological level, we proceeded to the selection of fifteen participants including five elderly victims of stroke, five caregivers and five professional speakers. Then we crossed three techniques for data collection, including semi-structured interviews, observations and document review. The data were analyzed using QSR NVivo 8 software, following a previously constructed tree theme, and we obtained 16 thematic codes and 34 sub- codes. Three main themes have emerged from the results of analysis such as: usability in social relations; the warmth in social relations and the social relations strategy. In addition, five following sub-themes have been identified: conflicts between the actors; agreements between stakeholders; social support; changes in social roles and alteration of social relationships among actors. The analysis of the results allowed us to sketch three structured profiles (friendly cases, suggestive cases and intrinsic case) between the main actors involved in the management of care and home help after rehabilitation following a stroke. Then we made the clarification of key concepts in our study. These are the altered social relations, the warmth social relations and the strategic social relations. Subsequently, we proceeded to the systematization of results in behaviors and attitudes that generates conflicts and/or further promote collaboration between stakeholders to finally take an interest in social relationships between the elderly, the caregivers and stakeholders making an intra-and inter-case analysis case in order to demonstrate the convergences and divergences between cases with reference to four concepts in our conceptual framework. In case user-friendly, there is a lack of differences, as they manifest themselves more by controversy between actors in suggestive cases. In intrinsic and/or suggestive cases, the differences are marked by antagonism between the players, although they manifest themselves in the friendly xix and/or intrinsic case by reluctance and disinterest in social relations. In interpreting the results, it was question of them compare our results with reference to concepts in the conceptual framework, the information obtained through our research question and the previous work that examined the phenomenon studied. We conclude with organizational analysis of home care services to then demonstrate aspects of the operation of home care that exacerbate conflicts or promote collaboration between actors. Finally, the conclusion of our research highlights how key facts identified are consistent with the results of our study, especially the new contributions to the problem studied.

Keyphrases: Social relationships, Seniors, Caregivers, Speakers, Home help and care, Stroke, Rehabilitation, Case study