Understanding the Socio-cultural Challenges and Opportunities for Affordable Wearables to Support Post-Stroke Upper-Limb Rehabilitation: A Qualitative Study (Preprint)
Authors: Rony Rahat Jahangir , Amir Shajnush , Ahmed Nova , Atiba Samuelson , Verdezoto Dias Nervo , Sparkes Valerie , Stawarz Katarzyna 
Published: December 2023

BACKGROUND

People who survive a stroke, in many cases require upper-limb rehabilitation (ULR), which plays a vital role in stroke recovery practices. However, rehabilitation services in the Global South are often not affordable or easily accessible. For example, in Bangladesh, the access to and use of rehabilitation services is limited and influenced by cultural factors and patient’s everyday lives. In addition, while wearable devices have been used to enhance ULR exercises to support self-directed home-based rehabilitation, this has primarily been applied in developed regions and is not common in many Global South countries due to potential costs and limited access to technology.

OBJECTIVE

Our goal was to understand rehabilitation practices better to identify opportunities and requirements for developing affordable wearable devices that could support ULR in home settings.

METHODS

We interviewed physiotherapists and patients in Bangladesh to understand their approaches, rehabilitation experiences and challenges, and technology use in this context. We also interviewed physiotherapists in the United Kingdom (UK) to explore the similarities and differences between the two countries and identify specific contextual and design requirements for low-cost wearables for ULR. We remotely interviewed 8 physiotherapists (4 in the UK, 4 in Bangladesh), 3 ULR patients in Bangladesh, and 3 caregivers in Bangladesh. Participants were recruited through formal communications and personal contacts. Each interview was conducted online, except for two interviews, and audio was recorded with consent. A total of 10 hours of discussions have been transcribed. The results were analyzed using thematic analysis.

RESULTS

We identified several socio-cultural factors that affect ULR and should be taken into account when developing technologies for the home: the important role of family who may influence the treatment based on social and cultural perceptions; the impact of gender norms and their influence on attitudes towards rehabilitation and physiotherapists; and differences in approach to rehabilitation between the UK and Bangladesh, with Bangladeshi physiotherapists focusing on individual movements that are necessary to build strength in the affected parts, and their British counterparts favoring a more holistic approach. We also identified the types of hand movements that should be supported by the rehabilitation device.

CONCLUSIONS

Our work shows that while it is possible to build a low-cost wearable device, the difficulty lies in addressing socio-technical challenges. When developing new health technologies, it is imperative to not only understand how well they could fit into patients’, caregivers’ and physiotherapists’ everyday lives, but also how they may influence any potential tensions concerning culture, religion, and the characteristics of the local healthcare system.