Physical Therapist's Perceptions of Cultural Influences on Stroke Rehabilitation in the State of Qatar: An Exploratory Analysis
Authors: Ajimsha Ms , Ninan Ajith Jacob , Kurien Anush , Oswald Cyril Christopher , Thavayil Shajahan , Al-Mudahka Noora R , Al-Madzhar Ja 
Published: July 2019

IntroductionCulture has been defined as: “a tradition of knowledge and practice that is shared, albeit imperfectly, across the members of a society and across its generations” [Zou et al 2009]. It shapes people's experiences and their emotional reactions [Gard et al 2005], including their understandings of what it means to be healthy, the meanings of symptoms, attitudes towards disability and treatment, and coping strategies [Dean et al 2006; Gallaher et al 2001]. The study suggested here may offer new insights by exploring how culture shapes the experience of stroke care through the perceptions of Physical therapists working in the state of Qatar. Qatar is one of the wealthiest countries in the world. The culture reveals the modernising influences associated with oil exploration and technological advances whilst preserving collective traditions. The state provides extensive financial support for its own citizens including generous pensions and access to health care. However, in common with other Gulf states, the majority of the population are migrant or expatriate workers [Gallahar et al 2001], The Islamic faith plays a central role in government legislation and everyday life. This is a unique culture, as in Qatar, strong commitment to the Muslim religion, collective values, and generous financial support to purchase physical therapy services abroad, may result in an experience of care that is different from that reported in other areas of the world. Physiotherapists require not only cultural sensitivity but cultural competency, which is “the ability to honor, understand, and respect the beliefs, lifestyles, attitudes and behaviors demonstrated by diverse groups of people, and to diligently act on that understanding” [Omu et al 2012; Dean et al 2006]. Culturally competent care invites maximal cooperation with patients and their family members with the aim of promoting better outcomes [Niemeier et al 2007; Balcazar et al 2010].PurposeThe aim of this study was to investigate the perceptions of Physical therapy professionals who treat stroke patients regarding cultural influences on the experience of stroke rehabilitation in the state of Qatar. Physical therapy professionals interviewed were from a variety of cultural backgrounds thus providing an opportunity to investigate how they perceived the influence of culture on stroke recovery and Physical therapy in Qatar.MethodA descriptive qualitative exploratory research approach was used for the study. Semi-structured interviews were carried out with 23 Physical therapy professionals with current/recent stroke Physical therapy experience meeting the inclusion criteria from the department of Physical therapy, Rumailah hospital, Hamad Medical Corporation, Doha, Qatar, followed by thematic analysis of the verbatim transcripts.Inclusion Criteria: Physical therapy professionals with current experience of working in stroke rehabilitation in the Department of Physical therapy, Hamad Medical Corporation, Doha, Qatar, those who are able and willing to participate in a 45-minute face-to-face interview which will be audio recorded, those who are having clinical experience of 5 years or more in the field of stroke rehabilitation and those who are having more than 2 year's experience working in stroke rehabilitation in the state of Qatar.Exclusion crieteria: Other Health Care professionals and Physiotherapists poor in English language Data Collection: Primary data was collected through semi-structured face-to-face interviews. The interview consist of structured open ended questions. Trained researchers conducted all the informant interviews at the department. All interviews were conducted in English, and once the interview were completed, the researcher immediately transcribed it into an MS Word document. A second researcher who had not transcribed the interviews reviewed each of the audio recordings and subsequent transcriptions in order to ensure that the qualitative data is accurately transcribed and translated.ProcedureThe interviews were taken place in a quiet room at the Physiotherapy department, Rumailah Hospital. Interviews were conducted in English and were of 45 minutes duration which were audio recorded. The main questions/topic were as follows: In your experience, what are the Most significant challenges faced by stroke patients in the state of Qatar? How have you addressed psychological social issues during stroke rehabilitation? In your experience, does culture have any influence on the stroke experience and rehabilitation process in the state of Qatar (if so, why and how?)? What is your opinion regarding willingness of the patients for home exercise programs and their motivation level for doing so, does the culture is having any impact over this?Data AnalysisTranscribed interview data were entered into a qualitative data analysis software package (NVivo 2.0) for systematic coding. A content analysis was performed to identify themes that emerged from the interviews. Content analysis, or qualitative description, has been reported as useful when the description of phenomena is desired (Pope et al. 2000). The identified themes were based on informants' collective perceptions and experiences relevant to the issues being explored in the study. Once transcripts were coded, reports weer generated which the research team analyzed according to the research objectives. The team met regularly to share impressions, develop main themes and discuss alternate interpretations.ResultsThe Physical therapy professionals identified several features of the Qatari culture that they believed affected the experiences of stroke patients. These were religious views, family participation, lack of awareness regarding expected outcomes and use of Physical therapy, inadequate education and public information about stroke, prevailing negative attitudes toward stroke, depression and loss of hope, social stigma and the public invisibility of disabled people, difficulties in identifying meaningful goals for Physical therapy, lack of patient and family centeredness and an reception of reliance linked with the extensive help of maids or helpers in Qatari homes. Community reintegration of the stroke victims need to be addressed in a vider perspective Lack of ‘self help groups’ with expert back up is not yet established to satisfy the demand. Lack of recreational and group activity scenarios for the stroke survivors in association with community groups Perodic councelling and antidepression measues at the social level has to be addressed. The key features identified for non-Qatari populations are insecurity, financial burden, social and emotional isolation. The anxiety of the future, lack of family support, fear of unemployment and repatriation worsens the scenario for those staying in group accommodations. Majority of the non-Qatari population wants a complete recovery and participates heavily in Physical therapy practice in order to resume back to their jobs as early as possible.ConclusionTo offer culturally delicate care, these issues should be taken into account during the provision of Physical therapy or rehabilitation for stroke survivors in a culturally compatable way. There should be more emphasis on ongoing education, community out reach programs and environmental modifications for an ulitilame rehabilitation of such patients Insinuations for Rehabilitation Physical therapy professionals need to mold therapy to the patient's and family's model of care, reflecting their cultural background. Physical therapy professional can suggest, develop and actively participate stroke awareness sessions and community out reach programs, deliverable at home and community levels addressing the nation. Physical therapy professionals may need to be attentive that the presence of house maids and privately hired nursing staff may decrease the motivation of people to engage in Physical therapy after stroke. A care giver education and training should be considered as an important adjunct to the stroke physical therapy care. Cultural variations in degree of family involvement, prevailing negative attitudes towards stroke, and acceptance of dependency should be taken into consideration by stroke Physical therapy professionals. Physical therapy professionals should participate actively in the community based rehabilitation of stroke survivors. As patients spent more time with Physical Therapy professionals than any other health care professionals, physical therapists can act as counselors and/or motivators for the survivors. Physical therapist can be deployed as captains of self help groups which can be designed in the national level. There should be community out reach programs for the stroke survivors where Physical therapy potentials can be tapped further Physical therapist can facilitate the ongoing rehabilitation process of non Qatari expatriate survivors with the help of concerned employers and embassies once they are discharged from the active care, if it is acceptable.LimitationThe main limitation was the sample size and difference in the percentage of national and expatriate Physical therapists interviewed, which any way will have a strong influence on the result. This was a reporting own perceptions about the stroke physical therapy care and familial and cultural back ground of the patients which will be different from the patient perspectives. Conclusions Physical Therapy professionals need to deliver therapy which is culturally molded and acceptable to the patient, family and the community. Care giver training need special emphasize in Qatari culture. Qatari and non-Qatari patients are facing dissimilar psychosocial issues which needs to be analyzed and managed as different topics. Cultural sensitivity entails Physical therapy professionals to engross with the family of the stroke survivors and to escalate their confidence and hue their perception own their disability, as well as offering more education about the principles behind therapeutic strategies.Declaration of interestThe authors report no conflicts of interest.ReferencesZou X, Tam KP, Morris MW, Lee SL, Lau IY, Chiu CY. Culture as common sense: Perceived consensus versus personal beliefs as mechanisms of cultural influence. J Pers Soc Psychol 2009;97:579–597.Gard G, Cavlak U, Sunden B, Ozdincler A. Life-views and ethical viewpoints among Physical therapy students in Sweden and Turkey: A comparative study. Advances in Physical therapyDean E, Mahomed S, Maulana A. Cultural considerations for Middle Eastern cultures. In: Lattanzi J, Purnell L, (eds.). 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