Early Opportunities to Explore Occupational Identity Change: Qualitative Study of Return-To-Work Experiences After Stroke

Abstract

Background: Rates of return-to-work after stroke are low, yet work is known to positively impact people’s wellbeing and overall health outcomes. Objective: To understand return-to-work trajectories, barriers encountered, and resources that may be used to better support participants during early recovery and rehabilitation. Participants: The experiences of 31 participants (aged 25–76 years) who had or had not returned to work after stroke were explored. Methods: Interview data were analysed using reflexive thematic analysis methods within a broader realist research approach. Results: Participants identified an early need to explore a changed and changing occupational identity within a range of affirming environments, thereby ascertaining their return-to-work options early after stroke. The results articulate resources participants identified as most important for their occupational explorations. Theme 1 provides an overview of opportunities participants found helpful when exploring work options, while theme 2 explores fundamental principles for ensuring the provided opportunities were perceived as beneficial. Finally, theme 3 provides an overview of prioritized return-to-work service characteristics. Conclusion: The range and severity of impairments experienced by people following stroke are broad, and therefore their return-to-work needs are diverse. However, all participants, irrespective of impairment, highlighted the need for early opportunities to explore their changed and changing occupational identity. LAY ABSTRACT The aim of this study was to understand how best to support people returning to work after a stroke. A total of 31 people who had or had not been able to return to paid work after stroke were interviewed. We listened to their experiences and considered what worked best for different people with a range of needs and aspirations. People talked about wanting opportunities soon after their stroke to explore changing thoughts about themselves and their ability to return to work. Conversations with participants and their families, often starting very early after stroke, were important. People also wanted opportunities to practise skills they typically used at work, such as social skills or planning and organizational tasks. Through these ongoing conversations and opportunities to practise, people talked about gradually regaining their confidence in the skills they had retained after their stroke, rather than focusing only on the difficulties they were experiencing.

Keywords

• Stroke
• Work
• Employment
• Vocational Rehabilitation
• Community Participation
• Social identification