Access to health care for people with stroke in South Africa: a qualitative study of community perspectives

Smythe, Tracey, Inglis-Jassiem, Gakeemah, Conradie, ‪Tersia, Kamalakannan, Sureshkumar, Fernandes, Silke, Van Niekerk, Sjan Mari, English, René, Webster, Jayne, Hameed, Shaffa and Louw, Quinette Abegail (2022) Access to health care for people with stroke in South Africa: a qualitative study of community perspectives. BMC Health Services Research, 22 (1). p. 464. ISSN 1472-6963

s12913-022-07903-9.pdf - Published Version
Available under License Creative Commons Attribution 4.0.

Download (1MB) | Preview
Official URL:


Background: Incidence of stroke is increasing in sub‑Saharan Africa. People who survive stroke experience disability and require long‑term care. Health systems in South Africa (SA) are experiencing important challenges, and services in the public health system for people with stroke (PWS) are fragmented. We aimed to explore the perspectives and experiences of PWS related to stroke care services to inform health system strengthening measures.

Methods: In‑depth interviews with 16 PWS in urban and rural areas in the Western and Eastern Cape Provinces of SA were conducted between August and October 2020. PWS were recruited through existing research networks, non‑government organisations and organisations of persons with disabilities by snowball sampling. Interviews were transcribed, coded, and thematically analysed. We used the conceptual framework of access to health care as pro‑posed by Levesque et al. to map and inform barriers to accessing health care from the user perspective.

Results: PWS recognised the need for health care when they experienced signs of acute stroke. Health literacy on determinants of stroke was low. Challenges to accessing stroke care include complex pathways to care, physical mobility related to stroke, long travel distances and limited transport options, waiting times and out of pocket expenses. The perceived quality of services was influenced by cultural beliefs, attitudinal barriers, and information challenges. Some PWS experienced excellent care and others particularly poor care. Positive staff attitude, perceived competence and trustworthiness went in hand with many technical and interpersonal deficits, such as long waiting times and poor staff attitude that resulted in poor satisfaction and reportedly poor outcomes for PWS.

Conclusions: Strategic leadership, governance and better resources at multiple levels are required to address the unmet demands and needs for health care of PWS. Stroke care could be strengthened by service providers routinely providing information about prevention and symptoms of stroke, treatment, and services to patients and their social support network. The role of family members in continuity of care could be strengthened by raising awareness of existing resources and referral pathways, and facilitating connections within services.

Item Type: Article
Additional Information: Funding information: This research was commissioned by the National Institute for Health Research (NIHR) Global Health Policy and Systems Research Development Award using UK aid from the UK government. Grant number NIHR130180.
Uncontrolled Keywords: South Africa, Disability, Equity, Access, Health service, Stroke
Subjects: B800 Medical Technology
B900 Others in Subjects allied to Medicine
Department: Faculties > Health and Life Sciences > Social Work, Education and Community Wellbeing
Depositing User: Rachel Branson
Date Deposited: 11 Apr 2022 09:40
Last Modified: 25 Apr 2022 08:30

Actions (login required)

View Item View Item


Downloads per month over past year

View more statistics