Perceived self-care ability is a dynamic, complicated, and multidimensional concept [1-5]. Being able to take care of oneself implies that the individual can understand the disease and knows how to manage it. Management refers to what patients do daily. Self-care comprises the activities and actions carried out by patients on their own .
Stroke is one of the most common causes of long term disability worldwide. It is a global health-care problem that affects about 16 million people . During the past decades, there has been an increase in stroke incidence and mortality rates in the Middle East (ME) . According to the National Geographic Atlas of the Middle East (2003) , the ME countries include Egypt, Iran, Turkey, Iraq, Saudi Arabia, Yemen, Syria, United Arab Emirates, Israel, Jordan, Lebanon, Oman, Kuwait, Qatar, Bahrain, Cyprus, and the State of Palestine. Therefore, this paper aims to review data on perceived self-care ability in stroke patients living at home in the said countries and to compare them with developed settings.
Stroke is a leading public health problem causing significant disability and premature mortality, particularly in low-and-middle-income countries .
According to the World Bank, the majority of countries in the ME region are classified as low-income states. Hence, it is predicted that complications arising from disability caused by chronic diseases such as stroke are more prevalent in these areas. Extensive research on the topic of self-care in patients in the acute and chronic phases of stroke have been carried out in developed and high-income countries; thus, it seems that such studies have seldom been conducted in the ME region, and therefore, poses a significant knowledge gap regarding the subject.
In recent years, numerous epidemiological studies have been carried out in the Middle East and North Africa (MENA) region on stroke and other chronic diseases such as diabetes [8-10]. Nonetheless, there is an evident shortage of studies on the concept of perceived self-care ability in stroke patients living at home, and such studies have briefly mentioned the concept and or have utilized similar concepts . In this section, we attempt to reference the studies that have been conducted in developed countries and outside of the ME region, which has briefly addressed the concept of perceived self-care ability in stroke patients living at home.
Dale established that the understanding and definitions of the concept of self-care are different based on theoretical, philosophical, and professional perspectives and approaches. In Orem’s theory, for example, self-care is defined as a function or activity that the individual initiates and conducts to maintain their life, health, and well-being . There are some similarities, overlaps, and differences between the concept of perceived self-care ability and other concepts such as self-management, self-monitoring, self-efficacy, self-confidence, self-care maintenance, supportive self-management, self-maintenance, disease management, and symptom management, which make such concepts interchangeable . Over time, the concept of self-care and its related concepts have evolved, and somewhat different definitions have been proposed based on the different priorities of the field vis-à-vis the provision of health, therapeutic, and care services . However, the multiplicity of definitions has led to some misinterpretations, and thus, there is an ever-growing need to identify and present these concepts.
Perceived self-care ability is derived from the concept of self-care. Sidani conducted a concept analysis to develop and validate the criteria for self-care ability measurement in patients with acute conditions. She emphasized that the literature on self-care focuses on the acute care context and explicitly mentioned the necessity of analyzing this concept in patients with chronic diseases . Riegel expressed their ideas about self-care and stated that self-care education and support should be addressed as a significant consideration of the healthcare system. However, the complexity of conceptualizing and employing the results of the concept in health clinics has led to less attention to self-care by physicians and other members of the health team. As a result, physicians do not emphasize self-care, and the vast majority of people with chronic illnesses do not exhibit appropriate self-care behaviors, thereby jeopardizing their health condition and quality of life .
In a systematic review, Jones examined the effects of self-efficacy on post-stroke conditions. They also examined empirical evidence to support self-management interventions based on self-efficacy principles for the survival of patients with stroke. They attempted to offer a clear picture of these concepts despite the lack of adequate literature on the topic .
Although recent advances and extensive studies on the methods of caring for patients with stroke have improved their functional outcomes and survival rates , evidence indicates that patients with stroke have limited participation in daily activities because of incapacitation and that they express dissatisfaction with their lives after returning home [16-17]. In the development of rehabilitation programs, particular emphasis is placed on physical activities, mobility, self-care, and encouraging patients to live an active life . Patients with stroke may have limited perceptual functions, which affect their self-care ability within five weeks after the occurrence of a stroke . Studies have demonstrated that within the first three months after a stroke, some patients may not experience improvement in cognitive functions, which may exert unpleasant effects on the patient’s self-care ability. Along with the improvement in perceptual functions, the improvement of cognitive functions such as proper concentration, attention, and function of the upper extremity play a significant role in maintaining the patient’s independence .
Today, for people with chronic diseases and those who must live with it for an extended period, the focus of nursing care is changing from acute care in hospital environments to chronic care at home and mobile aid care outside hospital environments . In the transition from hospitals to home or other care environments, it is imperative that patients have the ability to care for themselves.
In recent years, many studies have been conducted to explain and analyze the concept of self-care and its associated concepts, which have played an essential role in reaching the definitions of such concepts and differentiating them from other similar concepts [1-3, 6, 15, 22-31]. For example, in a systematic and integrative literature review by Matarese that aimed at defining, combining, and integrating the analysis of the self-care concept and other relevant concepts, the results indicated that the accurate identification of similarities and differences between the self-care concept and other associated concepts can lead to the more conscious use of such concepts in clinical and research contexts, and in formulation of policies in the nursing field. It was also demonstrated that identifying the various components of self-care related concepts could lead to the development, design, and use of tools that can accurately and comprehensively measure the dimensions of self-care. Matarese considered self-care as an activity, a capability (capacity), and a process .
Thompson introduced the self-efficacy theory as the foundation for developing and interpreting the measurement of the concept . Godfrey examined the definitions and evolution of the concept of self-care, care by others, and care for others based on research, clinical observations, and industrial policies and approaches. They concluded that the concept of self-care and many of its derivatives require an accurate analysis for better clarification .
Matarese reported on a study conducted by Marzband that analyzed the concept of self-care based on Islamic sources. The researchers stated that in the Islamic culture, self-care was addressed as a moral necessity and a right and that taking care of oneself as well as doing self-care activities means the human body has dignity and value and is regarded as a means of achieving spiritual perfection . Also, this study emphasized the necessity of identifying the dimensions of the concept of self-care, which are influenced by religions .
Although some studies have considered a degree of performance dependence on or independence from others as the self-care ability , these definitions have been presented regardless of the personal perceptions of the patients and the effects of the nature of the disease on this definition ; therefore, they are not yet complete. Hence, this review was carried out to fill this critical gap and definition of the perceived self-care ability in stroke patients living at home in ME countries and developed the settings to inform future research and practice.
While the definitions and status of perceived self-care ability in stroke patients living at home are unknown among many countries in the Middle East, current studies suggest it is common and may vary depending on the economic environment, religion, and culture of the country.