The 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, Jordan, Lebanon, Oman, Kuwait, Qatar, Bahrain, Cyprus, and the State of Palestine. Therefore, this paper aims to review data on the perceived self-care ability in stroke patients living at home in the mentioned countries and compare them with ones in developed countries.
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) regions on stroke and other chronic diseases such as diabetes [8-10]. Nonetheless, there is an evident shortage of studies on the concept of the perceived self-care ability in stroke survivors living at home, and such studies have briefly mentioned the concept and or utilized similar concepts . In this section, it is attempted to reference the studies conducted in developed countries and outside of the ME region, which have briefly addressed the concept of the perceived self-care ability in stroke patients living at home.
Dale established 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 was defined as a function or activity the individual initiates and conducts to maintain his/her life, health, and well-being . There are some similarities, overlaps, and differences between the concept of the 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, self-care and its related concepts have evolved, and somewhat different definitions have been proposed based ondifferent 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.
The 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 in acute conditions. She emphasized the literature on self-care focuses on the acute care context and explicitly mentioned the necessity of analyzing this concept in patients suffering from chronic diseases . Riegel expressed his ideas about self-care and stated 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 this 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 on self-care, and the vast majority of people with chronic illnesses do not exhibit appropriate self-care behaviors, thereby they jeopardize 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 stroke patients have limited participation in daily activities because of incapacitation and dissatisfaction felt by them with their lives after returning home [16-17]. In rehabilitation programs, particular emphasis is placed on physical activities, mobility, self-care toencourage patients to live an active life . Patients with stroke may face limited perceptual functions which affect their self-care ability within five weeks after the occurrence of a stroke . Studies have demonstrated 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 in cognitive functions such as proper concentration, attention, and function of the upper extremity plays a significant role in maintaining the patient’s independence .
Currently, for people with chronic diseases and those who must live with them 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 for patients to having 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 ideas, which have played an essential role in defining such concepts and differentiating them from other similar ones [1-3, 6, 15, 22-31]. For example, in a systematic and integrative literature review by Matarese it was aimed to define the analysis of the self-care concept and other relevant ones along with combine, and integrate them with each other. The results indicated the accurate identification of similarities and differences between the self-care concept and other associated ideas can lead to the more conscious use of such concepts in clinical and research contexts together with formulation of policies in the nursing field. It was also demonstrated identifying the various components of self-care related concepts could lead to the development, design, and use of tools which 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 concept measurement . 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. She concluded the concept of self-care and many of its derivatives require an accurate analysis to reach a better clarification .
Matarese report was based on a study conducted by Marzband who had analyzed the self-care concept through Islamic sources. The researchers stated in the Islamic culture, self-care has been addressed as a moral necessity and a right so as taking care of oneself as well as doing self-care activities imply the human body has dignity and value as a means for achieving spiritual perfection . Also, this study emphasized on the necessity of identifying the dimensions of the self-care concept, 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, paying no attention to personal perceptions of the patients and the effects of the disease nature on thses definitions ; therefore, they are not yet complete. Hence, this review will be carried out to fill this critical gap in the definition of the perceived self-care ability in stroke patients living at home in the ME countries compared with its prevalent definition in developed countries so that its findings could be applied as a basis for future research as well as a guidance to other researchers.
While the definitions and status of the perceived self-care ability in stroke patients living at home are unknown among many countries in the Middle East, current studies consider them variant regarding the economy, religion, and culture of the country.