CONTRASTACION DE LAS HIPOTESIS

Some element of fear was identified by all participants; however, the impact of fear on losing confidence and also regaining confidence varied between participants. Thefirst fear that participants described was the fear of having another stroke:

. . . Every time I had a headache, I feel lightheaded, my leg hurts, there is always that question, erm, maybe [laughs], just kinda maybe.

Mick 13.2 . . . you never know what is going to happen tomorrow.

June 17.6 . . . I am going to have another stroke? – So that was on my mind.

Ted 12.1 . . . alert to any changes in my body at all, you know? Anything, because I think now, perhaps this is going to be the big one, you know.

Barbara 19.4

Participants described living with this fear and how it prevented them from participating in everyday activities. Mick experienced a second stroke, and articulates this period, as:

cementing the fear in my brain

Mick 12.14.

This second event had a huge impact on his recovery and confidence to leave the house, and resulted in a period of avoiding going out. For Mick, confidence has been about gradually overcoming this fear to enable him to regain confidence, to enable him to engage in what he chooses. He describes this process as gradual, and experiences‘good and bad days’, suggesting confidence has a temporal component. Similar meanings evolved from June, indicating that fear is a factor that underpins her participation in going out of her home environment. Ted’s fear of having another stroke directly impacted on feeling anxious in crowds, and cites shopping centres as a place that held a particular anxiety. Avoidance was his coping strategy.

Fear of going out/social confidence

Fear of going out and being socially active after a stroke was a major concern voiced throughout the interviews by all of the 10 participants. Some were able to address their fears early on in their recovery, whereas others found it more difficult and, years after recovery, have not fully been able to achieve this, resulting in an avoidance of going out and a general sense of a diminished social lifestyle and

social confidence.

I don’t know whether it was that I was self-conscious about the fact that I was struggling with my wheelchair, or struggling to walk, people looking at me or not, but . . .

Ryan 15.13 Eventually, as your confidence grows, your bubble starts to get bigger, erm, the garden, then the street, then the shops, eventually.

Participants also attributed positive encouragement from others as an enabler to going out and not avoiding activities that caused fear.

Although participants acknowledged huge fears about going out and social interactions with others, coupled with this fear was an immense desire to overcome these fears. For example, Ryan states‘I had coping strategies pinned all over the wall’(15.17). It is clear from the descriptions evolving from participants that confidence improves over time. Nevertheless, for some this is a slow process that may never be fully resolved. In summary, fear has a huge impact on daily activities and lives after stroke, often linked with low self-efficacy and avoidance of engagement in tasks, roles and events.

Team confidence/collective efficacy

The influence of significant others, as touched on within the previous theme, impact on levels of

confidence. Although, not surprisingly, participants described positive influences as enablers to regaining confidence and conversely, negative influences act as barriers, the negatives and positives are not always overt in the context of participant’s daily lives and often require a period of reflection. Influence from a supportive friend, coupled with self-determination, one participant’s confidence levels increased to a point that enabled her to pursue ambitions she would not have considered prior to her stroke:

He [Friend] said ‘Let’s go to Cyprus.’ I said I’m not going to CYPRUS [increased tone: laughter] – you see I’ve never flown before, you see, so we flew to Cyprus.’ [laughter]

Freya 41.7

Conversely, another participant describes her family’s‘help’as being restrictive:

They don’t let me, well, I can’t go out of the back door without someone going with me.

Helen 11.13

Independently mobile and competent, this participant describes feelings of inadequate opportunities, to fulfil her potential. A message underpinning success for another participant, fundamental in gaining the confidence to mobilise outside after stroke, was a physiotherapy intervention:

. . . the best thing that happened to me, and the most erm, useful one to me, was being referred to a physiotherapist.

Barbara 11.1

Initially, unable to mobilise to the kerb without fear of falling, and apprehensive about physiotherapy intervention, she described factors such as humour, empathy, positive reinforcement and encouragement as the components that led to a positive treatment outcome. Keen to feedback her perceived success, once her treatment was completed, she describes telephoning the physiotherapist who delivered her treatment:

And I said to him, I can walk into town now, I can walk as far as Marks and Spencer’s, and he said ‘I can’t believe it, that’s wonderful.’ But I can, and I can now get as far as the shopping centre.

Barbara 24.19

Increased confidence after stroke appears to have a component that is influenced by the actions of others, in addition to the actions of self.