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Title: The health inequalities associated with post-stroke visual impairment
Author: Hanna, K. L.
ISNI:       0000 0004 7970 4616
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2019
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Aim: The aim of this project was to explore the possible health inequalities facing visually impaired stroke survivors and any possible means of overcoming these. Methods: This research consisted of three phases of work. The first phase included the development of three systematic reviews, investigating the overall health inequalities previously identified within this population, along with a review of the inequalities in assessing and treating post-stroke visual impairments. The second phase involved the recruitment of 1500 stroke admissions into an epidemiological clinical study across three hospital sites in the North West of England. Longitudinal follow-up assessments of their visual impairments was used to statistically analyse the recovery rates of post-stroke visual impairments between different patient groups. The third phase explored the long-term health inequalities facing stroke survivors as a result of their visual impairments. This was conducted using qualitative and thematic analysis of patient responses from telephone conversations regarding non-attendance of hospital appointments. Moreover, descriptive analysis of a nationwide survey of orthoptists was used to investigate an orthoptic home visit service as a potential means of addressing the health inequalities identified through the telephone conversations. Finally, thematic analysis of focus groups and one-to-one interviews with stroke survivors further explored additional, long-term issues caused by post-stroke visual impairments. Results: Health inequalities exist before the onset of stroke, during hospital care and following hospital discharge. The findings from this research have identified older patients, those that suffer severe strokes and those discharged to supportive forms of living are most at risk of the following health inequalities: suffering visual impairment after stroke, poor access to outpatient services and poor recovery of the visual impairments. Patient gender, ethnicity, area deprivation and whether the patient had an infarction or haemorrhage were not found to be significant factors in the above inequalities. Additional, inequalities identified from interviews with visually impaired stroke survivors were found to impact on the physical being, the psychosocial being, and the organisation of healthcare services. Conclusion: Key recommendations from this research include the need to incorporate vision as a priority of stroke care nationally. Where patients struggle to attend appointments due to stroke and visual disabilities, efforts should be made to address the barriers to attending. A domiciliary orthoptic service and the contribution of vision services to early supported discharge teams could address a small number of the identified inequalities. Furthermore, addressing the possible long-term, physical and psychosocial impact of post-stroke visual impairments prior to hospital discharge could further reduce some of the health inequalities facing this population.
Supervisor: Rowe, fiona ; Burnside, girvan Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral