NELSON EKECHUKWU

Background: Stroke continues to be one of the world's leading causes of long-term disability and a major factor in the exclusion of working-age adults from the workforce. Although there is little data from Southern Nigeria, returning to work (RTW) following a stroke is a key sign of effective rehabilitation and reintegration.

Aim: This study aimed to determine the socio-demographic, clinical, and psychosocial determinants of return to work among stroke survivors in Benin City, Edo State, Nigeria.

Methods: 67 stroke survivors who were 18 years of age or older and undergoing physical therapy at the University of Benin Teaching Hospital and Edo Specialist Hospital participated in a cross-sectional study. The Mini-Mental State Examination (MMSE) for cognitive function, the National Institutes of Health Stroke Scale (NIHSS) for stroke severity, the Modified Rankin Scale (mRS) for disability, the Functional Independence Measure (FIM) for functional ability, the Rosenberg Self-Esteem Scale (RSES), the Social Support Questionnaire (SSQ), and the General Self-Efficacy Scale (GSE) were among the standardised tools used. Descriptive statistics were used to summarise the data, and Chi-square tests were employed for inferential statistics to ascertain the relationship between RTW and variables with p < 0.05.

Results: The majority of participants 50 (75%) returned to work following stroke. Significant associations were observed between RTW and age (χ² = 9.216, p = 0.027), cognitive function (χ² = 8.544, p = 0.014), disability level (χ² = 12.463, p = 0.002), self-efficacy (χ² = 10.138, p = 0.019), and social support (χ² = 9.804, p = 0.012). While gender, marital status, stroke type, stroke laterality, stroke severity, and self-esteem were not significantly related. Younger survivors with better cognitive and functional abilities and higher self-efficacy and social support were more likely to return to work.

Conclusion: Functional independence, cognitive capacity, and psychosocial factors such as self- efficacy and social support are critical to post-stroke work reintegration. Rehabilitation programs should integrate vocational training, psychological empowerment, and family support to improve RTW outcomes.

Background: In Nigeria, stroke is a major cause of death and disability, and recovery are greatly impacted by health-seeking behaviour (HSB). According to the biopsychosocial (BPS) model, these behaviours are shaped by a combination of biological, psychological, and social factors; however, little is known about how these factors interact among stroke survivors in Edo State, Nigeria. Purpose: This study aimed to use a mixed-methods design to examine the Biopsychosocial determinants of Health Seeking Behaviour among stroke survivors in Edo State. Methods: For the quantitative arm, a convergent parallel mixed-methods approach was used to recruit 55 stroke survivors through multistage sampling. Structured questionnaires (NIHSS, MAS, Berg Balance Scale, HADS, MSPSS) were used to evaluate Biopsychosocial factors and Health Seeking Behaviour. From this group, ten individuals were specifically chosen to participate in in- depth qualitative interviews. While qualitative data was subjected to thematic analysis, quantitative data was subjected to descriptive and inferential statistics (chi-square tests) using SPSS version 27.0. Results: No statistically significant correlations (p > 0.05) were found between Health Seeking Behaviour and any of the Biopsychosocial variables (such as social support, anxiety, comorbidities, and stroke severity). However, a qualitative analysis revealed five major themes that impact HSB: coping strategies, emotional reactions, family, community, and spiritual influences, clinical features and perceived cause, and health-system barriers. Notably, family support, financial limitations, and cultural beliefs played a significant role in the pathways and decisions surrounding care-seeking. Conclusion: Although there was no statistically significant correlation between HSB and standard BPS measures in this sample, qualitative findings highlight the significant impact of systemic, social, and cultural factors. The results emphasize the need for stroke rehabilitation services in Edo State that are accessible, family-inclusive, and culturally sensitive.