The study birthed four themes and ten sub-themes from the analysis. First theme, knowledge about CVD-risk factors and caregiver role: sub-theme, knowledge about CVD-risk factors and education on caregiver role; second theme, challenges faced by caregiver: sub-themes, financial challenges, lack of cooperation from CVA survivors and work load, and hospital-based challenges. Third theme, impacts of caregiver role on carers: sub-themes, poor health, loss of job and income, and inability to further education and breakdown in relationships; fourth theme, coping strategies and knowledge: sub-themes, knowledge about coping strategies and coping strategies adopted.
Theme One – Knowledge about CVD-risk factors and caregiver role
This theme yielded two sub-themes including knowledge about CVD-risk factors and education on caregiver roles.
Sub-theme One – Knowledge about CVD-risk factors: We found that poor dieting, inadequate exercise, alcohol abuse, smoking, stress, and age were the CVD-risk factors identified by the caregivers. A female participant (40FHNDT15) explained: “….poor diet, inadequate exercise, smoking, drinking alcohol, genetics, and psychological problems. Yes, that is it. But, men must be careful because they are the ones at most risk.” (3yrs as caregiver).
Meanwhile, some caregivers identified spirituality and sex as risk factors. Participant ‘40FHNDT15’ again: “…Older men around 45yrs and above who engage in too much sex can have CVA. Too much sex is dangerous for older men….”
Participant ‘27MPSU26’ added: “…But, it could also be spiritually engineered through curses. So, one could be attacked with CVDs if not spiritually protected….”
Sub-theme Two – Education on caregiver roles: We also found that caregivers were not adequately prepared for their roles. A male participant (32MDMMV12) noted: “…I was not educated on how to take care of him (CVA survivor). Though I was not around on the day of the incident (CVA), I am the one who takes him to the hospital for review….” (Over 2yrs as caregiver).
A female participant (38FJHMMV27) explained: “Yes, they (heath staff) told me to use fish and more vegetable for his (CVA survivor’s) meals. I was also encouraged to give him more fruits and bring him to the hospital for physiotherapy. But, my main source of guidance came from a local herbalist with history of managing CVA survivors….” (3yrs as caregiver). Another female participant (45FPMMV18) submitted: “…No education about how to take care of him (CVA survivor), but given my mood on the day of the incident, I would not have paid attention even if they (health staff) did. Seeing him motionless on the hospital bed was shocking to me and seems hopeless…it is God who heals.” (2yrs as caregiver).
Theme Two – Challenges faced by caregiver
This theme produced three sub-themes including financial challenges, lack of cooperation from CVA survivors and workload, and hospital-based challenges.
Sub-theme One – Financial challenges: We identified financial challenges as major drawback to the role of the caregivers. A female participant (44FDTr6) explained: “…Lack of money to buy all the prescribed drugs, cost of taking him to the hospital for review, and the high cost of food items are unbearable. Everything is expensive and yet there is no support from anywhere (CVA survivor).” (Over 1 year as caregiver).
Another female participant (56FSMMV30) submitted: “…We contracted a herbalist who comes to massage her (CVA survivor) thrice weekly at a fee. If you consider the cost of drugs and special meals for her, the money they (siblings) give me for the month does not last beyond two weeks.” (2yrs as caregiver).
Sub-theme two – Lack of cooperation from CVA survivors and workload
We found that cooperation of the CVA survivors and workload affected the work of caregivers.
A female participant (47FSHU1) explained: “…it is difficult getting him (CVA survivor’s) to take his drugs, eat, and exercise. I have to plead for hours just to bathe him and in everything else. There were days that he refused to take the drugs.”(2yrs as caregiver).
Another female participant (24FDSA33) explained: “…I know this disease (CVA) affects the brain and therefore, the way they (CVA survivors) think is different from ‘normal’ people. I really struggle caring for him. In fact, he sometimes insults me for forcing him to take the drugs. I could not imagine my own father insulting me…”(2yrs as caregiver).
Participant ‘56FSMMV30’ again explained how time and labour intensive the work is: “Taking care of him (CVA survivor) involves so much work and time. On a typical morning starting from about 0800hrs, by the time I am done taking care of him, is already past 1200hrs. You have to lift and turn him many times....”
Participant ‘24FDSA33’ again: “…just as you are done taking care of him (CVA survivor) in the morning, you have to start preparing for lunch. This is a full time job and without that commitment he would die….”
Sub-theme three – Hospital-based challenges
We found that poor staff attitudes and communication and long waiting time at the hospital frustrated caregivers.
Participant ‘44FDTr6’ again: “…you have to wait for hours before they attend to you and some of them are not polite in their communication. Sometimes I wonder if they were not trained to take care of CVA survivors….”
Participant ‘45FPMMV18’ again: “you have to wait for so long before they attend to us and I always buy the drugs they prescribed. So, you see why some people prefer the herbalist?”
Theme three – Impacts of caregiver role on carers
This theme produced three sub-themes including poor health, loss of job and income, and inability to further education and breakdown of relationship.
Sub-theme One – Poor health
It emerged that stress and high blood pressure were common health complains by caregivers.
A female participant (35FDTr) explained: “…I am always worried about when he (CVA survivor) would get better and this sets me thinking always. I have lost appetite for food and sometimes eat only lunch. I realised at a point that there was something wrong with me and when I checked at the hospital, it was confirmed that my blood pressure was high…the stress is too much.” (2yrs as caregiver).
Another female participant (33FDU19) submitted: “…I become so tired due to the heavy workload involved in his (CVA survivor) care. It is also so frustrating when you think about the opportunities you have missed….” (2yrs as caregiver).
Sub-theme Two – Loss of job and income
Caregivers also reported loss of job and income since commencing care for CVA survivors.
A female participant (29FJHU20) lamented: “I was teaching in a private secondary school but had to leave the job to take care of her (CVA survivor). As it stands, I have no job, no income, and not even sure when she would recover fully for me to find something to do….” (Over 2yrs as caregiver).
Another female participant (37FSHSA14) commented: “I was a shop attendant but had to stop because of his (CVA survivor) condition. I cannot work, go to church, or leave a normal life at this time….” (Over 1 year as caregiver).
Sub-theme Three – Inability to further education and breakdown of relationship
Caregivers also reported their inability to further education and separation from partners due to their caregiving role.
A female participant (31FPSU13) lamented: “…I was hoping to enter the nursing training college but had to wait until next year, hoping he (CVA survivor) gets better by then. I am trusting God for a ‘miracle’….” (Over 2yrs as caregiver).
Another female participant (20FJHMMV9) explained: “My husband and I have separated because I had left him to take care of my father (CVA survivor) for over a year now. But, the Lord is with me….” (2yrs as caregiver).
Theme four – Coping strategies and knowledge
This theme yielded two sub-themes including knowledge about coping strategies and coping strategies adopted.
Sub-theme One – Knowledge about coping strategies
We found that caregivers were not very knowledgeable about positive coping strategies.
A male participant (35MDTr25) said: “….I had no prior education on how to deal with the challenges associated with taking care of him (CVA survivor) at all. It was all about how to mobilise resources and make sure he gets better in no time….” (Over 1 year as caregiver). Another male participant (21MHNDSA2) responded: “…no please! I was not advised on what and what not to avoid. Friends suggested I remain very prayerful….” (Over 2yrs as caregiver).
Sub-theme Two – Coping strategies adopted
Caregivers reported fasting and prayers and alcohol use as some coping strategies.
A female participant (36FHNDU8) submitted: “….visits and encouragements from my siblings, friends, and church members sustained me. I also became more prayerful than before.” (2yrs as caregiver).
Another female participant (27FDT10) responded: “….I took to fasting and prayers, since this was the second incident of this sickness (CVA) in this family. Hm!!! But, there were days I become depressed that I had to drink alcohol before I could eat….” (Over 1 year as caregiver).