This study explored the experiences of family members of young adults who had strokes through qualitative interviews. The researchers conducted 24 interviews with 11 family member participants over 2 years. They found that family members experienced disrupted relationships, felt their lives were taken for granted, and developed a sense of uncertainty and worry. The study highlights the need for rehabilitation professionals to acknowledge family concerns and provide psychological support to facilitate recovery. It provides evidence for adopting a family-centered approach to rehabilitation.

1. Author & Title:
Authors: Maggie Lawrence & Sue Kinn.
Title: Needs, priorities, and desired rehabilitation outcomes of
family members of young adults who have had a stroke:
findings from a phenomenological study.
Maggie Lawrence is a lecturer at Glasgow Caledonian
University, Scotland, UK, where she works in the Institute for
Applied Health Research/School of Health and Life Sciences.
Sue Kinn works in Scotland, UK, at the Research and Evidence
Division, Department for International Development, in East
Kilbride.
Both authors have the relevant expertise to write a paper on this
subject. They are also distinguished professionals with valuable
experience Health and Life Sciences.
Research Approach & Design
A qualitative approach based on Merleau-Ponty's existential
phenomenology.
The researchers adopted a qualitative approach, supported by
Merleau-Ponty's existential phenomenology, thus enabling them
to explore the experiences of family members in relation to
stroke. This approach to research is appropriate to the research
question because it provides a general way of thinking about a
problem (Smyth, 2013). This approach serves as a primary
exploratory research aimed at providing valuable insights
relating to the opinions, reasons, and motivations about the
research question (Ritchie, Lewis, Nicholls & Ormston, 2013).
More importantly, this approach helps the researchers to gain a
better understanding into the issue, enabling them to develop
hypotheses or ideas that would serve as the basis for potential
quantitative research. The use of Merleau-Ponty's existential
phenomenology is also appropriate because it highlights a focus
on the individual’s subjective interpretations and experiences of
the world (particularly, the issue at hand), thereby enabling the

2. researchers to understand how they perceive the problem
(Hamrick, 2013).
Sampling & Sample size
This research involved 11 participants (all family members)
who participated in 24 interviews conducted over a span of 2
years.
This research used purposive sampling to get the participants.
The sampling population of 11 family members included
spouses, parents, siblings, and children. They all participated in
24 interviews conducted over a 2-year period. Subsequently, the
researchers used an iterative process of critical reflection to
identify priorities, family-centred needs, and the related
rehabilitation outcomes.
The researchers used purposive sampling in which they were
able to recruit 10 young adults with stroke, and where those
adults had developed the condition between 3 months and 24
months prior to recruitment (Ritchie, Lewis, Nicholls &
Ormston, 2013).
As this was a qualitative research taking a phenomenological
approach, the sample size was appropriate for the research
approach that was chosen. The selected approach does not
require the sample size to be too large as that might affect the
researchers’ ability to analyze data properly. The sample size of
24 would be sufficient to support the aims that the researchers
intend to achieve. This sample size would also help to ensure
that the researchers do not waste a lot of time collecting and
analyzing unnecessary data (Levy & Lemeshow, 2013).
Therefore, researchers should be careful to pick appropriate
sample sizes as that has an effect on research results.
Data collection
The researchers used a longitudinal qualitative interview in this
study.
The researchers used a longitudinal qualitative interview in this
study. This data collection method was appropriate for the
phenomenological approach used in this study because the

3. interview focused (focus group interview) on a few selected
individuals. Focus group interviews are critical in qualitative
studies that adopt a phenomenological approach because it
provides the researchers with the opportunity to ask the
participants about their beliefs, opinions, attitudes, and
perceptions regarding a particular issue or problem, in this case,
the problem of stroke.
This method provides participants with the opportunity to
provide spontaneous accounts of their experiences and thoughts
regarding certain issues of interest to the researcher (Maxwell,
2012). Therefore, focus group interviews enable researchers to
acquire multiple levels of information from the questions
presented in the interviews. Through this method, researchers
are able to gather the reactions and interactions of participants
and to determine if there is group consensus. More importantly,
the interviews are likely to lead into unexpected conversations,
not initially intended, but which prove quite valuable to the
study.
Through these accounts presented in the interviews, the
researchers would then be able to make proper analyses and
provide informed descriptions of a particular phenomenon under
review. In this particular study, the researchers aimed to
describe the major aspects that are critical in patient-centred
rehabilitative care as presented from the accounts of young
adults (and their families) who have had a stroke.
Analysis
This study used an iterative three-stage process of
phenomenological analysis, consistent with the supporting
phenomenological approach.
As noted, the researchers used an iterative three-stage process
of phenomenological analysis, consistent with the supporting
phenomenological approach. In the first stage
(phenomenological description), the researchers adopted a
phenomenological position during the interviews, thus enabling
them to obtain spontaneous accounts of the participants
(Ritchie, Lewis, Nicholls & Ormston, 2013). In the second stage

4. (phenomenological reduction), the researchers demonstrated
their knowledge and experience in this subject to bear on the
data. The researchers also used a process of critical reflection
that enabled them to understand the phenomenon from different
perspectives. In this study, critical reflection required the
researcher to listen to the interview recordings repeatedly while
at the same time reading the transcripts.
In addition, the researchers involved an Advisory Group, which
played a critical role in ensuring reliable analysis, because their
considered and spontaneous responses provided diverse
perspectives to the anonymised interview excerpts.
This study identified Meaning units and themes, which were
critical in enhancing the quality of the analysis. Further, the
researchers used a conceptual framework to support the process
of phenomenological reduction, which incorporated existential
concepts such as Body, Time, World, and Other. In the third
stage, the study developed a phenomenological interpretation,
which facilitated the development of a theoretical framework
through modelling, writing, and the iterative process of
reflection. The researchers also met with other experienced
qualitative researchers and had discussions on how the themes
in the second stage related to one another, to develop a thematic
framework, and to identify overarching themes. The thematic
framework is critical in this study because helps to enhance
one’s understanding of how specific existential ideas improve
understanding of the issue under investigation.
Results or findings (edit heading to suit article)
This study reported the results in a clear manner, enabling the
reader to understand how the researchers arrived at their
conclusions.
In this research, 9 of the 10 participants (young adults) were
involved in the recruitment of eleven family members. The
researchers provide a clear indication of the manner in which all
the participants were recruited. The study also provides details
of the participants such as their age ranges and the settings in

5. which they lived. The study also reports the duration range of
the interviews and the position of the participants in their
families such as fathers, mothers, siblings, daughters, and
spouses/partners. The researchers recoded the interviews
digitally and were also all transcribed. The researchers invited
the participants to take part in 4 interviews conducted over a 2
year period and at 6 month intervals. However, all the
participants could not comply with the request with the
exception of one. Some of the reasons noted for non-compliance
include family and work-related stress and terminal illness in
the family. The researchers also reported that family members
experienced disappointment because their lives appeared to be
disrupted irrevocably and also developed a sense that their lives
were being taken for granted. These finding are all clearly and
elaborately reported in the study, enabling the reader to
understand how the conclusion was reached (Ritchie, Lewis,
Nicholls & Ormston, 2013).
Validity & reliability OR Trustworthiness & credibility, Rigour
(edit heading to suit article)
The researchers have ensured validity and reliability by
involving rigor, making ethical considerations, choosing an
appropriate research design, providing sufficient detail, and
using credible sources.
The researchers have involved rigor in their work by
incorporating transparency and systematicity. These two
qualities are critical in ensuring rigor in qualitative research.
The research approach was a phenomenological approach, which
means that the researchers have a great role to ensure
transparency in presenting and reporting the data collected
(Ritchie, Lewis, Nicholls & Ormston, 2013). In this case, the
researchers ensured to avail and document all the decisions they
made during the research. In particular, the researchers clearly
stated the research design of this study and also ensure to
describe and justify it appropriately to the reader. There was
systematicity in this research because the researchers ensured to
apply congruent methods for analysis and data collection in a

6. consistent manner throughout the research. More importantly,
the researchers ensured to discuss and record the deviations that
they made from the study protocol. In addition, the researchers
have ensured to provide readers with sufficient detail to justify
their decisions and conclusions.
The researchers also made important ethical considerations in
this study to ensure that it meets all the standards required for
qualitative studies (Maxwell, 2012). This research is reliable
because it was approved by the National Health Service Central
Office for Research Committees and the university Ethics
Committee. For instance, they ensured to observe the Principles
of Research Governance such as anonymity and seeking
informed consent throughout the study. These measures were
critical in protecting participants. During the interviews, there
was the possibility that some participants could become
distressed, especially because of the subject and the serial
nature of the interviews. In this case, the researchers arranged
for the participants to access a national stroke helpline or to
visit a local Stroke Nurse Specialist.
Discussion
The study provided a comprehensive and enlightening
discussion because it considered previous works on the same
topic.
This study presents findings from a qualitative enquiry of the
experience of stroke as presented from the accounts of family
members of young adults dealing with the stroke. The
researchers discuss the design and conduct of the research in
detail, enabling the reader to understand the major precepts of
Merleau-Ponty’s existential phenomenology. The
phenomenological investigation showed that the experience of
family members of young adults dealing with stroke was
grounded in Disrupted and Altered Relationships; Situatedness;
and time. The researchers discuss a previous study conducted on
the same issue by Banks and Pearson where the focus is on
young adults and their partners coping with stroke. The study
reveals that the experiences of persons dealing with stroke are

7. “universal” and not confined to family members of young
adults. From the qualitative findings, it was possible to
extrapolate the needs of families’ and the related rehabilitation
effects in the short, medium and long-term after developing
stroke (Ritchie, Lewis, Nicholls & Ormston, 2013). The study
reveals that there have been many arguments over recent years
in support of family-centred solutions to rehabilitation.
However, there has been little guidance as far as appropriate
interventions are concerned. The researchers in this study
discussed discuss key findings and the related family-centred
needs, ensuring to determine the interventions that would be
appropriate with the aim of promoting a multidisciplinary
rehabilitation practice period in which a person recovers from
stroke. As the researchers note, family members of young adults
who have had stroke is quite challenging because it is it mainly
characterized by worry and uncertainty. It is also noted that a
person with stroke tend to develop a sense of mortality after the
initial stroke event. Family members also tend to realize that
they need to have more appreciation to life more and that life
causes them to develop some form of fear because of its
uncertainty. Therefore, rehabilitation professionals need to
acknowledge and focus on promoting and developing familial
caring relationships and listening to the concerns of family
members because it helps to address their worries and fears. In
addition, the rehabilitation professionals should ensure to
provide appropriate psychological interventions to facilitate
healing and recovery. The researchers also noted that recent
psychological care guidance following stroke rarely mentions
the need to consider families’ needs.
Strengths & limitations
The authors specifically identified a number of limitations in
this study including a small sample size, lack of heterogeneity
in the sample, and sporadic participation in the interviews.
There were a number of limitations that the researchers
specifically identify and discuss in this study. One identifiable
limitation of this study is the small sample size. However, it is

8. common to find that phenomenological studies are associated
with small numbers. In these types of studies, between 6 and 12
participants is considered to be appropriate. In this particular
study, eleven family members participated, which means that it
met the methodological criterion. The other limitation of this
study was the fact that it lacked heterogeneity in the sample,
especially with regard to ethnicity, gender, and severity of
stroke (Ritchie, Lewis, Nicholls & Ormston, 2013). Most
participants in this study were females, which might be a
reflection of the characteristic “carer” role that they play in the
society. This also implies that informal carers are most likely to
be female. The researcher recruited the participants from two
major cities in the UK, which means that it would be expected
that the sample would be more representative in terms of ethnic
groups. However, the participants in this study were all
Caucasians. There was also a limitation in terms of severity of
stroke because only family member was identified to have
severe stroke. In this study, it happened that most of the young
adult participants had achieved good levels of recovery, and this
also means that they hardly displayed any “visible” effects of
stroke. It also emerged that younger adults with stroke have
significantly higher chances of recovery when compared to
older adults with the same condition.
Therefore, chances are high that the study participants were
representative of the young adults with stroke in the wider
population. As far as gaining understanding in relation to the
long-term experience perception and the related needs and
consequences, participation was sporadic. This was especially
the case at Time 4, where there were only three family member
participants in interviews. The 6 participants at the Time 3
and/or were instrumental in enabling the researchers to gain a
longitudinal perspective. The researchers noted the need to
develop a more flexible timetable in the future to facilitate
effectiveness in the interviews, especially with regard to their
sustained involvement.
Implications of the study findings for practice

9. This research has significant implication for practice because it
promotes a family-centred approach to rehabilitation, which
may improve practice as well as boost service provision.
This qualitative phenomenological study provided valuable
findings that enabled the reader to develop a deeper
understanding of stroke from the experiences of family members
with young adults with stroke. This study is significant because
it contributes a lot to the numerous research studies that provide
evidence that promote a family-centred approach to
rehabilitation. This research enables rehabilitation professionals
and family members to develop tables that would help to
identify the needs and outcomes of persons with stroke. The
rehabilitation professionals can achieve this by drawing on their
professional expertise and the available research evidence. This
approach to the problem may enable the rehabilitation
professionals to use the findings of this research to identify
short, medium, and long-term rehabilitation priorities and needs
of patients and their family members. In addition, the
rehabilitation professionals can choose appropriate
interventions that align with the needs and outcomes identified
based on family needs throughout the recovery course of the
stroke (Moustakas, 1994). Using the information and evidence
derived from this study, members of the multidisciplinary team
start involving family members in the development of
meaningful goals that would be beneficial not only to patients,
but to their families and the rehabilitation professionals as well.