Chapter I

Introduction
“All the people perceive the concept of living good or being well, that is the same as

being happy”.(Aristotle.384-322 BC. Ethica Nichomachea). Every one of us has our own

definition of a quality life. We all have different experiences and struggles in life, which in some

cases we let those phenomena define who we are and let those affect our perceptions about so

many aspects of life. Our perceptions about a quality of life mostly reflect our life experiences’,

significant life events and the current phase of the life and factors defining the quality of life.

Some patents are struggling alone which makes it harder for them to survive and to cope up.

Even if they wanted to survive, they chose to give up because they don’t want to walk with that

burden alone, that burden which is becoming heavier each day. Some survived because they are

walking with that burden with the help of their family and friends, their loved ones. One thing

that all human beings share in common is the aspiration to live a happy life.

According to World Health Organization, quality of life is defined as individuals’

perceptions of their position in life in the context of the culture and value systems in which they

live in relation to their goals, expectations, standards and concerns. Quality of life is the feeling

of overall satisfaction, as determined by the mentally alert individual whose life is being

evaluated. The quality of life encompasses the entire range of human experience, states,

perceptions and spheres of thought concerning the life of an individual or community.

Patrick and Erickson(1993) define health related quality of life as the value assigned for

duration of life as modified by the impairments, functional states, perceptions and opportunities

that are influenced by disease, injury, treatment, or policy

 Stroke is a serious illness caused when blood vessel in your brain suddenly breaks or

blocked (Meriam Webster Dictionary. As I observe the community, there are so many cases of

patients having an illness called stroke and it has different outcomes. Stroke patients can have a

difficulty in speaking and expressing their selves to everybody. Others can walk and speak

normally but can’t move their head without their body following the motion because their neck

seems paralyzed. Some cannot speak nor walk because their whole body seem paralyzed, while

others end up leaving their loved ones and this world. Stroke also causes permanent disability in

adults worldwide. A lot of people have suffered from this kind of illness, some manage to

survive, some people don’t. Another key in surviving to this kind of illness is the proper

knowledge about how to handle this and of course the love from the people around the patient.

There are cases that the patient choses to just give up because he/she can sense that the people

that he/she loves don’t care about them anymore because they think that they are just a burden

for them. Being a burden to the one you love is like a big and heavy sack that you have to carry,

some patients just let down this sack to be free from hardships because they are carrying that

sack of burden all alone.

The purpose of this study is to discover or determine how stroke patients view life, a life

that is meaningful and has quality. This is to understand what comprises a quality of life; to

provide information about the different perspectives of patients being treated for stroke towards a

quality life. This will also provide an encouragement for those people who are most likely to

give up living to view life positively. Even when it seems like everything is going to the wrong

place just think positively, view this life positively for God hasn’t given us challenges which we

cannot overcome.
Statement of the Problem

“Stroke illness gives way to disappointment, hopelessness, giving up, negative way of thinking,

and a bad perception of a quality life to those who are weak to stand firm in front of the giants”.

When people are faced in front of big challenges, some manage to survive and continue

living despite the struggle he/she have fought with. But then, some people has lost their hope and

think of their situation as the end of their journey in life. They have given up their hopes and

dreams because their minds are filled with negative things and thoughts. When this occurs, not

only the patients are affected but also the people around them, most specially their family and

friends. Some people blame God for what happened to them. They think that God hate them, that

God is cruel for giving them a challenge which they cannot survive and cannot resolve. Stroke

illness gives way to those kinds of things, it’s just up to the person whether to walk that way or

turn the other way.

Purpose

The goal of this study is to discover or determine how stroke patients view life, a life that

is meaningful and has quality. This is to determine what comprises a quality of life, to provide

information about the different perspectives of patients being treated for stroke towards a quality

life. This will also provide an encouragement for those people who are most likely to give up

living to view life positively.

Significance of the Study

This qualitative study will benefit everyone, but most especially to those people who are

currently struggling and recovering from stroke. This will help stroke patients to view life in a

positive manner, as it is because having faith in positivity will also give you a positive outcome.

This will also help the family members of stroke survivors to understand the patient’s and help

them recover from stroke. This will provide a deeper understanding for everyone about the

different perspectives of stroke survivors towards a quality life. This will also help stroke

survivors to voice out their emotions, perspectives and opinion about what comprises a quality of

life for them.

Research Questions

The research questions for this study will be:

1. What is the meaning of life for stroke patients?

2. What do they think of a quality life?

3. What are the things that for them make a meaningful and quality life?
 Chapter II

Review of Related Literature

Patients with chronic disease may experience complicated management plans requiring

significant personal investment. This has been termed ‘treatment burden’ and has been

associated with unfavourable outcomes. Treatment burden is a novel concept describing the self-

care practices that patients with chronic disease must perform to enact management strategies

and respond to the demands of health care providers and systems. Individuals will vary in their

capacity to accommodate and enact such practices, which may have a marked impact on patient

functioning and well-being and on adherence to management plans. No adherence to

management strategies by patients with chronic disease is a global health problem and has

potential to lead to negative outcomes for patients such as morbidity and wasted expenditure for

health care systems. Cerebrovascular disease (stroke) is the leading cause of long- term disability

in both the UK and the US [19,20]. Global projections of the year 2020 indicate that this disease

burden will increase, in both westernised and resource-poor countries [21]. Coping thresholds are

likely to vary substantially between patients, depending on environmental factors such as social

support and financial constraints, and on internal factors such as health literacy ad resilience

(Gallacher, K., et al., 2013).

According to Kalliopi Megari (2013), during the past decades there was an increasing

predominance of chronic disorders, with a large number of people living with chronic diseases

that can adversely affect their quality of life.

Quality of life

The World Health Organization (WHO) defines health as not merely the absence of

disease or infirmity, but a state of complete physical, mental and social well being. The

definition of Quality of Life (QoL) is more complex. According to WHO, QoL is defined as

individuals’ perceptions of their position in life in the context of the culture and value systems in

which they live in relation to their goals, expectations, standards and concerns. QoL is the feeling

of overall life satisfaction, as determined by the mentally alert individual whose lifeis being

evaluated. This appraisal is subjective, and encompasses all domains of life, including elements

of biopsychosocialspiritual model. The use of the term subjective has different connotations to

different people and can be perceived as not reliable because it is not objective. Subjective can

be synonymous with self-perceived meaning that a person primarily gives information about

him/herself.

Other definition of QoL suggest that it is a global assessment of a single dimension which

may be casually responsive to a variety of other distinct dimensions: it is a unidimensional

concept with multiple causes. Therefore, it encompasses the entire range of human experience,

states, perception and spheres of thought concerning the life of an individual or a community.

Both objective and subjective QoL can include cultural, spiritual, financial, political, temporal

and philosophical dimensions. QoL implies a judgement of value placed on the experience of

communities, groups such as families or individuals.

Finally, it is suggested that QoL can theoretically encompass a wide ranging array of

domains and components. These involve functional ability including the role functioning

(functional ability in different roles like in physical activities and achievement beliefs), the
degree and quality of social interaction, psychological well-being, somatic sensations, happiness,

life situations, life satisfaction and need for satisfaction. It also reflects life experiences,

significant life events and the current phase of the life and the factors defining QoL in this

respect further include sex, socioeconomic status, age and generation. QoL is thus a complex

collection of interacting objective and subjective dimensions: encompasses the individual’s

perspective, is assessed through the eye of the experiencer, and is likely to be mediated by

cognitive factors.

Health related quality of life

Patrick and Erickson (1993) view the health related quality of life (HRQoL) as the value

assigned to duration of life as modified by the impairments, functional states, perceptions and

social opportunities that are influenced by disease, injury, treatment or policy. A main topic in

HRQoL includes patients’ appraisal of their current level of functioning, as well as satisfaction

with it, compared to what they believe to be ideal. An important aspect in HRQoL study is how

the manifestation of an illness or treatment is experienced by an individual. Patients’ health

status which includes their personal experiences which is affected by the health care

interventions as well as changes over time with a chronic disease and no particular treatment. For

example, evaluation of HRQoL over time after disease such as stroke, for individuals who have

completed treatment and rehabilitation and are living with the effects of this disease.

There are several papers or manuscripts that have been published about studies about

health related quality of life in stroke patients. Their findings and results conveys that factors

such as hemispheral localization of the lesion, paresis, coordination disturbances and especially

subjective tendency to depression are highly correlated with poor health related quality of life. It
also conveys that post stroke disability is an example of a stronger predictor of low HRQoL than

depression. The study also states that one year after stroke patients with severe to moderate

disability will most likely have lower health related quality of life than depressed patients. Health

related quality of life is said to be independently associated with handicap, anxiety,

institutionalization, and dementia.

It is generally accepted that HRQoL is a multidimensional construct that consists of at

least three broad domains – Physical, psychological, and social functioning – that are affected

by one’s disease and/or treatment. Physical functioning is usually defines as the ability to

perform a range of activities of daily living, as well as physical symptoms resulting from the

disease itself or from the treatment. Psychological functioning ranges from severe psychological

distress to a positive sense of well-being and may also encompass cognitive functioning. Social

functioning refers to a quantitative and qualitative aspects of social relationships and interactions

and social integration.

According to Yoon, S., (2002), he conducted a qualitative study about the perceptions of

stroke in the general public and patients with stroke which states that other studies of acute

intervention for stroke have shown that it will be more favourable to the outcome if the

symptoms were recognised earlier. He stated that the public has lack of knowledge about

symptoms and warning signs of stroke that’s why there are so many cases of delay in seeking

medical care. His study was conducted in order to obtain insight into people’s thoughts about

stroke, which includes the risk factors, symptoms, treatment, information resources, and

prevention; to inform the development of an strategy to early recognise the symptoms and to

provide an appropriate responses to these in the community and also to inform the development

of an educational programme for people who have had a stroke. Conducting an educational
programme for people who have been treated for stroke is a crucial thing to conduct because this

will help them recover and continue living life happily and positively, it will help them to keep

away from negative impacts that stroke illness can brought to humans. Effectiveness community

educational programmes are vital to increase public awareness of stroke.

 Chapter III

Methodology

This research study tends to determine how stroke patients view life, understand what

comprises the quality of life, provide information about the different perspectives of stroke

survivors towards a quality life, and provide an encouragement for those people who are

susceptible to negative thinking.

This study seeks to answer the following questions:

1. What is the meaning of life for stroke patients?

2. What do they think of a quality life?

3. What are the things that for them make a meaningful and quality life?

Population and sampling

The participants for this study are the patients being treated for stroke. Gathering data and

information will be conducted through the use of an interview and content analysis in their

medical records. This will be conducted at the Municipality of Narra. The researcher will use

simple random sampling in which all the participants have an equal chance of being chosen as a

respondents of this study. The researcher will provide a consent that the respondents will read

and will decide whether they will participate in the interview or not. This will be conducted on

the most convenient time of the respondents.

Instrumentation

The researcher will provide interview questions that will be answered by the respondents,

and a letter of consent that is asking for the permission of the respondents to participate in

providing data and information for this manuscript to be constructed. The researcher will use in

depth interview and thematic analysis on the data and information collected. The interview will

attempt to measure the meaning of quality of life for stroke survivor and the things and

experiences that comprises their perspective on a quality life. A copy of the interview questions

were attached in the appendix.

Procedure and time frame

This research study will be conducted when the aimed number of respondents agreed to

be a sample of this study and this will end when the gathered data and information was analysed

and the results were interpreted by the researcher. This study was conducted from January 2019

up to March 2019. A letter of consent will be given to the respondents.

Analysis plan

The researcher will use thematic analysis on the data and information gathered through

the use of an interview. An interview protocol was read to the participants and given them time

to answer every question included in the interview protocol. The interview will be recorded to

fully understand and highlight the key concepts to identify the themes. This process involved

asking questions that was necessary to further understand their perceptions and whether it could

be abstracted and labelled. After conducting an interview, the researcher identified the key

concepts and identifies the themes based on the data and information given by the respondents.
In discussing the themes, the researcher used pseudonyms to protect the respondent’s identity.

Final identification of the themes were done in order to verify that the theme and accompanying

constituents were explicitly expressed and is compatible with the participants’ words. Themes

were discussed and analysed individually and are used to culminate an overall essence of the

study. Themes are presented at the fourth chapter of this study.

Assumptions

The respondents will answer the questions truthfully and will take the interview

seriously. The interview questions will answer the research questions of this research and will

meet the desired purpose and objective of this study of the researcher. The respondents will

respond to the questions given from the bottom of their heart. The answers of the interviewee

will answer the research questions of this study.

Scope and limitations

This study is only limited in discovering or determining how stroke patients view

life, a life that is meaningful and has quality. Second, is to determine the things that comprises a

quality of life for the participants and to provide information about the different perspectives of

patients being treated for stroke towards a quality life. Also, to provide an encouragement for

those people who are most likely to give up life because of experiencing stroke.
 CHAPTER IV

RESULTS

Results

From the data collected on the ten (10) participants, six themes emerged from the stroke

patient’s perception about the meaning of quality of life. These are named: (1) barriers, (2)

second chances, (3) family, (4) freedom, (5) Christ-centred, and (6) healthiness. The quoted

statements presented in this chapter use pseudonyms in order to protect the participants’ identity.

Barriers

Stroke patients perceived life as a hard and difficult after experiencing stroke because of

all the things that they want to do but cannot. There are so many things that they want to do but

they are prohibited because those activities may shorten their lives or they are just not able to do,

the life which they consider as their second life. Stroke gave them barriers to having normal life

like people who did not have this kind of illness have.

“After I experienced this, life became very hard for me because there is a lot of food that I want to eat but
it is not allowed; many things I want to do but cannot; and jobs that I want to perform but also cannot. My
actions are limited but I have to get used to it in order for me to live long and be with my family much
longer”. (Jay)

Some participants believed that those limitations hindrances their ability to live a happy

life because they think that they can’t enjoy their lives anymore because of their disability to

move, to speak and many more. Other participant used those disabilities as their strength, as their

motivation to recover and cope with each and every challenge that may come in their way and be

happy despite all the things that have happened.

Second chances

The participants view life after experiencing stroke as their second chance. A second

chance to do or say things that they were not able do before. They believe that God has given

that chance for them to change and become a much better person. Others stated that it is their

second chance to change their attitudes, way of thinking, way of socializing with others, and the

second chance to keep their relationship with their family, loved ones and friends much closer.

“In my perception, I view my life now as a second chance given to me by God to repent from all my sins

and serve Him until the day I die. Also, to spend more time with my family and have a closer relationship

with them; to give advices and help them to achieve their goals with my guidance for they will remember

me when I am gone”. (Kayce)

They all have their own way of living that second chance that’s been given to them and

all of them did not waste that. They have used that second chance in serving God, spending more

time with their family, conducting good deeds, being a good example to everybody and doing

their very best to be a great help to everyone despite their situation.

Family

The respondents stated that having your family at your side is a quality life. One of the

things that for them comprise a quality life is to have their family right beside them to help them,

care for them, love them, and cherish them. A kind of family which will help them carry the

burden and join them in laughter and in tears or sorrow also means having a quality life. For

them, they cannot carry the burden without their family’s help. It seems like life is meaningless if

their family is not around. Their families make them strong; enough to be firm to fight with the

struggles that life gives.

“Um... A quality life for me means family. I said that because my family is very important for me and I
think my family is the very treasure that I really want to keep. I need them to help me with my problems
and share with them my happiness. My quality life revolves around my family”. (Flor)

Family plays a very important role when it comes to this kind of situation when

somebody in the family became ill and not be able to do things because they’ll be the one who

will take care of the patient. They’ll be the one who will do the things that the patient can’t do.

Family members should understand the patient and learn the things that must be done to assist

the patient. The recovery of the patient depends mostly on his/her family, which is why other

patient looked to their family as their only hope and think that life would be meaningless without

their family beside them.

Freedom

Besides family, others said that the meaning of a quality life for them also includes

freedom. The respondents looked freedom as one of the things that will complete their quality

life. Freedom to do the things they want, eat the foods they want, and visit places that they

dream of going to. All of these seem unreachable because of the situation that they are in. There

are limited activities that they can perform and limited foods that they can eat. In terms of

educational attainment, even though they want to continue their chosen profession they cannot

continue anymore because their capabilities now are far from their capabilities before they

experienced stroke. Due to this reason also, them having a good decent job seems improbable.

“Now that I am like this, many things have changed, like my job. I cannot even walk properly now so I

cannot continue my job anymore and that is a big challenge for me, for us, because I should be the one to

provide our needs in the family. My freedom to do things I wanted has also changed, it changed a lot

because you know, in the kind of situation I am in, I should consider a lot of things before performing an

action”. (John)
Christ-centred

God at the center of everything is one of the recipes of a quality life from most of the

participants. They all believed in God, and are religious people even though they are in different

denominations. They all believed that in order for a person to have a quality life, he/she should

put God at the center of everything. They should put God at the center of their lives, at the center

of their hearts. One of the main sources of their strength is our God Almighty. God has given

them strength to go on with life even though it is hard and difficult. They have stated that even

though you are poor here in this world it does not matter, you just have to serve God with all

your heart because the place that you have to pile your treasure is in heaven not in this sinful

world.

“You will have a quality life if you’re serving God from the bottom of your heart and you have accepted
Him as your personal saviour. It doesn’t matter if you’re poor now because according to the bible, pile
your treasures in heaven not in this world. God will provide everything that you need, just trust in Him
and of course seek Him first”. (Paul)

Spirituality seems to play an important role in coping because others felt that their

emotional needs were not looked so spiritual beliefs are there and consider having an influence

in the ability of a person to cope and also prevent a person to experience depression because

persons with illness are more vulnerable to emotional distress. For stroke patients, strong

spiritual connection could help them accept the new situation they are in, withholding hope, and

increasing their motivation to work hard in recovering, and also to encourage them to continually

fight through all the challenges and problems that may come in their life.

Healthiness

There is this saying that goes “Health is wealth.” Although a person is not rich, but if he

has a healthy body he can consider himself wealthy. Healthiness is an important part of a
person’s life. With a good health a person can do his tasks effectively and efficiently without

health being a hindrance. But then, a person who is unhealthy may not be able to do his tasks like

a person who has a healthy body. The participants stated that the healthiness of a person must be

cherished because you can function properly if you are holistically healthy. Healthiness is also

one of the things that will complete their quality life. After they have experienced stroke, they

really value their health that’s why they have therapies and maintenance of medicine and of

course, a change of lifestyle to maintain a good health to reduce the risk of having stroke over

and over again because there is a possibility that in the next episode of stroke, they can’t survive.

“Of course healthiness is one of the things that comprise my quality of life. In my situation, I have to do
things and eat foods that will help me become healthy because I want to have a good and happy life. One
of the stepping stones in order to have the life that I desire is to have a good health in order for me to
function properly and efficiently”. (Paula)
 CHAPTER V

CONCLUSION AND RECOMMENDATION

Discussion

This study conducted an in-depth interview on the 10 participants that has been selected

using simple random sampling in order to determine the perception of stroke patients towards

the meaning of a quality life. Six specific themes emerged in this study: (1) barriers, (2) second

chances, (3) family, (4) freedom, (5) Christ-centred, and (6) healthiness. The quoted statements

presented in this study to support the identified themes used pseudonyms in order to protect the

participants’ identity.

It has been analysed that even though there are so many barriers that the participants have

faced, they still find a way to be happy in their life despite the situation they are in. Even though

life now was hard and difficult for them, they still find a way to recover, cope and survive

through the help of their family, friends and God. Their disabilities became their strength and

their experienced became their lesson and of course it gave way for them to change their

attitudes and deeds that must be changed before it’s too late.

They have valued their second chance and used it to perform good deeds and live their

life to the fullest without stepping foot on to the life of others instead of giving up and just sit

around not trying to make a difference. They consider themselves lucky for waking up because

others who have experienced having stroke like them have rest already without having the

chance to change their way of living.

They value and loved their family more because their family didn’t leave them when they

needed them. Their family was always there for them to love and cherish them even though they
are disabled and can’t perform things properly and can’t perform other actions on their own.

They’re family members performed their role more than enough because of the love they have

for each and every one of their family members. Blood is really thicker than water.

Even though they’re freedom to do things they wanted has been gone, they still manage

to recover and survive because of the other factors that can fill the position of freedom in

completing their perception about the things that will complete their quality life. Take God for

example, God is more than enough to fulfil the position of freedom. They can cling to God

whenever they wanted because God is everywhere and He’s always there for everyone who

needs His help, you just have to serve and love Him whole heartedly in return. It is therefore

concluded that Filipino’s are absolutely religious people.

A change of lifestyle is necessary for someone who has experienced stroke to survive

because the most advice of their health care providers was to be healthy. Health and wellness is

another way of saying that you are wealthy because “Health is wealth”. Being holistically

healthy is one of the contributors for someone to function properly and efficiently. The

participants are doing the best they can to maintain a good health. They are having therapies,

maintenance of medicine, exercises like walking, watering plants and etc. in order for them to be

healthy and avoid the risk of experiencing stroke again cause there is a very small possibility that

they can survive if that happens again.

Overall, even though their perceptions of a quality life was not met in their situation now,

they still decide to go on with life because for them, life was a gift given to them by God and

must be cherished. That life must be lived through conducting good deeds and be a good person

that everyone can consider as their role model. “All the people perceive the concept of living
good or being well, that is the same as being happy”.(Aristotle.384-322 BC. Ethica

Nichomachea).

Recommendations

After conducting this study, the researcher would like to recommend the following:

1. For stroke patients, continue living your life in being a role model for every one and never let

your disabilities be your weakness. Start living your life in making a difference.

2. For other researchers, you can use this study as your guide and basis in creating or

constructing your own research.

 The meaning of quality of life in

stroke patients being treated for stroke: a

qualitative study

Jaizanie Lyn Bacabac

(Grade 11 STEM)
Date:

Name of Respondent:
Title:
Name of Office:
Address:

Dear_____________________,

I am a Grade 11 student of Narra National High School who is currently doing a research
on “The meaning of quality of life in patients being treated for stroke”. This study is a
major requirement for Practical Research 1 Course. In this regard, I would like to solicit
your permission to have an interview with you to learn more about how you view the
word “life” and what, for you, comprises a quality of life.

If you choose to participate in this study, I will schedule a time to meet with you on your
most convenient time. During this time, I would like to ask questions concerning your
perspective and opinion about life and also to ask questions about what the word “life”
means to you. This interview will take approximately 30 minutes. With your permission,
I would like to audio tape the interview in order to focus on the conversation. Only I will
have access to the tape. The recordings will be transcribed and I will remove any
identifiers during the transcription. The tape will then be erased and your identity will be
kept confidential and will not be revealed in the final manuscript. I would also ask for
your permission to have a copy of your medical records.

We will contact you again in a few days to clarify and answer any questions you may
have about this project and possibly schedule an interview.

Please do not hesitate to contact me if you have any questions through my gmails account
[email protected] and my contact number 09077436617.

I am thanking you in advance for your consideration to participate in this study.

Respectfully yours,
Jaizanie Lyn Bacabac

Noted by:

Josie Joshua R. Pasion

Practical Research 1 Teacher