Social participation and representations of stroke in post-stroke patients.

Summary Stroke is a frequent and serious pathology, constituting the first cause of acquired disability in adults. The impact of stroke on the daily life of patients is multiple due to the polymorphous nature of post-stroke after-effects and can have dramatic consequences on people's lives. Patients often find themselves alone and helpless when they return home and must readjust to daily life by adjusting to their new condition. Confronted with the stroke and its consequences, patients will develop representations of the stroke that influence self-management behaviors and the adoption of health-promoting behaviors. The objective of this thesis was to identify, through a systematic review of the literature and a quantitative study, the contextual factors associated with the social participation of stroke patients. The contextual factors are both related to the patient (socio-behavioural, psychosocial, socio-demographic characteristics) and to the living environment of the persons. In addition, a qualitative study was carried out to gain a better understanding of the stroke experience and, in particular, to understand individual representations of stroke. The literature review showed the importance of socio-behavioural and psychosocial factors (self-esteem, motivation, acceptance) as well as the influence of environmental factors (social support, attitudes of others towards the patient, physical environment, access to care and services) on the social participation of stroke patients. The quantitative study (TYBRA-quanti) additionally showed that gender, stroke adjustment strategies, and self-reported satisfaction with the living environment were independent determinants of stroke patient social participation. In a nested design, the qualitative study (TYBRA-quali) provided additional information about the lived experience of stroke and in particular about the individual representations developed by patients without major disability (mRs ≤ 2). All reported problems in the construction of an identity around stroke in both the acute and chronic phases. They had difficulty recognizing that lifestyle risk factors (smoking, alcohol, and diet) may have played a role in the occurrence of stroke. Lack of information or information delivered at an inappropriate time by healthcare professionals resulted in poor knowledge of medications and poor perceived control over the risk of stroke recurrence, causing anxiety and fear. Patients who considered stroke as a chronic disease reported more difficulties in managing the consequences of daily life. Support from family members and health professionals was a major factor in the recovery process and in the adoption of health-promoting behaviors. The objective of this research was to better understand the impact of stroke on patients' daily lives and how they cope with it. Based on three research operations with varied methods, this thesis provided knowledge about the rehabilitation process of people after a stroke. This thesis opens the way to future research and clinical avenues related to the improvement of patient support in the rehabilitation phase. In addition to the management of functional and cognitive deficits of patients, proposing a support focused on psychosocial, socio-behavioral and ecological processes inherent to patients would allow an optimization of the rehabilitation process (improvement of social participation and self-management capacities in particular). Stroke is a frequent and serious disease, constituting the first cause of acquired disability in adults.