Psychosocial adaptation experiences among patients with ischemic stroke: a qualitative study

Abstract

Based on the Roy Adaptation Model, this study aims to explore the factors influencing of psychosocial adaptability in patients with ischemic stroke, so as to provide evidence for formulating intervention programs. A descriptive qualitative study with a phenomenological approach was conducted. Using purposive sampling with maximum variation strategy, 15 patients with ischemic stroke and poor psychosocial adaptation (PAIS-SR scores > 50) were recruited from the Department of Neurology at a tertiary hospital in Qiqihar City between July and November 2025. Data were collected through face-to-face, semi-structured interviews lasting 25–30 min each. The interview guide was developed based on the four adaptive modes of the Roy Adaptation Model. All interviews were audio-recorded and transcribed verbatim within 24 h. Data were analyzed using Colaizzi’s seven-step phenomenological method, with coding independently performed by two researchers and managed using NVivo 15 software. Thematic saturation was achieved after 15 interviews. Four themes and sixteen sub-themes were generalized, including the following: Theme1 Disease and physiological related stimuli (physical symptom distress, disease uncertainty, dependence in daily activities, somatic perception abnormalities); Theme2 Disease perception and emotional coping(inadequate and misaligned disease perception, reduced self-worth and negative emotional spillover, passive coping and passive adaptation); Theme3 Social support and role pressure (limited or absent sources of social support, family role conflicts and pressure, supporting perceived differences, social isolation and fear of discrimination, economic pressure and weak perception of relevant policies); Theme4 Self-identity and behavior management (identity crisis, perceived self-burden, challenges in health behavior change, barriers in rehabilitation knowledge acquisition and application). This study employed the Roy Adaptation Model to explore factors influencing psychosocial adaptation in stroke patients. Through comprehensive assessment across four domains, four themes and sixteen sub-themes were identified. The findings reveal that adaptation experiences are shaped by the interplay of physiological impairments, cognitive biases, emotional distress, inadequate social support, role conflicts, identity crises, and behavioral change difficulties. These findings underscore the need for comprehensive, individualized support strategies that address patients’ multifaceted needs. They also highlight the importance of recognizing dynamic interactions among the four domains, as interventions targeting a single domain may have ripple effects across others. Future longitudinal or mixed-methods studies with larger, multi-center samples are warranted to validate and extend these findings and to evaluate intervention strategies derived from this qualitative evidence.