“Flexible Trade-Off”: Social Participation Change Model among Middle-Aged and Older Stroke Survivors: A Grounded Theory Study

Abstract Objectives Stroke survivors face significant challenges in social participation and great restrictions in returning to normal life. However, studies about the social participation change process and how they cope with challenges are scarce. This study aimed to explore social participation changes among middle-aged and older stroke survivors and to construct a model that elucidates the recovery process of social participation. Methods A grounded theory approach by Glaser and Strauss was employed. Adults diagnosed with stroke were recruited in two acute tertiary hospitals in Northeast China. Face-to-face individual interviews and participant observations were conducted with 45 stroke survivors (mean age = 66.30) between March and November 2023. Data collection and analysis occurred concurrently. Open, axial, and selective coding were used along with memo writing and figure drawing. Results Three change phases of social participation were identified: decreased social participation level, “flexible trade-off” in social participation (core category), and differentiated social participation extents. Stroke survivors weighed the cumulative influences of barriers and facilitators of social participation and generated four opinions. They flexibly employed positive, non-effective, or negative coping strategies to reorganize personal and environmental resources and establish daily routines in participation. Under the “flexible trade-off” process, stroke survivors showed open-ended, semi-open, or blocked participation. Discussion Findings could guide middle-aged and older stroke survivors to balance multiple barriers and facilitators, mitigate negative emotions, and enhance positive coping abilities. Healthcare providers should assist them in effectively adjusting social participation extents based on specific personal and environmental conditions and to reestablish daily routines in participation.