All ETDs from UAB

Advisory Committee Chair

Karen Heaton

Advisory Committee Members

Nataliya Ivankova

Loretta Lee

Victor Mark

Pariya Wheeler

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Nursing


BACKGROUND: Stroke is a highly prevalent and disabling condition among African Americans. Although there is limited research regarding barriers and facilitators to return to work among stroke survivors, evidence suggests that African American stroke survivors return to work (RTW) less frequently than Caucasians. Most of the research on this topic has been conducted in European countries, leaving significant knowledge gaps on RTW among African Americans in the United States. The purpose of this study was to identify factors that affect RTW for African American stroke survivors and then build upon those results to better understand facilitators and barriers to RTW. METHODS: Factors affecting RTW were explored using a sequential Quan → QUAL mixed methods design. Data collected included the National Institute for Occupational Safety and Health (NIOSH) Worker Well Being Questionnaire (WellBQ), which examines the five domains of worker well-being (work evaluation and experience; workplace policies and culture; workplace physical environment and safety climate; health status; and home, community, and society). Quantitative data were analyzed using SPSS v. 28. Univariate analyses were conducted to compare demographics and worker well-being indices between those who were and were not currently working. A subsample of nine participants, who responded to the quantitative questionnaire, subsequently completed a 45-60 minute, semi-structured interview to further explore iv facilitators and barriers to RTW. Interviews were transcribed verbatim and analyzed using thematic analysis and NVivo 12. RESULTS: Thirty-one African American stroke survivors were included in the quantitative analyses. Associations with being employed (p < 0.05) included higher education, higher household income, supportive work culture, increased availability of health programs at work, higher levels of work to non-work conflict, increased mental distress, decreased fatigue, and higher levels of productivity. The five domains of worker well-being were used as overarching themes in analysis of qualitative interview data to describe facilitators and barriers to RTW. Having meaningful work, support, and access to rehabilitation were reported as contributing factors to RTW, whereas lack of accommodations, discrimination, cognitive and physical impairments were reported as barriers to RTW. CONCLUSION: Returning to work is a dynamic process that includes personal, societal, and work-related factors.

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Nursing Commons