Table 3.

Contextual barriers and enablers to stroke care in SA

Domain	Barrier	Enabler
Ability to perceive	•Unmet expectations of health care professionals •Low health literacy on stroke prevention •Health beliefs	•Awareness of functional changes requiring medical care
Ability to seek	•Poor understanding of care options •Lack of privacy •Cultural and spiritual beliefs •Stigma	•Being treated with kindness, respecting personal values •Friendliness of staff
Ability to reach	•Limited transport •Complex and variable pathways to care •Physical mobility related to stroke	•Social /family support
Ability to pay	•Out of pocket payments (private health care) •Transport costs •Opportunity costs for seeking care	•Some private health insurance coverage (associated with higher socio-economic status) •Free/scaled costs of public health care
Ability to engage	•Negative health provider – user relationships •Limited engagement of health staff •No support for carers and children of PWS	•Low expectations of good treatment •Printed information and information with graphics •Personal resilience and family support