Understanding the Sociocultural Challenges and Opportunities for Affordable Wearables to Support Poststroke Upper-Limb Rehabilitation: Qualitative Study

Background: People who survive a stroke in many cases require upper-limb rehabilitation (ULR), which plays a vital role instroke recovery practices. However, rehabilitation services in the Global South are often not affordable or easily accessible.For example, in Bangladesh, the access to and use of rehabilitation services is limited and influenced by cultural factors andpatients' everyday lives. In addition, while wearable devices have been used to enhance ULR exercises to support self-directedhome-based rehabilitation, this has primarily been applied in developed regions and is not common in many Global Southcountries due to potential costs and limited access to technology. Objective: Our goal was to better understand physiotherapists', patients', and caregivers' experiences of rehabilitation inBangladesh, existing rehabilitation practices, and how they differ from the rehabilitation approach in the United Kingdom.Understanding these differences and experiences would help to identify opportunities and requirements for developingaffordable wearable devices that could support ULR in home settings. Methods: We conducted an exploratory study with 14 participants representing key stakeholder groups. We interviewedphysiotherapists and patients in Bangladesh to understand their approaches, rehabilitation experiences and challenges, andtechnology use in this context. We also interviewed UK physiotherapists to explore the similarities and differences betweenthe 2 countries and identify specific contextual and design requirements for low-cost wearables for ULR. Overall, we remotelyinterviewed 8 physiotherapists (4 in the United Kingdom, 4 in Bangladesh), 3 ULR patients in Bangladesh, and 3 caregivers inBangladesh. Participants were recruited through formal communications and personal contacts. Each interview was conductedvia videoconference, except for 2 interviews, and audio was recorded with consent. A total of 10 hours of discussions weretranscribed. The results were analyzed using thematic analysis. Results: We identified several sociocultural factors that affect ULR and should be taken into account when developingtechnologies for the home: the important role of family, who may influence the treatment based on social and culturalperceptions; the impact of gender norms and their influence on attitudes toward rehabilitation and physiotherapists; anddifferences in approach to rehabilitation between the United Kingdom and Bangladesh, with Bangladeshi physiotherapistsfocusing on individual movements that are necessary to build strength in the affected parts and their British counterpartsfavoring a more holistic approach. We propose practical considerations and design recommendations for developing ULRdevices for low-resource settings. Conclusions: Our work shows that while it is possible to build a low-cost wearable device, the difficulty lies in addressingsociotechnical challenges. When developing new health technologies, it is imperative to not only understand how well theycould fit into patients', caregivers', and physiotherapists' everyday lives, but also how they may influence any potentialtensions concerning culture, religion, and the characteristics of the local health care system.