"I feel like half my body is clogged up": Lay models of stroke in Central Aceh, Indonesia

Stroke in low and middle income countries is an increasing cause of death and disability, with rates and the estimated burden considerably higher than that of high income countries. Lay explanatory models are believed to be one of the major influences on health seeking behaviour and essential to understand for appropriate education strategies. Despite stroke being a considerable health concern in Indonesia and particularly in Aceh, no studies to date have explored lay stroke models in that context. This paper presents the findings of a qualitative study informed by both hermeneutic phenomenology and ethnography. Based in rural communities in Bener Meriah and Aceh Tengah in Central Aceh, Indonesia, data were gathered through interviews, photographs and observations with 11 persons with stroke (aged 32-69 years) and 18 of their carers. Fieldwork was conducted over nine months between 2007 and 2008. The study examined lay concepts of stroke, described as a condition resulting from a local blockage in blood from multiple causes, many of which are not recognised within the biomedical frame. The blockage is understood to be reversible and therefore the condition curable. This understanding is embedded and sustained in the specific political, cultural, religious and social context. The results illustrate similarities and differences with other cross-cultural studies and suggest areas of future research and points of consideration for stroke education strategies.