Understanding stroke caregiving in rural contexts: a qualitative study of family caregivers' cultural values, coping behaviors, and technology use.

Background: Stroke is a leading cause of long-term disability worldwide, with recovery increasingly dependent on family caregivers who provide complex medical, rehabilitative, and emotional support. In rural and under-resourced settings, caregivers often assume these responsibilities with limited training and restricted access to formal services. Although caregiver burden is well documented, less is known about how cultural values, caregiving beliefs, and technology use shape caregiving practices and adaptation in real-world contexts where structural barriers are pervasive. Objective: To examine the experiences and support needs of rural family caregivers of individuals with chronic stroke, identifying culturally grounded caregiving behaviors, structural barriers to support, and technology-enabled strategies that can inform scalable, caregiver-centered interventions. Methods: Using a qualitative descriptive design, semi-structured interviews were conducted with 15 caregivers of rural-dwelling individuals with chronic stroke in Alabama. An integrative framework drawing on Leininger's Transcultural Nursing Theory, the Health Belief Model, and the Technology Acceptance Model guided data collection and interpretation. Data were analyzed using Braun and Clarke's six-phase thematic analysis. Results: Six interrelated themes emerged: cultural meaning of care and self-reliant caregiving; barriers to health services and limited formal support; informal learning and technology-based resources; family support and role adaptation; positive outlook on patient recovery; and emotional resilience through informal coping. Caregiving was framed as a moral and relational obligation rooted in cultural values, sustaining engagement despite emotional, physical, and financial strain. Caregivers reported barriers to formal support, including cost, insurance limitations, transportation challenges, and programs perceived as impractical. After brief in-hospital guidance, many relied on YouTube, social media, and telehealth to reinforce caregiving skills as needs evolved and professional support remained limited. Conclusion: Stroke caregiving in rural settings is shaped by cultural obligation, perceived necessity, and structural barriers. Caregivers function as extensions of the care team, highlighting the need for practical discharge training and accessible follow-up support. Culturally informed, family-centered, technology-enabled interventions that reduce cost and access burdens may improve caregiver well-being and strengthen stroke recovery outcomes.