City Research Online

Abstract

Background:
The social consequences of having a stroke can be severe, with social isolation a reported problem. It is little explored, however, what factors predict who will feel well supported and retain a strong social network after a stroke, nor is it well understood why friendships and other social contacts are lost.

Aims:
This thesis explored: 1) how social support and social network change over time following a stroke, and whether this is different for those with aphasia; 2) what factors predict perceived social support and social network six months post stroke; 3) why people lose contact with friends, and whether there are any protective factors; 4) how the changing dynamics within the family unit are perceived by the stroke survivor.

Design and setting:
Repeated measures cohort study. Participants were recruited from two acute stroke units and assessed at two weeks (baseline), three months and six months post stroke. A subset of participants was selected for in-depth qualitative interviews 8 – 15 months post stroke.

Measures and methods:
Stroke Social Network Scale; MOS Social Support Survey; General Health Questionnaire; National Institute of Health Stroke Scale; Frenchay Aphasia Screening Test; Frenchay Activities Index; and the Barthel Index. Multiple regression, ANOVA, correlation and t-tests were used as appropriate.

Results:
87 participants were recruited of whom 71 were followed up at six months. At six months, 56% of participants were male, 16% had aphasia, and the average age was 69 years old. 29 participants took part in qualitative interviews. Perceived social support at six months was not significantly different from pre-morbid levels; social network, however, did significantly reduce (p = .001). Those with aphasia had comparable levels of perceived social support but significantly reduced social networks (p < .05) compared to those without aphasia.
Concurrent predictors of perceived social support at six months were: a person’s social network, their marital status, and their level of psychological distress (adjusted R2 = .37). There was only one baseline predictor of social support at six months: perceived social support prior to the stroke (adjusted R2 = .43). Concurrent predictors of social network at six months were: perceived social support, ethnic background, aphasia and extended activities of daily living (adjusted R2 = .42). There were two baseline predictors: pre-morbid social network and aphasia (adjusted R2 = .60).
There was a significant reduction in the Friends factor of the social network measure (p < .001). The main reasons for losing friends were: changing social desires especially a sense that many participants were ‘closing in’ on themselves; aphasia; loss of shared activities; reduced energy levels; physical disability; environmental barriers; and unhelpful responses of others. Family were generally robust members of the social network post stroke. The spouse was the main provider of all support functions. Nonetheless, beneath the apparent stability of the quantitative data there were changes in how family relationships functioned, including some distressing role shifts, for example, receiving rather than providing support.

Conclusion:
Contact with family and perceived social support remained stable post stroke. In contrast, a person’s social network, in particular contact with friends, was found to reduce, especially for those with aphasia. Indeed, aphasia was the only stroke-related factor at the time of the stroke that predicted social network six months later. Intervention aimed at addressing social isolation may be most effective if it takes into account the multiple reasons for friendship loss, including new language and physical disabilities, as well as changing social desires.

Publication Type:	Thesis (Doctoral)
Subjects:	R Medicine > R Medicine (General) R Medicine > RT Nursing
Departments:	Doctoral Theses School of Health & Psychological Sciences

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