Türkiye de İnmeli Kadınların Aileden Algıladıkları Sosyal Destek h

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1 e r l n i j ri O Ar þ t ý r m O i g in Socil Support from the Fmilies of Femle Stroke Survivors in Turkey Türkiye de İnmeli Kdınlrın Aileden Algıldıklrı Sosyl Destek h c r s Re l Ayşegül Koç Deprtment of Nursing, Bozok Unv. Helth College, Yozgt, Turkiye Özet Amç: Bu çlışm inmeli kdınlrın ileden lgıldıklrı sosyl desteğin incelenmesi mcıyl ypılmıştır. Gereç ve Yöntem: Veriler sosyo demogrfik özellikleri belirleyen bir nket formu ve Aileden Algılnn Sosyl Destek Ölçeği ile 36 inmeli kdındn toplnmıştır. Verilerin değerlendirilmesinde yüzdelik, bğımsız gruplrd t testi, one wy ANOVA kullnılmıştır. Bulgulr: Aileden lgılnn sosyl destek toplm punının düşük düzeyde olduğu bulunmuştur. İnme sonrsı süre uzdıkç ileden lgılnn sosyl destek düzeyinin düştüğü görülürken bu ilişki önemli bulunmdı. Medeni durum, lgılnn ile desteğini etkilemiştir. İnmeli kdınlrın eğitimi, mesleği, ko morbid hstlık vrlığı, bkım vericilerin cinsiyeti, bkım verenin ileden y d ile dışındn olmsı, bkım vericinin medeni durumu, eğitim durumu, çlışm durumu ile krşılştırıldığınd rdki frk isttistiksel olrk nlmlı bulunmmıştır. Trtışm: Bu çlışmy göre, inmeli kdınlrın sosyl destek lmlrının istenilen seviyede olmdığı görülmüştür. Bu doğrultud inme sonrsı birey ve ileye verilen fiziksel rehbilitsyon ilve olrk psikososyl rehbilitsyon progrmlrı d verilebilir. Anhtr Kelimeler Sosyl Destek; İnme; Aile; Kdın Abstrct Aim: This study ws conducted to determine the socil support from the fmilies perceived by women fter stroke. Mteril nd Method: The dt were collected from 36 women with stroke using the Perceived Socil Support Scle nd questionnire determining the socio-demogrphic chrcteristics. For the nlysis of dt, percentges, t-test for independent smples, nd one wy ANOVA were used. Results: Totl score of perceived socil support from fmily ws found to be low. As the time from stroke got longer, the level of perceived socil support from fmily decresed, while the difference ws not significnt. Mritl sttus hs lso ffected the perceived socil support from fmily. There were no sttisticlly significnt differences were found in terms of women s eduction, occuption, co-morbid illness, gender of the cregiver, whether the cregiver is from the fmily, cregiver s mritl sttus, eduction nd employment sttus. Discussion: In conclusion, it ws founded tht the benefit of the women fter stroke with regrd to socil support ws not t the desired level. In this respect, in ddition to the physicl rehbilittion fter stroke, psychosocil rehbilittion progrms for the individul nd the fmily cn be designed. Keywords Socil Support; Stroke; Fmily; Women DOI: /JCAM.1454 Received: Accepted: Printed: J Clin Anl Med 2014;5(6): Corresponding Author: Ayşegül Koç, Deprtment of Nursing, Bozok Unv. Helth College, Yozgt, Turkiye. T.: F.: E-Mil: [email protected] 480 Journl of Clinicl nd Anlyticl Medicine Journl of Clinicl nd Anlyticl Medicine 1

2 Introduction Being the leding chronic disese, stroke is n importnt cuse of morbidity nd mortlity ll over the world [1]. According to the dt from the developed countries, stroke, which is the most frequent neurologicl condition, is the third cuse of mortlity fter hert disese nd cncer, nd rnks first s cuse of morbidity. [2]. According to the World Helth Orgniztion, worldwide 15 million people suffer from stroke ech yer. Of these, 5 million die nd 5 million re permnently disbled [3]. Bsed on reports from seven countries (USA, Frnce, Germny, Itly, Spin, the United Kingdom nd Jpn) the incidence of stroke is 214 in 100,000 per yer nd this rte is incresing with 1.9% per yer due to the ging popultion. This mens tht, for exmple in the U.S., every 40 seconds one person hs stroke, nd pproximtely 2,200 people per dy suffer from stroke [4,5]. According to some studies conducted in Turkey, the incidence of stroke is 175 per 100,000 people. Clculted ccording to the country s overll popultion, nnully n verge of new cses of stroke re encountered. Stroke cn ffect people of ll ges, regrdless of gender. However, the mjority of stroke cses occur in people over the ge of 65 nd over the ge of 55, the rte of stroke doubles for both men nd women for every ten yers [6,9]. In cse of permnent disbilities, the individul nd the fmily re in need of gret support nd n intensive trining in selfcre [10]. The multi-fceted chnge in the functionl sttus of individul with stroke hs lso multi-fceted impct on the cregiver. The presence of disbled or chroniclly ill individul in the fmily, who need continuing cre, cn crete significnt problems in prticulr, depending on the person s role within the fmily [11]. Illness, disbility nd deth re universl experiences tht ech individul nd fmily cn experience. Anything tht ffects the fmily system s whole lso ffects the members individully. Serious illness of member of the fmily results in chnge in homeosttic blnce of the fmily. As in ll systems, the homeosttic blnce is ttempted to be mintined in the fmily system. To chieve this gol, fmilies develop their own unique nd different styles in communiction ptterns, role flexibility, nd boundries within frmework of the sub-system rules nd the fmily rules [12]. The cre, tretment, rehbilittion, trining, re-cquisition of profession nd the survivl of the individul with stroke in n independent wy re crucil for the fmily [13]. Therefore, both the individul nd fmily require n intensive support [14]. One third of these ptients re dependent on others in mintining the dily ctivities. The ptients qulity of life is ffected by the degree of dependence nd the other complictions cused by stroke [13]. Individuls with stroke experience economic nd socil problems s well s physicl nd mentl disbility. Socil support is very importnt for the individul, s the life becomes extremely difficult fter stroke. The life will hve ups nd downs, nd the individul will be dependent on vrious levels. Continuous distress nd chnging helth conditions cuse stress in individuls with stroke nd their environment. Therefore, socil support is not only importnt for the ptient but lso for the cregiver nd the fmilies. Socil support hs been reported to fll drmticlly in spouses of individuls with chronic stroke with decrese in the life stisfction [15]. Socil support mens tht the bsic needs, such s belonging, love, pprecition nd selfctuliztion, which tke plce in the individul s hierrchy of needs, re stisfied s result of interction with other individuls such s friends, fmily, nd professionl dvisors. Individuls with high levels of socil support hve been reported to hve no feeling of insecurity, which is one of the sources of stress, nd to experience less stress thn individuls who do not hve socil support in the sme environment [16,17]. In n integrted (holistic) pproch to helth, stroke ptients must be considered together with the reltives. The chnges in the life of stroke ptients cuse lso chnges in the life of cregivers. Although there re mny studies on the positive impct of the socil support on the individuls with stroke in the literture, studies in our country on this topic re extremely limited. It is crucil to identify the chnging eductionl needs of the ptients nd the cregivers from the fmily fter stroke, nd to provide the continuity of the cre. This study ws conducted to determine the perceived socil support of women with stroke. The im ws to define the shortcomings of the socil support perceived by the women with stroke nd their socil environment. Mteril nd Method This ws descriptive study,tht ws conducted to identify the perceived socil support of the women with ischemic stroke from their fmilies. The women dmitted to Yozgt Stte Hospitl Neurology Outptient Clinics with n ischemic stroke within the lst three months between November 2011 nd December 2011, who hd no severe disbility ccording to the Brthel index (65 points nd bove), with no prior history of stroke, with one-sided lesion, without speech disorder, not dignosed with psychitric disorders, nd who greed to prticipte were included in the study. Tools Scle of Perceived Socil Support from Fmily Perceived Socil Support Scle (PSS-F) from Fmily ws developed by Procidno nd Heller nd the Turkish trnsltion nd the vlidity study ws done by Eskin (1993) [18]. The scle consists of 20 items will be nswered by checking one of the options: yes, no nd do not know. For ech item the response showing the perceived socil support is scored s +1. Scores rnge from I do not know option is not rted. The items 3, 4, 16, nd 19 on the scle re expressed reversely. In these questions, the option no is rted with +1 point. The obtined high score indictes higher perceived socil support from fmily. The Cronbch s lph internl consistency coefficient is Brthel Index The Brthel index (BI) is the scle of ctivities of dily living. The BI is one of the most commonly used disbility scles for rehbilittion ptients. It evlutes the mobility nd self-cre ctivities. [19]. Dt Collection A totl of 36 literte women who were dmitted to Yozgt Stte Hospitl Neurology Outptient Clinics with n ischemic 2 Journl of Clinicl nd Anlyticl Medicine Journl of Clinicl nd Anlyticl Medicine 481

3 stroke, who greed to prticipte in the study were included in the study. A questionnire ws given to ll individuls. In the collection of dt, the questionnire form contining informtion bout the disese nd the socio-demogrphic chrcteristics of ptients, nd for the ssessment of the ptients perceived socil support (PSS-F) (Eskin, 1993) were used. In this study, the tests were pplied using fce to fce interviews by the resercher, nd the ppliction took n verge of minutes. Independent vribles of the study: Age, gender, mritl sttus, eduction level, economic sttus, employment sttus, durtion of illness. Dependent vribles of the study: The ptients men score obtined from the scle of perceived socil support from fmily. Evlution of the dt The dt ws nlyzed using the SPSS sttisticl pckge progrm. For the nlysis of dt, percentges, t-test to nlyze the differences between two independent groups nd the dependent vrible, nd one wy ANOVA were used. Ethicl Aspects To begin the study, n officil written permission ws obtined from the Helth Directorte of Yozgt. Ptients included in the study were informed bout the content nd purpose of the reserch. The prticiption ws done on voluntry bsis. No nmes were written on the dt collection forms. It ws stted tht the informtion collected ws only to be used for the reserch. Limittions of the Study Limittion of the study is the use of very smll number of ptients nd the rndom smpling method. Results The results obtined from the study investigting the role of perceived socil support from fmily mong women with stroke, re presented below. The men ge of women with stroke ws 54.5 ± 15.8 yers. As to the etiology of stroke, hypertension nd dibetes mellitus were the leding cuses, ech with rte of 23.8%. The men ge of ptients with dibetes mellitus ws 57.8 yers, wheres the men ge of ptients with hypertension ws Of ll the women with stroke included in the study, 78.6% hd expenses equl to their incomes. Of the included ptients, 63.6% were unemployed housewives, 18.2% were frmers, 36.4% hd just bsic level of litercy, nd 48.5% hd primry eduction for 5 yers. 21.2% were mrried, while 78.8% percent were single (divorced-widowed). Of ll the women with stroke, 73.4% were found to be in 0-6 months of post-stroke sub-cute phse. 54.6% of women hve reported tht they experience physicl nd psychologicl helth problems since the event. The men perceived socil support score ws 11.45±2.75 (Tble 1). The person responsible for the cre of women with stroke ws the ptient s dughter in 42.9%, dughter-in-lw in 10.7%, son in 7.1% nd the pid femle cregivers in 39.3% of the cses. 80% of women with stroke indicted tht two or more elderly individuls lived in the sme house. The verge durtion of time of cre spent by the cregivers ws 12.2 ± 1.12 months (N = 25). Tble 1. Distribution of men scores of the ptients perceived socil support from the fmilies Scle perceived socil support from the fmilies Possible upper nd lower vlues The men perceived socil support score ws 11.1 ± 7.2. PSS- F score decreses with incresing ge. The men perceived PSS-F score of mrried women (N=11) ws 10.4±2.7, wheres tht of the single (widow-divorced) women (N = 25) ws 11.4 ± 2.7; the difference ws not sttisticlly significnt (t=0.83, P >0.005) (Tble 2). Of ll the women with stroke included in the study, 78.6% hd expenses equl to their incomes. 57.9% stted tht they did not smoke, wheres 42.1% were ctive smokers. The men perceived socil support score of non-smokers (11.5 ±2.21) were lessr thn tht of the smokers (12.2±4.02with stroke (t=0.48, p>0.05). The lesion re ws unknown in 41.6%. The women with lesion on the left side ppered to hve higher scores on socil support. There is insignificnts difference in the men score Tble 2. The distribution of the Mens of Perceived Socil Support Scores Depending on the Identifible Chrcteristics of the Ptients with Stroke (n = 36) Identifible Chrcteristics n X ±SD Significnce Mritl sttus Mrried ±2.7 t=0.83 Widow-divorced ±2.7 Eduction Primry eduction (5 yers nd under) ±2.8 t=1.07 Higher eduction ±1.5 Occuption Housewife/unemployed ±2.6 F=1.226 Frmer ±3.1 Other (3 Self-employed, 3 employed for wges) ±1.4 Co-morbide disese Hypertension ±2.5 F=.245 Dibetes Mellitus ±1.0 Other(1 Asthm, 1 rheum, 1 chronic renl filure, 2 chronic crdic filure) Mrked upper nd lower vlues in this study ±3.2 The mens tken out of the vilble dt. 4 dt ws missing. X±SD ±2.75 of perceived socil support from fmily with regrd to the loction of the lesion (Tble 3). Of ll the cregivers of women with stroke, 69.4% were women. The men ge of the cregivers ws 44.5 ± 17.5 yers. There were no sttisticlly significnt differences in the scores of perceived socil support from fmily with respect to the demogrphic chrcteristics of the cregiver such s gender, mritl sttus, eduction level, employment sttus, nd whether the cregiver ws fmily member (p> 0.05, Tble 4). Discussion In this section of the findings of this study were compred with the literture nd discussed. In this study, the ptient s stte 482 Journl of Clinicl nd Anlyticl Medicine Journl of Clinicl nd Anlyticl Medicine 3

4 Tble 3. The Distribution of Men Perceived Socil Support Scores Depending of the Chrcteristics of the Disese (n = 36) Chrcteristics of the Disese n X ±SD Significnce Brin lesion re Right ±2.7 t=2.012 Left ±2.3 P=0.059 Durtion of Disese 0-6 months ±2.2 t= months nd longer ± ptient didn t know to which brin lesion re Tble 4. The Distribution of Mens of Perceived Socil Support Scores Depending on the Fetures of the Cregivers Fetures n X ±SD Significnce Gender Femle ±2.6 t=1.22 p>0.05 Mle ±2.9 Cregiver Fmily member ±2.4 t= 0.49 p>0.05 Non-fmily member, pid cregiver ±3.1 Mritl Sttus Mrried ±2.9 t=0.476 p>0.05 Single ±1.5 Eduction of the cregiver Primry eduction (5 yers nd under) ±2.3 t=0.836 p>0.05 High eduction ±1.9 Employment sttus Employed ±2.2 t=0.920 p>0.05 Unemployed ±2.8 of perceived socil support ws investigted together with the fctors independent from the disese, such s the ptient s ge, gender, the cregiver s ge nd the degree of kinship. Especilly in cute onset diseses, such s stroke, the sensory nd instrumentl chnges compress the sttus of the individul nd the fmily, into short process. The individul nd the fmily should chieve the crisis mngement skills s fst s possible. Effective problem solving, effective use of externl resources in flexible mnner nd defining the role distribution fter the illness my increse the gins. Otherwise, the ptient will be left lone with the dverse impcts of stroke, while the fmily members of individuls my experience burnout. The individuls with more socil support were found to experience psychologicl distress to lesser extent, nd to mintin their psychologicl nd physicl helth even in presence of highly stressful events [20]. As result of this study, the perceived socil support scores of women with stroke were found to be low. Smurwsk et l (1994) (trnslted by Dypoğlu nd Tn, 2009) hve reported tht the perceived socil support of the femle ptients ws lower thn tht of the men [21]. A study conducted with the spouses of individuls with stroke reveled tht the men perceived socil support scores of women were lower thn tht of the men [22]. The results obtined from this study re similr to the literture. The lower perceived socil support of women with stroke compred to men is probbly due to the women s perception of self-help in the socil role distribution, nd the continution of women s trditionl cre-giver functions fter the disese. In our country, in studies investigting the effect of socil support on chronic disese, the socil support scores of men were higher, which is similr to our results [23]. In study of ptients with cncer, socil support score ws found to be higher in mles thn femles. Atlı et l. hve found tht the overll socil support score in cncer ptients ws similr in both gender, however, the perceived socil support from fmily ws sttisticlly significntly higher in men [24]. In their study in ptients with COPD, Ars nd Tel [25] hve lso stted tht the perceived socil support in men ws more thn women. The men perceived socil support score of mrried women (n=11) ws 10.4±2.7, wheres tht of the single (widowdivorced) women (n = 25) ws 11.4 ± 2.7; the difference ws sttisticlly insignificnt (P <0.005). In study in cncer ptients, Svcı et l [26] hve found higher totl score of perceived socil support nd score of perceived socil support from fmily in mrried ptients, nd the difference ws sttisticlly significnt for the perceived socil support from fmily. In study in COPD ptients, the perceived fmily support ws higher in the mrried individuls, wheres friend support ws higher in the singles [25]. The higher level of socil support of mrried individuls is probbly due to the support of their wives nd children, long with the support received from the prents nd the siblings. However, in the literture, it is emphsized tht mrrige is not stnd-lone source of socil support, nd tht there is need for side resources nd hppy mrrige is n importnt fctor for socil support. Incomptible mrriges my even cuse illness [27]. The perceived socil support scores of women with stroke re hrdy ffected by their level of eduction. No sttisticlly significnt difference ws found between the perceived socil support scores of the subjects with n eduction of less or more thn 5 yers (p > 0.05). There re studies indicting tht low levels of eduction hve negtive effects on chronic diseses nd the behvior of helth improvement. Women with higher eduction level tke more responsibility for their own helth, nd their stress mngement, nutrition, nd self-ctuliztion scores re significntly higher [28,32]. This is probbly due to the fct tht they re better informed bout their disese thnks to their higher levels of eduction nd they use it to del with socil support resources. Individuls with better eduction lso hve better finncil sttus nd they hve bility to estblish network of socil reltions. In ddition, the concept of n individul s helth will chnge in positive wy in prllel with n increse in the level of eduction, which in turn cn contribute to the process of tretment nd rehbilittion. At the community level, trining progrms bout chronic diseses nd life fter the disese cn be plnned. In our study, of ll the women with stroke included in the study, 78.6% hd expenses equl to their incomes, nd this group hd perceived socil fmily support score of 11.4±2.6. Sttisticlly there ws no difference (p>0.05). Köçkr nd Uzun [33] hve found higher perceived socil support subscle scores in individuls with high income however, the difference ws not significnt. Dypoğlu nd Tn [21] hve stted tht, in stroke ptients, scores of perceived socil support from fmily incresed with the incresing level of income. In two other stud- 4 Journl of Clinicl nd Anlyticl Medicine Journl of Clinicl nd Anlyticl Medicine 483

5 ies in individuls with chronic diseses, it ws shown tht in individuls with low socio-economic sttus, the perceived socil support from fmily ws low [34,35]. Our results re consistent with results of the literture. Filure to provide mteril requirements is n importnt fctor in climing nd providing socil support. In fmilies, who cn only meet their bsic needs with their level of income, the perceived socil support is low probbly they cnnot fford their dditionl mintennce costs nd the requirements of socil life. Of ll the women with stroke, 57.9% were non-smokers nd 42.1% were ctive smokers. The socil support scores of nonsmokers were higher (12.3 ±.7) (p <0.005). Smoking itself is fctor tht increses the risk of stroke [36], nd it lso hs n impct on the socil environment of the individuls. Smokers were found to hve fewer bilities in problem solving nd socil skills [37,38]. The reson of higher socil support scores of non-smoking women re probbly due to their better use of communiction skills. In this reserch, 83.3% of the cregivers were women. Altın [39] hs concluded tht 86.0 % of cregivers of Alzheimer s ptients, nd 75.0% of the cregivers of depression ptients were women. In study conducted in Europe, more thn 50.0% of cregivers were found to be women [40]. Seventy-three percent of cregivers of ptients with chronic neurologicl disese hve been found to be women [41]. The results obtined from our study were similr to the literture. In literture, this sitution is explined by the culturl cceptnce tht function of cregiving is relted to household nd fmily, which is seen s nturl tsk for women [42,43]. In this study, 65.6% of the cregivers were one of the fmily members (dughter, son, dughter-inlw, or grndchild). It ws found tht 88.9% of the cregivers of Alzheimer s ptients were children [39]. It hs been observed tht the degree of closeness of the cregivers vries mong countries. Although vrious dt re vilble, the mjority of cregivers were found to be the children, with spouses on the second plce[44,45]. In studies conducted in different cultures [46], it ws determined tht the mjority of cregivers were spouses in Tiwn, nd their children in the United Sttes nd Chin. In nother study, the vst mjority of cregivers were spouses [47]. In this study, 60.6% of the ptients included, hd stroke for 6 months or longer t the time of dmission to the hospitl. The reson of this lte dmission in the chronic phse of the disese is probbly due to the frequency of complictions. Home cre nd rehbilittion fter stroke should be encourged. In the cute phse, i.e. in the first 6 months fter stroke, the fctors tht cn ffect the functionl sttus of ptient should be ssessed [14]. When the socio-demogrphic chrcteristics of cregivers were compred with the level of perceived socil support, there were no sttisticlly significnt differences in terms of ptient s eduction level, occuption, co morbid illness nd durtion of the disese; nd cregiver s gender, being fmily member, mritl sttus, eduction level, nd employment sttus. The support of the fmily members, which is especilly importnt for the chronic diseses, not only ensures the ptient s physicl nd emotionl functionlity, but lso encourges the ptient to dopt pproprite behviors to helth nd to fully comply with recommendtions of the physicin [48,49]. The impct of socil support cn be reduced by brriers either formed by the individul or from the outside. The estblishment of the obstcles ffecting the individul is very importnt to increse the impct of socil support [50,53]. Conclusion nd Recommendtions It ws found tht the perceived socil support from the fmily ws low. Ptients ge, gender, eduction level, mritl sttus ll ffected the perceived socil support from fmily. Occuption nd employment sttus of ptients, durtion of illness, nd the demogrphic chrcteristics of the cregiver hd no effect on perceived socil support from fmily. While the medicl tretment of the individuls is crried on fter stroke, the nurses prepre for dischrge. Post-stroke ptients nd their cregivers should be evluted periodiclly for psychologicl symptoms nd guidnce for the mintennce of their socil contcts should be provided. By this wy, the fmily cregivers will be included in the process of cre, nd form bridge between the community nd the hospitl, which in turn will led to sustinble socil support of individuls with stroke. The multidisciplinry stroke tem cre should tke the fctors tht influence fmily support into ccount, while estblishing the plns for the ptient s cre nd the tretment. Competing interests The uthors declre tht they hve no competing interests. References 1. Utku U. 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