Social support and participation restrictions in patients living with stroke in the Western Cape, South Africa
Cerebro-vascular accidents or stroke remain a leading cause of death worldwide accounting for 5.5 million deaths, leaving individuals disabled in many aspects of functioning. The International Classification of Functioning, Disability and Health (ICF) is a framework that assesses disability in relation to impairments, activity limitations, participation restrictions and environmental factors and many individuals post stroke have reported restrictions in these areas. Literature has proven that participation restrictions post stroke are very common, which means that individuals are not able to return to their normal functioning as before. Once these individuals are discharged into the community, supportive networks become an essential aspect aiding participation. There is some literature present which shows positive relations between social support and participation, however this is minimal. The aim of this study was to determine participation restrictions and social support in patients with stroke, living in the Western Cape. To further understand the relationship between social support and participation restriction post stroke, a systematic review was conducted. The databases searched were Ebscohost full text, which included CINAHL +, Health Source: Nursing, Academic edition, Medline, Psych articles and Soc index, Science Direct, Biomed Central, Google Scholar, Cochrane Library, Pedro Central, and Wiley Online between the years 2001 - 2013. Once the methodology of the review was completed, a total of three articles were the only articles that met the study‟s inclusion criteria and were included in the review. These articles highlighted the importance of the quality and quantity of social support on participation. The review presented level 4 and 6 evidence, based on the hierarchical evidence model which showed a positive relationship between social support and participation. Thus, social support is found to be an important factor aiding participation. The methodology of the survey included a target population of all individuals attending the Community Health Centres in the Southern Western and Klipfontein Mitchell‟s Plain Metro District Health Service who were sampled by convenience. This study was cross-sectional in design, using descriptive surveys. All individuals diagnosed with a stroke and living in the community for at least six months were included in this study. The World Health Organisation Disability Assessment Schedule 2.0. (WHODAS 2.0.) was used to determine the participation restrictions in the participants, while the Social Support Questionnaire 6 (SSQ6) was used to determine the individual’s social support. Completed questionnaires wereanalysed using the Statistical Package for the Social Sciences (SPSS) version 23 where descriptive statistics were used to define continuous and categorical variables. The Pearsons correlation test was used to determine the association between social support and participation, with significance set at 0.05. Confidentiality was maintained throughout the study and participants were required to provide verbal and written informed consent. All questionnaires and consent forms were available in English, Afrikaans and isiXhosa to accommodate all participants. Participants were assured that their participation in the study was completely voluntary and that their agreement, refusal or withdrawal would not impact their treatment at the Community Health Centre. A total of 106 participants met the inclusion criteria for this study and agreed to partake. An equal number of males and females participated, with a mean age of 61.5 years. The results showed that 89.9% of participants in the study were classified as having low levels of social support, with family support playing an important role in the social support of participants (P=0.000). The majority of participants (30.2%) indicated that their children, and families, were the people providing the most support to participants. Caregiver strain and burnout was highlighted as an aspect of importance. The majority of participants (51.8%) were severely affected in the domain of participation, reporting common problems joining in community activities (28.3%), emotional status (18.9%) and financial status (45.3%) which affected participation adversely. Extreme difficulty with concerns of barriers in the community (19.8%), and time spent on health condition (8.5%), with regard to participation were reported. It has been highlighted that many participants had not returned to work post stroke, a factor to consider when planning interventions in the clinical setting. When comparing the respective domains of the WHODAS 2.0., mobility, household activities and participation was discovered to be amongst the highest scoring domains. Pearsons correlation test between social support and participation produced a non-significant result (P = 0.146). This study outlines that although an insignificant result was obtained, the participants (10.1%) who scored the highest for social support had only been moderately affected in the domain of participation. A limitation of this study include design, and it is thus recommended that additional studies be conducted in the form of controlled trials to determine the effects of social support on participation restrictions post stroke.