The Application Of The Modified Chinese Version Of Medical Outcomes Study Social Support Scale In Stroke Patients

BackgroudThere are a lot of researches about social support, self-efficacy and quality of life of stroke patients, so do the correlation researches between any two of them. The results showed that the quality of life of stroke patients in recovery phase had a degree of decline and it was significantly lower than that of healthy people. It was no doubt that a better social support could result in a better kind of emotional experience and a higher level of self-efficacy of stroke patients in recovery phase, which led to functional recovery faster and wider. While lack of social support might result in dependence, depression of stroke patients in recovery phase, which led to functional recovery more slow, even seriously affected the patient’s quality of life. The intervention of self-efficacy theory was applied in lots of research about stroke patients, the results showed that the self-efficacy level of stroke patients was improved, which not only could improve the psychological status of patients, but also could improve the executive function, the effect of rehabilitation training, the effect of limb function rehabilitation, the activity of daily living, thus to improve the patient’s quality of life.Correlation researches in stroke patients showed that:①Social support was clos-ely related to self-efficacy, a better social support led to a higher self-efficacy level;② The quality of life of stroke patients of social isolation significantly decreased;③ Self-efficacy was related to quality of life, they influenced and restrained each other:On the one hand, the low level of self-efficacy caused the low level of quality of life, and the improvement of self-efficacy caused the improvement of patients’rehabilitation effect and quality of life; On the other hand, the low level of quality of life also caused the low level of self-efficacy. At present, no studies explored the relationship among social support, self-efficacy and quality of life of stroke patients. Self-efficacy is a kind of cognitive mechanism, and it plays a key regulating role between social support and treatment adherence in patients with heart failure. Therefore, is it also plays a certain intermediary role between social support and quality of life of stroke patients. This is the problem of this study and the reacher will try to solve it.This study aims to apply the modified Chinese version of MOS social support scale, stroke rehabilitation self-efficacy scale and stroke impact scale to investigate the social support, self-efficacy and quality of life of stroke patients, then to explore if self-efficacy can regulate the relationship between social support and quality of life of stroke patients.Objectives①To translate the spiritual support subscale into Chinese and to form the modified Chinese version of Medical Outcomes Study social support scale, then test its reliability and validity.②To investigate the level of social support, self-efficacy and quality of life of stroke patients in recovery phase.③To analysis the influence factors of social support of stroke patients in recovery phase.④To explore the relationship among social supports self-efficacy and quality of life of stroke patients in recovery phase.⑤To explore the intervention measures to improve the level of social support of stroke patients in recovery phase.Methods1. SubjectsA descriptive cross-sectional observation study was used. Using the convenine-ce sampling method to extract patients according to the inclusion and exclusion crit-eria, one hundred and sixty-four stroke inpatients which received treatment in five different levels and different kinds of hospitals in Guangzhou City were separately and randomly chosen from November 2015 to the end of Junary 2016. They all read the written consent and agreed voluntarily to participate in the study.Inclusion criteria: ①With the diagnosis of stroke according to the fourth nation-nal cerebravascular diseases conference after brain CT or MRI comfirming; ②With conscious and with a stable condition; ③The ability of comprehend, respond, written and langusge communication; ④Agreement in this study.Exclusion criteria:①Patients with intellecture disability or cognitive disability or psychiatric disorder; ②Patients with a progressive deterioration;③Patients with serious status because of heart, lung, liver or kindey diseases; ④Patients with obvio-usly serious complications, such as the central nervous system disease or malignant tumor;⑤Other diseases or poor things which affect the quality of life of patients in nearly a year.2.Procedures①Contact the author of every scale to obtain the use right of scales.②Translate the spiritual support subscale. An English teacher and a nursing postgraduate student respectively translated the English spiritual support subscale into Chinese, then formed the second version of spiritual support subscale after modifica-tion; Without reading the first version of subscale, a nurse-in-charge with a nursing master degree and a nurse director respectively translated the second version of subscale into English and formed the third version of subscale. Two medical experts who were good at English and Chinese compaired the differences among the three versions of subscales and made the cultural adjustment and the language adjustment. According to their suggestion, the second version of subscale was modified and then formed the predicted Chinese version of spiritual support subscale.③Expert review of the Chinese predicted version of spiritual support subscale. Invite three nursing directors of neurology and two public health experts to review the Chinese predicted version of spiritual support subscale. Researchers had a interview with each of them to confirm the measurement concept and the content of items in order to know whether it could accurately reflect the level of spiritual support of patients. Use item content validity index (I-CVI) to evaluate the content validity of 3 items of the spiritual support subscale.④Informed consent. Contact some hospitals to determine the source of the subjects. The study should be approved by the Medical Ethics Committee of each hospital. All subjects agreed voluntarily to enter in the study and signed a informed consent with the researcher after understanding the related information. The informed consent detailed the name, the purposes, the research process, the risks, the benefits and the secrecy of the study. The subjects fully understanded the content of the informed consent then signed it with the researcher face to face. The subjects with reading or writing disability listened to the content of the informed consent which were read by the research and decided whether to participate in the study after self-understanding. The agreed ones signed the informed consent and pressed the thumb fingerprint. The subjects with writing disability can be instead of by their relatives to sign the informed consent.⑤Pre-survey study. After determining the source of subjects,20 subjects was extracted from the neurology department of Nanfang Hospital belonging to Southern Medical University using the convenience sampling method according to the inclusion and exclusion criteria. According to the pre-survey results, problems of the predicted Chinese version of spiritual support subscale, the stroke patients’general information queationnaire and the stroke patients’disease information queationnaire were found and modified in time. The results showed that the data collectioning is feasible.⑥The formal investigation. One hundred and sixty-four stroke patients from five different levels of hospitals in Guangzhou were included in this study. One hundred and sixty-two patients filled all items.⑦The internal consistency reliability test were made. Comparing the results of Social Support Rating Scale and that of the modified Chinese version of MOS-SSS in 162 stroke patients and made the criterion-related validity test.⑧To analysis stroke patients’social support situation and its influencing factors and to analyse the relationship between social support and self-efficacy, quality of life. The relationship among them was also explored.3.Instruments①The stroke patient’s general information questionnaire designed by the resear-cher will be used for measuring the patient’s social demographic data, including eighteen items, such as sex, date of birth, nationality, height, weight, living conditions, and so on.②The stroke patient’s disease information questionnaire designed by the researcher will be used for measuring the patient’s disease-related information, including seven items, such as the stroke position, complications, hospital days, and so on. The severity of stroke was assessed using the modified Rankin scale.③The stroke self-efficacy scale will be used for measuring the self-efficacy of stroke patients.④The modified Chinese version of Medical Outcomes Study social support scale which was modified by the researcher will be used for measuring the social support of stroke patients.⑤The stroke impact scale will be used for measuring the quality of life of stroke patients.⑥The social support rating scale will be used for measuring the social support of stroke patients and be used as the validity test standard of the modified Chinese version of MOS-SSS.4.Statistical MethodsUse SPSS 17.0 statistical software to analyse all data. The measurement data was expressed by x±s, while the count data and the hierarchical data were expressed by frequency and percentage (%). Use the internal consistency test to evaluate the reliability of the modified Chinese version of MOS-SSS; and use the Pearson relation analysis to analyse the relationship between modified Chinese version of MOS-SSS scores and social support rating scale scores to evaluate the validity of the former. Subjects were divided into better social support group and poor social support group according to the sixty percent of MOS-SSS scores. Logistic single factor regression analysis was used by using the social demographic data and the disease-related information data as independent variables and using the score group of the modified Chinese version of MOS-SSS of stroke patients as the dependent variable. Logistic multifactor regression analysis was used and it used influence factors of social support as the independent variables according to the results of single factor analysis and used the score group of the modified Chinese version of MOS-SSS of stroke patients as the dependent variable. Pearson correlation analysis was used between social support scores and self-efficacy scores of stroke patients, so do it between self-efficacy scores and quality of life scores, so do it between social support scores and quality of life scores. Multiple stepwise linear regressions were used to explore the relationship among the social support, self-efficacy and quality of life of stroke patients.Results1.The Cronbach’a coefficient of the modified Chinese version of MOS-SSS is 0.792. The score of the modified Chinese version of MOS-SSS has a moderate relationship with the score of social support rating scale(r=0.436,p=0.000). It indicates that the modified Chinese version of MOS-SSS has a good reliability and a certain validity.2.The average score of social support rating scale of stroke patients is 36.76±8.64, and the average score of the modified Chinese version of MOS-SSS is 65.06±12.87. The subscales from high score to low score in turn are informational and emotional support, tangible support, positive social interactional support, affectionate support, spiritual support.3.The result of Logistic single factor regression analysis reveals that no live alone, no other people cares, healthy partner, with a job, no community barrier-free facilities, medical expenses reimbursed, educational level, personal monthly income, family monthly income, BMI separately has a positive relationship with social support. The result of multifactor Logistic regression analysis reveals that no other people cares, no community barrier-free facilities, educational level, body mass index, personal monthly income, family monthly income have a positive relationship with social support.4.The actual average score of self-efficacy of stroke patients is 79.65±28.79, and the standard average score is 61.27±22.15,and it is in the medium level.5.The average score of quality of life of stroke patients is 56.85±27.67, and it is in the low level. The subscales from high score to low score in turn are communication, memory and thinking, ADL/IADL, hand function, emotion, strength, mobility ability and participation.6.Social support of stroke patiens has a separately weak positive relationship with self-efficacy (r=0.275, P<0.001) or quality of life (r=0.241, P<0.001) Self-efficay has a strong positive relationship with quality of life (r=0.863, P< 0.001)7.The results of multiple stepwise regression analysis show that the quality of life of stroke patients with better social support is improved (β=0.518,t=2.276, p=0.024), the self-efficacy of stroke patients with better social support is improved (β=0.512,t=2.106,β=0.037). Eliminating the influence of the covariate, the quality of life of stroke patients with better self-efficacy is improved (β=0.756, t=16.604, p=0.000), but the impact of social support on quality of life becomes no statistical significance (β=0.340)Conclusions1.The modified Chinese version of MOS-SSS can be used for evaluating the social support of stroke patients.2.The level of social support is low and the level of spiritual support is the lowest, followed by affectionate support, positive interactional support.3.The social support of stroke patients is improved when they live with family or take care by themselves or have a healthy partner or have a job or make medical expenses reimbursed. Economic income, admission times, BMI and educational level have a positive effect on the quality of life of stroke patients. Living in a community with no barrier-free facilities has a negative effect on the quality of life of stroke patients.4.The level of self-efficacy of stroke patients is in the medium level and it needs to be improved.5.The level of quality of life of stroke patients is in the low level and it needs to be improved. The results of subscales are different. The communication domain is in the high level. The memory and thinking domain, the ADL/IADL domain, the hand function domain, the emotion domain and the strength domain are all in the medium level. The participation domain is in the low level.6.There is a mutual influence and promotion relationship between each two of social support, self-efficacy and quality of life of stroke patients.7. We can try to improve the level of social support of stroke patients according to following measurements:helping patients broaden the social support network, informing stroke self-management projects to provide self-management education; establishing continous nursing management model.