Social support in people with chronic aphasia

TLDR: The relationship between social support and quality of life was examined, exploring which aspects of social support (social network versus perceived social support) were most associated with health-relatedquality of life (HRQL).

Abstract: Background & Aims : Stroke and aphasia can have a profound impact on people's social activities, and family and social relationships. This study looked at patterns of social support in people with chronic aphasia following stroke. It examined the relationship between social support and quality of life, exploring which aspects of social support (social network versus perceived social support) were most associated with health-related quality of life (HRQL). Methods & Procedures : A cross-sectional interview-based survey study was conducted. A cluster-sampling framework was used to recruit participants with chronic aphasia following stroke (> 1 year) from three different sites in the south-east of England. Measures included the Stroke and Aphasia Quality of Life Scale-39 item version (SAQOL-39), the MOS Social Support Survey (SSS), and a social network questionnaire. Descriptive statistics, correlation, t -tests, and ANOVAs were used as appropriate. Outcomes & Results : The results of those able to self-r...

Figures

Table 2: Correlations (Spearman’s rho) between perceived social support and social network (N=83)

Table 1: Respondents’ characteristics (N=83)

Figure 3: Frequency of contact with social network and HRQL (N=83)

Figure 2: Frequency of contact with children, friends and relatives

Figure 1: Individual components of network size

Table 3: Correlations (Spearman’s rho) between perceived social support and HRQL (N=83)

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City, University of London Institutional Repository
Citation: Hilari, K. and Northcott, S. (2006). Social support in people with chronic aphasia.
Aphasiology, 20(1), pp. 17-36. doi: 10.1080/02687030500279982
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Social Support in chronic aphasia
1
Social support in people with chronic aphasia
Katerina Hilari and Sarah Northcott
Department of Language and Communication Science, City University, London, UK
Acknowledgements
We are grateful to all the respondents and their families for participating in this study and to the Speech and
Language Therapists in the recruiting sites for their help. We would also like to thank Prof Jane Marshall for her
helpful comments in reviewing an earlier version of this paper. Thanks are also due to the funders of this
research: the Stroke Association and the Dunhill Medical Trust.

Social Support in chronic aphasia
2
Abstract
Background and aims: Stroke and aphasia can have a profound impact on people’s social activities, family and
social relationships. This study looked at patterns of social support in people with chronic aphasia following
stroke. It examined the relationship between social support and quality of life, exploring which aspects of social
support (social network versus perceived social support) were most associated with health-related quality of life
(HRQL).
Methods: A cross-sectional interview based survey study was conducted. A cluster sampling framework was
used to recruit participants with chronic aphasia following stroke (> 1 year) from three different sites in the
South-East of England. Measures included the Stroke and Aphasia Quality of Life Scale- 39 item version
(SAQOL-39), the MOS Social Support Survey (SSS) and a social network questionnaire. Descriptive statistics,
correlation, t-tests and ANOVAs were used as appropriate.
Results: The results of those able to self-report (83 out of 95 participants, 87%) are reported here. In terms of
social networks, the mode of the size of network was 4. Size of network was associated with HRQL for women
only. Most participants (71%) reported they had the same amount of contact with their children following the
stroke, while 64% reported they saw their friends less. Those who had the same level of contact with their
family as before the stroke had the highest HRQL scores; those who saw them either less or more than before
the stroke had lower HRQL. In terms of perceived social support, the SSS scores were positively skewed with
a mean (SD) of 3.69 (.95), suggesting that participants felt overall well supported. Two types of support were
significantly correlated with HRQL: social companionship and informational support.
Clinical implications: Therapy services for people with aphasia could consider ways to enhance social
companionship and informational support as this may positively impact on HRQL. Implications could include
complementing and supporting existing social networks, and facilitating access to information and social
participation.
(319 words)
Keywords: stroke, aphasia, social support, social networks, health-related quality of life.

Social Support in chronic aphasia
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INTRODUCTION
Social support: Structure and function
Social support and the links between individuals and the society they live in have long been of interest to
sociologists, anthropologists and psychologists. Potentially, the nature of someone’s social ties can contribute
to explaining behaviour. Over 100 years ago, Durkheim (1879, trans 1952) argued that even an apparently
‘individual’ act such as suicide could be explained sociologically. He found that suicide rates were lower in
societies where individuals were more embedded or integrated into the social groups around them. Thus the
individual is influenced by the quality and quantity of their social relationships. Following in this tradition,
numerous studies have since found that people with strong social relations have lower morbidity and mortality
(Berkman and Syme, 1979; House, Robbins & Metzner, 1982; Blazer, 1982; Broadhead, Kaplan, James,
Wagner, Schoenbach, Grimson et al., 1982; Orth-Gomer & Johnson, 1987; Olsen, 1993), better possibility of
recovery or survival after illness (Ruberman, Weinblatt, Goldberg & Chaudhary, 1984; Waxler-Morrisson,
Hislop, Mears & Kan, 1991; Glass & Maddox, 1992; Vogt, Mullooly, Ernst, Pope & Hollis, 1992) and better
psychological health, well-being and quality of life (Aneshensel & Frerichs, 1982; Billings & Moos, 1982; Turner,
1981).
Still, there is a lack of consensus in conceptualising social support. This paper examines social support in
terms of its structure and function, as described by Cohen and Wills (1985). Social network is seen as the
structural element. Bowling (1997, p. 90) describes social network as ‘the web of identified social relationships
that surround an individual and the characteristics of those linkages’. Thus each individual is seen as a node in
the network, with each exchange between network members constituting a link. Characteristics of a network
can include size of network, frequency of contact, geographic dispersion, density (how much network members
are in each other’s networks) and composition of members (for example, whether the members are friends,
neighbours, children, other relatives etc). Cohen and Wills (1985) suggest the role of a social network is to
provide a sense of social integration, a set of stable, socially rewarded roles, as well as stability and
predictability.

Social Support in chronic aphasia
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With functional social support, the emphasis is on a person’s subjective experience of support and the degree
to which interpersonal relationships serve particular needs. Sherbourne and Stewart (1991) distinguish five
categories of functional social support:
1. Emotional support: for example, feeling that there is someone to confide in who will be empathetic,
someone with whom to share private thoughts and fears.
2. Informational support: e.g., feeling there is someone whose advice you value, who can offer information,
guidance or feedback.
3. Tangible support: more practical support such as behavioural assistance or material aid.
4. Affectionate support: e.g., whether there is someone who will show you love and affection
5. Social companionship: the availability of other people to do fun things with you. This concept is also
referred to as positive social interaction, ‘belongingness’, and social integration.
This paper focuses on perceived functional support, rather than received support, as the latter may be
confounded with need. The fact that a person does not receive support during a given time period does not
necessarily mean that they are unsupported (Sherbourne & Stewart, 1991).
Social networks can be seen as the structure through which perceived social support is provided (Lin, Dean &
Ensel, 1981). However, social networks have a variety of functions of which the provision of social support is
but one (O’Reilly, 1988). Seeman and Berkman (1988) confirm that the two concepts are independent, finding
that the characteristics of someone’s network and social support are not so highly correlated as to make them
interchangeable.
The impact of stroke and aphasia on social support
Stroke is the most common cause of long-term disability in England and Wales (Department of Health, 1998).
More than 50% of people who survive a stroke are left with physical disabilities and at least 15% with aphasia
(Wade, 1994). A number of studies have noted that size of social networks reduces post stroke. For example,
Astrom, Adolfsson, Asplund and Astrom (1992a) describe a ‘disintegration’ in the social network over the first 3
months post stroke; Knapp and Hewison (1998) found that stroke survivors became isolated from their social
networks in the first 6 months post stroke. Astrom et al. (1992a) report a reduction in contacts with friends,

Frequently asked questions

Q1. What have the authors contributed in "Social support in people with chronic aphasia" ?

In this paper, the authors explored the social network and perceived social support of people with chronic aphasia and their relationship to health-related quality of life. 

Q2. What are the future works in "Social support in people with chronic aphasia" ?

Future research directions were explored, such as further research looking at how aphasia affects the processes of forming and maintaining social contacts, as well as evaluating intervention studies aimed at enhancing social support. 

Q3. What is the obvious interpretation of the study?

Perhaps the most obvious interpretation is that increased contact suggests increased need, and therefore increased dependence; loss of independence may be expected to correlate with lower HRQL. 

Q4. What is the significance of social networks for stroke survivors?

Cohen and Wills (1985) suggest that when not experiencing acute stress, social networks may be important for good quality of life. 

Q5. What subscales were significantly associated with the HRQL of people with aphas?

The two subscales that correlated significantly with size of network were social companionship (Spearman’s rho = .259, p<0.018) and informational support (Spearman’s rho = .302, p<0.006). 

Q6. What is the effect of citing a friend on the outcome of the study?

those who cited their spouse as their significant other experienced the greatest decrease in social activity, whereas if they cited a friend they had a much greater chance of maintaining some kind of outside social life. 

Q7. What was the assumption that people could not reliably respond to the questionnaires?

If people scored less than 7/15 on the receptive domains of the FAST it was assumed, based on their previous research (Hilari & Byng, 2001), that they could not reliably respond to the questionnaires that were used. 

Q8. How many people were unable to self-report on the questionnaires?

Of the ninety-five people who took part in the study, 12 had such severe language problems (FAST receptive score < 7/15) that they were unable to selfreport on the questionnaires that were used. 

Q9. What is the significance of social companionship?

That social companionship was associated with HRQL replicates the findings of research into other chronic illness: Symister and Friend (2003) found the social companionship subscale the most important for predicting decreases in depression and increases in optimism in end-stage renal disease patients. 

Q10. What was the effect of attending groups on the social network?

Since none of the participants had returned to full-time employment following stroke, attending groups may have taken on some of the social functions of the work place. 

Q11. What were the additional questions asked in order to gain insight into how the network is functioning?

Some additional questions were therefore asked in order to gain insight into changes in the use of network from before the stroke, focusing on changes in frequency of contact.