INTRODUCTION:

“Most of the important things in the world have been accomplished by people who have kept on trying when there seemed to be no hope at all”.¹ (Dale Carnegie)

Stroke or cerebrovascular accident is defined as the sudden or acute focal neurological deficit, non- convulsive in nature that results from pathologic process involving cerebral blood vessels². The stroke is the leading cause of functional impairments.³

The burden of caring for stroke survivors usually rests with family members who have neither chosen nor volunteered for the role of caregivers.⁴ Stroke is defined as a clinical syndrome of rapidly developing clinical signs of focal (or a global in case of coma) disturbance of cerebral function, with symptoms lasting twenty four hours or longer or leading to death with no apparent cause other than of vascular origin.⁵ Stroke is one of the leading causes of mortality and morbidity worldwide.⁶

According to the Global Burden of disease Study, cerebrovascular accidents are the second leading cause of mortality worldwide, with 3 million of 4.4 million deaths arising in developing countries. In a study conducted in Australia, it has been reported that within 12 months of stroke, approximately 37% will die and 10% will experience a recurrent stroke⁷. Stroke is the third leading cause of death and more than 140,000 people die each year and it is the leading cause of serious, long-term disability in the United States. Each year, approximately 795,000 people suffer from stroke. Nearly one fourth of strokes occur in people under the age of 65.⁶ According to the National Stroke Association, stroke is one of the leading causes of permanent disability in adults. Of the long term stroke survivors, 15% required institutional care, 30% were independent in activities of daily living and 60% had decreased socialization outside home. Media campaigns have been launched to increase the public awareness about the stroke. So that to seek the care promptly.⁸ Study on impact of stroke on survivors as well as their family showed that stroke is a common disabling disease that often results in permanent physical, cognitive and emotional changes for the survivors.⁹ Hemiplegia is one of the most common and undesirable consequences of stroke. The disability in daily life is of longer duration for paralysis of the upper extremity than the lower extremity.¹⁰

A study on stroke, a reality check for young India showed that annual incidence of stroke, range from 100 - 150 per 100,000 people, it is higher in urban than in rural areas. In India 10 to 15 % of the strokes occur in people less than 40 years of age.¹¹ A report in Times of India states that by 2015, India will report 1 million cases of stroke annually, at least one-third of whom will be disabled and it causes 6.4 lakhs deaths in India, most of the people being less than 45 years old.¹²

The non-modifiable risk factors are family history, age, gender and race. Modifiable risk factors include hypertension, diabetes, abnormal lipids, cigarette smoking, heavy alcohol consumption, obesity and physical inactivity.¹³

Study on determinants of care giving burden and quality of life in caregivers of stroke patients found that advancing age and anxiety accounts for high dependency and poor family support in patients and caregivers. To reduce the adverse outcomes, caregivers training should be provided.¹⁴

A critical review on effect of group intervention programs on the quality of life of caregivers of stroke showed that 95% of caregivers experience changes in their life after stroke, as they cope with the patient’s physical, cognitive impairments, as well as emotional, behavioural and personality changes. Providing caregivers with support therefore may not only improve the caregiver’s quality of life but the patient’s quality of life as well.¹⁵

A randomized controlled trial on effectiveness of education support package for patients and caregivers showed that intervention group had improved self-efficacy for accessing stroke information and satisfaction with information.¹⁶ A study on impact and burden of care giving for long-term stroke survivors, showed adverse effect on caregivers are on emotional health, social activities, leisure time and family relationships. The community services need to focus on the neuropsychological aspects of stroke patients and the social functioning of caregivers who support them.¹⁷ A study on associations between social support and stroke survivors health related quality of life a systematic review showed a positive relation between perceived social support and stroke survivors health related quality of life. Relations between perceived social support and health related quality of life seems to be more often significant and were stronger than relationship between specific social support types or sources and health related quality of life.¹⁸ Studies on impact of social outcome on first stroke found that social support may be an important prognostic factor in recovery from stroke. Socially isolated patients may be at particular risk for poor outcome.¹⁹ Study on social support interventions, found that improvement of available social support could be an important strategy in reducing or preventing psychiatric distress and warding off post-stroke depression.²⁰ Reduction in the risk of stroke and increase in the speed of hospital presentation after the onset of stroke both depend on the level of knowledge of stroke in the general population.²¹

STATEMENT OF THE PROBLEM:

A study to assess the perceived social support of caregivers of patients with stroke, at selected Public Health Centers of Thiruvalla Taluk.

OBJECTIVES OF THE STUDY:

· To assess the perceived social support of caregivers of patients with stroke

· To find out the association between perceived social support of caregivers of patients with stroke and selected baseline variables.

· To prepare a social support package for caregivers of patients with stroke.

HYPOTHESIS:

H₁ -There is a significant association between perceived social support of caregivers of patients with stroke and selected baseline variables.

METHODOLOGY:

Quantitative approach was used for the study to assess the perceived social support levels of caregivers of patients with stroke, in selected Public Health Centres of Thiruvalla Taluk. Non-experimental-descriptive design was adopted to assess the perceived social support levels of caregivers of patients with stroke, in selected Public Health Centres of Thiruvalla Taluk. After obtaining the formal permission from the concerned authority, the investigator conducted the pilot study in Kaviyoor FHC, 03/02/20 and 07/02/20 with ten samples. The caregivers of patients with stroke who met the sampling criteria were selected by non-probability convenient sampling and informed consent was taken. Variables of Section- I was collected by questionnaire technique and section- II was collected by self-report. After conducting the pilot study few modifications and rearrangements were done in the tool for more clarification of the statements. In this study the sample consists of one hundred caregivers of patients with stroke who meet the inclusion criteria were selected.

RESULT AND DISCUSSION:

Section 1 Description of baseline variables:

Section I (a): Baseline variables of caregivers of patients with stroke.

This part deals with the baseline variables of caregivers of patients with stroke. It includes age, gender, education, employment, marital status and monthly income, and residence, type of family, religion and duration of care.

Figure-1 depicts that 37%, 26%, 22% and 15% of the care givers were between the age group of 40-49 years, 60-69 years, 50-59 years and 30-39 years respectively. It means that majority of caregivers (74%) were less than the age of 60.

Table 1: Frequency distribution and percentage of caregivers of patients with stroke based on gender, education, employment, marital status, monthly income, place of residence, type of family and religion.

Gender
Male		30	30
Female		70	70
Education
Illiterate		6	6
Primary school		20	20
High school		16	16
Higher Secondary School		37	37
Degree		21	21
Employment
Yes		68	68
No		32	32
Marital status
Married		80	80
Unmarried		20
Monthly income
<5000/-		25	25
5000- 10,000/-		25	25
10,000- 15000/-		30	30
<15000/-		20	20
Urban		44	44
Rural		56	56
Type of Family
Nuclear		44	44
Joint		53	53
Others		3	3
Religion
Hindu	36		36
Christian	48		48
Muslim	16		16

Table 1 reveals that 30% of caregivers were male and 70% were female. Among the caregivers 6% were illiterate, 20% completed their primary education, 16% completed high school, 37% higher secondary school and 21% completed degree. 68% of caregivers of stroke patients were employed and 32% were non-employed. With respect to the marital status 80% caregivers were married and 20% were unmarried. 50% of caregivers had monthly income below 10,000/-, 30% between 10,000-15,000/- and 20% above 15,000/ and 44% of caregivers were from urban and 56% were from rural. With respect to type of family 53% of caregivers were from joint family, 44% from nuclear family and 3% were from religious community. 48% of caregivers were Christians, 36% were Hindu’s and 16% were Muslim

Section: II

Perceived social support level (physical, emotional, financial and informational) of caregivers of patients with stroke.

This parts deal with the percentage of perceived social support of caregivers of patients with stroke. It also includes percentage of perceived social support on physical, emotional, financial and informational aspects.

Figure 2 reveals that 11% of caregivers had medium support, 75% low support and 14% were having very low social support. 75% caregivers had low physical support, 14% had medium support and 11% had high physical support. 15% caregivers had medium support, 73% had low support, 12% had very low support and nobody was having high emotional support.

Figure 3 shows that 14% caregivers had medium support, 36% had low support and 50% had very low support. No one having high informational support. 13% caregivers had medium informational support, 33% had low support and 53% had very low support and only 1% had high support.

Table 2: Association between perceived social, support of, caregivers, of patients with, stroke and selected baseline variables. (n =100)

			P value
Baseline variable	Calculated χ2	Df	0.951
Age	1.617	6	0.508
Gender	1.355	2	0.589
Education	6.523	8	0.577
Employment status	1.098	2	0.606
Marital status	1.000	2	0.745
Monthly income	0.5113	8	0.903
Residence	0.203	2	0.586
Type of family	2.836	4	0.230
Religion	5.617	4	0.476
Duration of care	5.545	6

Section III:

Association between perceived social support of caregivers of patient with stroke and selected baseline variables.

Section III a): Association between perceived social support of caregivers of patients with stroke and selected baseline variables of caregivers of patients with stroke.

This part deals with the association between perceived social support of caregivers of patients with stroke and selected baseline variables such as age, gender, education, employment, marital status, place of residence, type of family, religion, monthly income and duration of care

Table 2 shows that there is no significant association between perceived social support and selected baseline variables of caregivers of patients with stroke.

Section III b): Association between perceived social support and selected baseline variables of patients with stroke.

This part deals with the association between perceived social support of patients with stroke and selected baseline variables such as age, gender, education, employment, marital status, place of residence, type of family, religion, monthly income and duration of illness.

Table 3: Association between perceived social support of caregivers of patient with stroke and selected baseline variables (n =100)

Baseline variable	Calculated χ2	Df	P value
Age	14.857	8	0.62
Gender	0.303	2	0.859
Employment	0.657	2	0.720
Marital status	0.659	2	0.719
Duration of illness	5.545	6	0.476

Table 3 shows that there was no significant association between perceived social support and selected baseline variables.

CONCLUSION:

Findings of the study highlights the importance of establishing an adequate self-care system that provides emotional support, physical, financial and informational help for the caregivers. Majority of caregivers were having low support in all aspects, if knowledge regarding physical and informational support are provided, they can make modifications in caring of patients to some extent. To conclude, the caregivers were having low perceived social support in physical, emotional, financial and informational aspects.

REFERENCES:

1. Constant The rapys favorite motivational quotes- when being a survivor of stroke or brain injury or a caregivers, Feeling Over whelming. 2015 march [Internet]. Available from URL:http://constanttherapy.com/blog/constant-therapys-favorite- motivational-quotes-when-being-a-survivor-of-stroke-or-brain-injury-or-a- caregiver-feels-overwhelming/.

2. Bhavya SV, Vidya.M. Knowledge and Attitude of Care Givers regarding Home Care Management of Stroke Patients. Int. J. Nur. Edu. and Research. 2017; 5(3): 341-343.

3. Douglas Chumney, Kristen Nollinger, Kristina Shesko, Karen Skop, Madeleine Spencer, Roberta A. Newton,. Ability of Functional Independence Measure to accurately predict functional outcome of stroke-specific population: Systematic review.JRRD.2010November; 47(1):.Available from http://www.ncbi.nlm.nih.gov/pubmed/20437324.

4. Smith LN, Lawrence M k, Kerr S M, Langhorne P, Less K R. Informal carers experience of caring for stroke survivor’s AdvNurs [Internet] 2004 May;46(3):235-244. Available from http: www.ncbi. nlm. nih, gov / PubMed / 1536115.

5. Sue Woodward, Anne Marie Mestecky. Neuroscience Evidenced Based Practice. USA; Blackwell Publishing Limited: 2011.p.357-358.

6. Asha. S. Kumar, Thomas Iype, Remedevi S. Recovery from stroke, challenges and perceptions- A qualitative approach. Kerala Nursing Forum, 2013; 8 (4 ) : 5-8.

7. Prabhu C Jevoor, Preeti Bhupali P. Effectiveness of the Self Instructional Module (SIM) on Knowledge regarding Management of the Patients with Stroke among the Staff Nurses. Int. J. Nur. Edu. and Research 3(1): Jan.-March, 2015; Page 20-29.http: //www.strokecentre.org / patients / about- stroke / stroke- statistics.

8. Patricia Gona Mortan, Dorrie k Fontaine, Carolyn M Hudak, Barbara M Gallo.

9. Critical Care Nursing. 8th ed. Philadelphia: Lippincott Williams; 2005.p 624-625.

10. Koushal Dave, Nirmala Singh. Knowledge Among Stroke and High Risk Patients Regarding Risk Factors, Warning Signs and Immediate Treatment of Stroke. Int. J. Adv. Nur. Management. 2016; 4(4): 331-333.

11. Matchar D, Chow W.L, Quah S, Chan A, Menon E. The impact of stroke surviours as well as their family structure and their mental health caregiver. Health Services andSystem.2010July; Available fromURL:http://hssr.duke-nus.edu.sg/projects/study-impact-caregiving-stroke-survivors-family-structure-and- mental-health-caregiver.

12. Dr.PoonamKurugant. Stroke a reality check for young India. [ Cited2012, September 29 ]; Available from URL: http; // health. India. Com / disease conditions / stroke a reality check for young India.

13. KounteyaSinha, TNN. India will report 1.6 million strokes causes a year by 2015. [Cited 2010 march 21]; The Times of India. Available from http;// times of India. India times com/ India will report 1-6- million stroke cases a year by 2015/ articles show/ 5707274. cms.

14. Smeltzer SC, Bare BG, Hinkle JL, Cheever KH. Textbook of medical surgical nursing. 12th ed. Philadelphia: Lippincott williams&wilkins;2010.p- 1896-1910.

15. McCullagh E1, Brigstocke G, Donaldson N, Kalra L. Determinants of caregiving burden and quality of life in caregivers of stroke patients. Stroke [internet].2005October; 36(10):2181-6 Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/16151029.

16. Stephanie Yallin, Critical Review. What effect do group intervention programs have on quality of life of caregivers of survivors of stroke. [Internet]. Available from URL: https://www.uwo.ca/fhs/lwm/ebp/reviews/2009-10/Yallin.pdf.

17. Sally Eames, Tammy Hofforman, Linda Worrall, Stephen Read, Andrew Wrong. A randomized control trial of an education and support package for stroke patients and their careers. BMJ Open [Internet].2013 May; 3(5):. Available from URL: http://bmjopen.bmj.com/content/3/5/e002538.full.

18. Anderson CS, Linto J, Stewart Williams EG. Impact and burden of care giving for long-term stroke survivors. Stroke 995[Internet].1995 May; 26(5): 843-9. Available from URL: www.ncbi.nlm.nih. gov/pubmed/7740578.

19. Kruithof WJ, van Mierlo ML, Visser-Meily JM, van Heugten CM, Post MW. Associations between social support and stroke survivors' health-related quality of life--a systematic review. [Internet].2013 Nov [cited on 2013 July 17]; 93(2):169-76.AvailablefroURL:http://www.ncbi.nlm.nih.gov/pubmed/23870177.

20. Glass T.A, Matchar D.B, Belyea M, Feussner JR. Impact of social support on outcome in first stroke. [Internet]. 1993 [cited on 1992 October 5]; 24. Available from http:// www.stroke.ahajournals.org/content/24/1/64.abstract.

21. Friedland JF, McColl M. Social support intervention after stroke: results of a randomized trial. Arch Phys Med Rehabilitation. [Internet]. 1992June;73(6):573-81. Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/1622308.

Received on 24.06.2022 Modified on 29.08.2022

Int. J. of Advances in Nur. Management. 2023; 11(1):47-51.

DOI: 10.52711/2454-2652.2023.00010