The relationship between health-related quality of life, perceived social support, and social network size in African Americans with aphasia: a cross-sectional study

Exploring the association between social determinants and aphasia impairment: A retrospective data integration approach

INTRODUCTION

Traditionally, the study of aphasia focused on brain trauma, clinical biomarkers, and cognitive processes, rarely considering the social determinants of health. This study evaluates the relationship between aphasia impairment and demographic, socioeconomic, and contextual determinants among people with aphasia (PWA).

METHODS

PWA indexed within AphasiaBank-a database populated by multiple clinical aphasiology centers with standardized protocols characterizing language, neuropsychological functioning, and demographic information-were matched with respondents in the Medical Expenditure Panel Survey based on response year, age, sex, race, ethnicity, time post stroke, and mental health status. Generalized log-linear regression models with bootstrapped standard errors evaluated the association between scores on the Western Aphasia Battery-Revised Aphasia Quotient (WAB-R AQ) and demographic, economic, and contextual characteristics accounting for clustering of respondents and the stratification of data collection. Region, age, and income specific models tested the sensitivity of results.

RESULTS

PWA over age 60 had 2.4% (SE = 0.020) lower WAB-R AQ scores compared with younger PWA. Compared to White PWA, Black and Hispanic PWA had 4.7% (SE = 0.03) and 0.81% (SE = 0.06) lower WAB-R AQ scores, respectively, as did those and living in the Southern US (-2.2%, SE = 0.03) even after controlling for age, family size, and aphasia type. Those living in larger families (β = 0.005, SE = 0.008), with income over $30,000 (β = 0.017, SE = 0.022), and a college degree (β = 0.030, SE = 0.035) had higher WAB-R AQ relative to their counterparts. Region-specific models showed that racial differences were only significant in the South and Midwest, while ethnic differences are only significant in the West. Sex differences only appeared in age-specific models. Racial and ethnic differences were not significant in the high-income group regression.

CONCLUSION

These findings support evidence that circumstances in which individuals live, work, and age are significantly associated with their health outcomes including aphasia impairment.

Mediating Effects of Rehabilitation Motivation between Social Support and Health-Related Quality of Life among Patients with Stroke

Post-stroke health-related quality of life (HRQoL) is poor, which is related to low social support levels and lack of rehabilitation motivation. However, there are limited studies that have systematically analyzed the mechanisms underlying this relationship in stroke patients. This study aimed to identify the mediating effects of rehabilitation motivation on the relationship between social support and HRQoL among stroke patients. A cross-sectional descriptive study was conducted on 176 Koreans aged ≥19 years who were admitted for rehabilitation treatment after stroke at three general hospitals in Jeonbuk. Data collection was conducted from September to December 2020 through face-to-face interviews using structured questionnaires and review of medical records. The significance of the mediation model was tested using SPSS 25.0 and the PROCESS macro for SPSS v3.5. Significant associations were identified between social support and HRQoL. Our findings revealed an indirect effect, suggesting that the effects of social support on HRQoL are mediated by rehabilitation motivation (B = 0.004, 95% bias-corrected bootstrap confidence interval = 0.002, 0.006). Social support for stroke patients had a positive effect on HRQoL, and rehabilitation motivation was found to have a partial mediating effect on this relationship. This study suggests that social support from healthcare professionals and families for post-stroke can improve patients' HRQoL by inducing positive rehabilitation motivation. Therefore, developing intervention strategies to motivate rehabilitation could improve the HRQoL of patients with stroke.