Social Isolation And Associated Factors In Patients With Chronic Heart Failure With Chronic Heart Failure

ObjectivesThe aim of the study was to explore the prevalence and associated factors of objective social isolation and subjective social isolation in patients with chronic heart failure based on Society Ecosystems Theory,in order to provide a basis for interventions to reduce social isolation and improve clinical outcomes in patients with chronic heart failure.Methods:Using a cross-sectional study design,303 patients with chronic heart failure were recruited from two tertiary hospitals in Jinan City from November 2019 to December 2020.The objective social isolation of patients with chronic heart failure was assessed by Lubben Social Network Scale,and the subjective social isolation was assessed by UCLA Loneliness Scale.The Self-designed general characteristics questionnaire,Symptom Status Questionnaire-Heart Failure,Activity of Daily Living Scale,Acceptance of Illness Scale,Community’s Self-Efficacy Scale,Family APGAR Index,Perceived Social Support Scale,Self-designed residence resource,activity participation and social media usage questionnaire and Subjective Socioeconomic Status Scale were used to evaluate associated factors of objective and subjective social isolation in patients with chronic heart failure.Statistical analyses included descriptive analysis,Student’s t-test,one-way analysis of variance,Pearson’s correlation analysis and multiple linear regression analysis.SPSS 24.0 was used to analyze the data.Results:1.The prevalence of social isolation in patients with chronic heart failureThe mean score for social network in patients with chronic heart failure was(18.86±5.68),two subscales’ scores for family network and friend network were(10.19 ±2.53)and(8.66 ± 4.24),respectively.Out of 303 patients,37(12.2%)patients had social isolation,11(3.6%)patients had family isolation and 73(24.1%)patients had friend isolation.The mean score for loneliness in patients with chronic heart failure was(31.77±9.59).Thirty-five(11.6%)patients were not alone,202(66.7%)were at a mild level of loneliness and 66(21.8%)patients were at a moderate level of loneliness.2.Relationships between general characteristics and social isolation in patients with chronic heart failureAge was negatively correlated with social network score(r=-0.179,P<0.01)in patients with chronic heart failure.Patients who were married,hospitalized for cardiovascular reasons ≤3 times,New York Heart Association(NYHA)class Ⅰ/Ⅱ,left ventricular ejection fraction(LVEF)≥50%,non-cardiovascular comorbidity<3,reported higher scores for social network than those who were single,hospitalized for cardiovascular reasons>3 times,NYHA class III/IV,LVEF<40%,non-cardiovascular comorbidity≥3(all P<0.05).Age was positively correlated with loneliness score(r=0.114,P<0.05)in patients with chronic heart failure.Patients who were married,NYHA class Ⅰ/Ⅱ,non-cardiovascular comorbidity<3,reported lower scores for loneliness than those who were single,NYHA class Ⅲ/Ⅳ,non-cardiovascular comorbidity≥3(all P<0.05).3.Relationships between micro factors and social isolation in patients with chronic heart failure(1)Physical symptoms:Patients who had daytime dyspnea,fatigue,edema,difficulty sleeping,≥4 symptoms reported lower social network scores than those who without above symptoms and<3 symptoms(all P<0.05).Patients who had fatigue,edema,difficulty sleeping,≥4 symptoms reported higher loneliness scores than those who without above symptoms and<3 symptoms(allP<0.05).(2)Activity of daily living(ADL):Patients with normal and mild impairment ADL reported higher social network scores than those with severe impairment ADL(all P<0.001).Patients with normal ADL reported lower loneliness scores than those with mild impairment ADL(P=0.001)and severe impairment ADL(P<0.001).(3)Acceptance of illness:The mean score for acceptance of illness was(27.52 ±6.91).Acceptance of illness was positively correlated with social network score(r=0.228,P<0.01),and negatively correlated with loneliness score(r--0.525,P<0.01).(4)Self-efficacy for preventing social isolation:Patients with low self-efficacy for preventing social isolation reported lower social network scores and higher loneliness scores than those with high self-efficacy for preventing social isolation(all P<0.001).4.Relationships between mezzo factors and social isolation in patients with chronic heart failure(1)Family function:Patients with poor family function reported lower social network scores and higher loneliness scores than those with good family function(all P<0.001).(2)Social support:Patients with low family support,friend support and other support reported lower social network scores and higher loneliness scores than those with high family support,friend support and other support(all P<0.001).5.Relationships between macro factors and social isolation in patients with chronic heart failure(1)Residence resource:Patients with poor residence resource reported lower social network scores(P=0.007)and higher loneliness scores(P=0.002)than those with good residence resource(2)Activity participation:Patients who did not participate in social activities reported lower social network scores(P=0.007)and higher loneliness scores(P=0.002)than those who participated in social activities(all P<.0.001).(3)Subjective socioeconomic status:The mean score for subjective socioeconomic status was(9.66± 3.09),which was positively correlated with social network scores(r=0.145,P<0.05),but not correlated with loneliness scores(r=-0.084,P>0.05).(4)Social media usage:Patients who did not use social media reported lower social network scores(P=0.007)and higher loneliness scores(P=0.002)than those who used social media(all P<0.05).6.Multiple linear regression analyses of social isolation in patients with chronic heart failureResults of multiple linear regression analyses showed that factors associated with objective social isolation(social network)were daytime dyspnea(β=-0.114,P=0.031),self-efficacy for preventing social isolation(β=0.313,P<0.001),friend support(β=0.320,P<0.001)and marital status(β=0.194,P<0.001).Four variables accounted for 44.8%of the variance in objective social isolation.Factors associated with subjective social isolation(loneliness)were acceptance of illness(β=-0.333,P<0.001),self-efficacy for preventing social isolation(β=-0.111,P=0.040),family function(β=-0.121,P=0.006),friend support(β=-0.273,P<0.001)and activity participation(β=-0.112,P=0.029).Five variables accounted for 48.4%of the variance in subjective social isolation.Conclusions:1.Objective social isolation is common in patients with chronic heart failure,and friend isolation is more common than family isolation.Most patients with chronic heart failure have subjective social isolation.Attention should be paid to social isolation in patients with chronic heart failure.2.The factors associated with objective social isolation in patients with chronic heart failure are daytime dyspnea,self-efficacy for preventing social isolation,friend support and marital status.Clinical and social workers could take interventions to reduce objective social isolation by reducing daytime dyspnea,improving self-efficacy for preventing social isolation,and increasing friend support.3.The factors associated with subjective social isolation in patients with chronic heart failure are acceptance of illness,self-efficacy for preventing social isolation,family function,friend support and activity participation.Clinical and social workers could take interventions to reduce subjective social isolation by improving acceptance of illness,increasing self-efficacy for preventing social isolation,improving family function and friend support,and encouraging patients to participate in social activities.