Social participation mediates the relationship between self-efficacy and loneliness among people with stroke during COVID-19: a cross-sectional study

ABSTRACT

Background

People post-stroke experience increased loneliness, compared to their healthy peers and loneliness may have increased during COVID due to social distancing. How social distancing affected loneliness among people after stroke is unknown. Bandura’s self-efficacy theory suggests that self-efficacy may be a critical component affecting individuals’ emotions, behaviors, attitudes, and interpretation of everyday situations. Additionally, previous studies indicate that self-efficacy is associated with both loneliness and social participation. This study investigates relationships among self-efficacy, social participation, and loneliness in people with stroke.

Objectives

Determine how social participation affects the relationship between self-efficacy and loneliness in people with stroke during the COVID-19 pandemic.

Methods

44 participants were community-dwelling individuals, ≥ 6 months post-stroke who participated in a 2-hour phone interview. A regression-based mediation analysis was conducted using these measures: Participation Strategies Self-Efficacy Scale, Activity Card Sort for social participation, and UCLA Loneliness Scale for loneliness.

Results

The total effect of self-efficacy on loneliness was significant (b = -0.36, p = .01). However, social participation fully mediated the relationship between self-efficacy and loneliness (indirect effect, b = -0.11, 95% CI [−0.24, −0.01]; direct effect, b = -0.25, 95% CI [−0.03, 0]).

Conclusions

Self-efficacy is associated with both social participation and loneliness in people with stroke in this cross-sectional study. Mediation analysis findings suggest that interventions focused on increasing social participation may prevent or potentially alleviate loneliness in people with stroke who have low self-efficacy.

KEYWORDS:

• Stroke
• loneliness
• self-efficacy
• participation
• social activity

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Available upon request to authors at Washington University in St. Louis.

Additional information

Funding

Funding was provided by the Program in Occupational Therapy at Washington University School of Medicine.