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Korean J Adult Nurs : Korean Journal of Adult Nursing

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Original Research

The Influence of Self-care Agency and Social Support on Self-care Practice among Spinal Cord Injured Patients

Soyoung Choi, MSN, RN1, Il Sun Ko, RN, Ph.D.2
Korean Journal of Adult Nursing 2017;29(6):569-578.
Published online: December 18, 2017

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Corresponding author: Ko, Il Sun College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel: +82-2-2228-3255, Fax: +82-2-392-5440, E-mail: isko16@yuhs.ac
This manuscript is based on a part of the first author's master's thesis from the Yonsei University.
• Received: July 11, 2017   • Accepted: December 1, 2017

© 2017 Korean Society of Adult Nursing

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The purpose of this study was to identify how self-care agency and social support influence self-care prac-tices among spinal cord injured patients.
  • Methods
    106 spinal cord injured patients were recruited from April 12 to May 28, 2016. Structured questionnaires used were the Korean version of the Appraisal of the Self-Care Agency Scale Revised (ASAS-R), the Social Support Scale, and the Spinal Cord Injury Lifestyle Scale (SCILS). Data were analyzed using descriptive statistics, t-test, one-way ANOVA, Pearson correlations, and Stepwise multiple re-gression analysis with the SPSS/WIN 23.0 program.
  • Results
    Self-care practices had a significant association with self-care agency (β=.30, p=.002), social support (β=.24, p=.010), and monthly income (β=.18, p=.038). A total of 21.5% of the variance explained the self-care practice among spinal cord injured patients and was explained by self-care agency, social support, and monthly income. The self-care agency was the factor most influential on self-care practices among spinal cord injured patients explaining 15.4% of variance.
  • Conclusion
    The result sug-gests that developing strategies enhance spinal cord injured patients’ self-care agency and self-care practices.
  • Key Words: Spinal cord injuries; Self care; Social support
Table 1.
Difference of the Self-care Practice by Characteristics of Participants (N=106)
Variable Categories n (%) M± SD t or F (p)
Age (year) 20~29 9 (8.5) 54.00±6.48 0.36 (.780)
30~39 34 (32.1) 51.03±12.30  
40~49 35 (33.0) 53.34±11.03  
≥50 28 (26.4) 50.96±12.05  
Gender Male 83 (78.3) 52.28±12.51 0.40 (.688)
Female 23 (21.7) 51.13±10.44  
Education level ≤ Junior high school 12 (11.3) 52.33±13.41 0.46 (.636)
High school 43 (40.6) 50.70±13.13  
≥ College 51 (48.1) 53.08±10.86  
Spouse Yes 47 (44.3) 54.33±13.17 2.17 (.032)
No 59 (55.7) 49.80±10.68  
Religion Yes 58 (54.7) 52.84±11.30 2.17 (.052)
No 48 (45.3) 51.04±12.95  
Monthly household income (10,000 won/month)† ＜100 a 39 (36.8) 47.18±11.78 5.41 (.006)
100~＜300 b 41 (38.7) 54.85±9.85 b, c＞ a
300 c 26 (24.5) 54.85±13.64  
Duration of being injured (year) ＜10 33 (31.1) 52.79±14.55 0.17 (.844)
10~＜20 34 (32.1) 51.09±12.65  
≥20 39 (36.8) 52.21±9.10  
Regular health checkups Yes 56 (52.8) 54.55±11.47 2.33 (.022)
No 50 (47.2) 49.20±12.17  
Perceived health status Good 18 (17.0) 54.67±14.99 1.67 (.193)
Fair 52 (49.0) 53.10±8.80  
Bad 36 (34.0) 49.17±14.15  
Smoking Yes 33 (31.3) 51.52±12.17 -0.29 (.770)
No 73 (68.7) 52.26±12.08  
Drinking Yes 68 (64.2) 52.06±11.73 0.04 (.972)
No 38 (35.8) 51.97±12.79  
Level of injury‡ Cervical 38 (38.8) 53.53±12.41 1.42 (.246)
Thoracic 48 (49.0) 53.40±11.42  
Lumbar 12 (12.2) 47.33±11.10  

†Scheffé test;

‡Excluded no response.

Table 2.
Descriptive Statistics of Participants' Self-care Agency, Social Support and Self-care Practice (N=106)
Variables Items Min Max M± SD Average M± SD
Self-care agency 15 32 70 50.87±6.83 3.39±0.46
Social support 24 27 120 83.86±15.11 3.49±0.63
Family support 12 14 60 46.66±9.00 3.89±0.75
Medical staff support 12 14 60 37.20±9.91 3.10±0.83
Self-care practices 25 16 87 52.03±12.05 2.07±0.48
Cardiovascular 4 0 14 6.58±2.94 1.64±0.74
Genitourinary 4 2 15 8.38±2.73 2.09±0.68
Neuromusculoskeletal 8 2 32 14.77±5.28 1.85±0.66
Skin 7 1 27 16.40±4.93 2.34±0.70
Psychosocial 2 0 8 5.91±1.99 2.95±0.99
Table 3.
Self-care Practices Assessment Scores of Participants (N=106)
Categories Item M± SD
Cardiovascular I monitor my blood pressure regularly 2.03±1.67
I attempt to reduce my heart disease risk factors 1.57±1.27
I avoid smoking 1.56±1.33
I eat limited amounts of fat and cholesterol 1.42±1.20
Genitourinary I change my catheters as often as recommended 2.28±1.36
I use an intermittent catheterization and stick to the recommended schedule 2.18±1.59
I have episodes of bladder incontinence 2.05±1.57
I use suppository for my regular bowel movement 1.87±1.44
Neuromusculoskeletal If I notice the beginning of a contracture, I would know exactly what to do. 2.52±1.17
I pay attention to my body position while sitting in a wheelchair. 2.25±1.28
I exercise to put weights on my leg bones for increasing bone density about 3 times a week 2.06±1.39
I pay attention to my body position while sleeping 2.06±1.24
I perform range of motion daily for joint flexibility 1.73±1.31
Muscle strengthening exercises are monitored by a therapist at least once a year 1.37±1.13
I rest my shoulder joints when I feel pain from overusing 1.36±1.25
I perform muscle strengthening exercise at least 3 times a week 1.16±1.28
Skin I am knowledgeable of my wheelchair condition and time for repair 3.06±1.15
I am careful with handling of hot liquids by not carrying them in my lap 2.92±1.28
I am aware of the condition of wheelchair cushion 2.75±1.22
I am careful with transfers so that my legs, feet, or buttocks are not injured 2.62±1.55
I check my skin for redness or breakdown 2.33±1.27
I wear something on my feet when out of bed 2.08±1.57
I relieve pressure every 30 minutes while sitting in chair or driving 0.63±1.21
Psychosocial I am able to get around in my house 2.99±1.15
  I am with or talk to others at least once a day 2.92±1.16
Table 4.
Pearson Correlations among Self-care Agency, Social Support, and Self-care Practices (N=106)
Variables Self-care agency Social support -total Social support -family Social support -medical staff
r (p) r (p) r (p) r (p)
Social support-total .36 (＜.001)      
Social support-family .33 (.001) .78 (＜.001)    
Social support-medical staff .25 (.011) .82 (＜.001) .28 (.004)  
Self-care practices .40 (＜.001) .34 (＜.001) .31 (.001) .24 (.015)
Table 5.
Influencing Factors on Self-care Practices
Variables B SE β t R2 Δ R2 p
(Constant) 6.92 8.49   0.82     .420
Self-care agency 0.53 0.17 .30 3.23 .15 .15 .002
Social support 0.20 0.07 .24 2.62 .19 .04 .010
Monthly household income: 100~＜300(10,000 won/month) 4.53 2.15 .18 2.11 .22 .03 .040
  F=10.61, p＜.001
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    The Influence of Self-care Agency and Social Support on Self-care Practice among Spinal Cord Injured Patients
    Korean J Adult Nurs. 2017;29(6):569-578.   Published online December 31, 2017
    DOI: https://doi.org/10.7475/kjan.2017.29.6.569
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    The Influence of Self-care Agency and Social Support on Self-care Practice among Spinal Cord Injured Patients
    Korean J Adult Nurs. 2017;29(6):569-578.   Published online December 31, 2017
    DOI: https://doi.org/10.7475/kjan.2017.29.6.569
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    The Influence of Self-care Agency and Social Support on Self-care Practice among Spinal Cord Injured Patients
    The Influence of Self-care Agency and Social Support on Self-care Practice among Spinal Cord Injured Patients

    Difference of the Self-care Practice by Characteristics of Participants (N=106)

    Variable Categories n (%) M± SD t or F (p)
    Age (year) 20~29 9 (8.5) 54.00±6.48 0.36 (.780)
    30~39 34 (32.1) 51.03±12.30  
    40~49 35 (33.0) 53.34±11.03  
    ≥50 28 (26.4) 50.96±12.05  
    Gender Male 83 (78.3) 52.28±12.51 0.40 (.688)
    Female 23 (21.7) 51.13±10.44  
    Education level ≤ Junior high school 12 (11.3) 52.33±13.41 0.46 (.636)
    High school 43 (40.6) 50.70±13.13  
    ≥ College 51 (48.1) 53.08±10.86  
    Spouse Yes 47 (44.3) 54.33±13.17 2.17 (.032)
    No 59 (55.7) 49.80±10.68  
    Religion Yes 58 (54.7) 52.84±11.30 2.17 (.052)
    No 48 (45.3) 51.04±12.95  
    Monthly household income (10,000 won/month)† ＜100 a 39 (36.8) 47.18±11.78 5.41 (.006)
    100~＜300 b 41 (38.7) 54.85±9.85 b, c＞ a
    300 c 26 (24.5) 54.85±13.64  
    Duration of being injured (year) ＜10 33 (31.1) 52.79±14.55 0.17 (.844)
    10~＜20 34 (32.1) 51.09±12.65  
    ≥20 39 (36.8) 52.21±9.10  
    Regular health checkups Yes 56 (52.8) 54.55±11.47 2.33 (.022)
    No 50 (47.2) 49.20±12.17  
    Perceived health status Good 18 (17.0) 54.67±14.99 1.67 (.193)
    Fair 52 (49.0) 53.10±8.80  
    Bad 36 (34.0) 49.17±14.15  
    Smoking Yes 33 (31.3) 51.52±12.17 -0.29 (.770)
    No 73 (68.7) 52.26±12.08  
    Drinking Yes 68 (64.2) 52.06±11.73 0.04 (.972)
    No 38 (35.8) 51.97±12.79  
    Level of injury‡ Cervical 38 (38.8) 53.53±12.41 1.42 (.246)
    Thoracic 48 (49.0) 53.40±11.42  
    Lumbar 12 (12.2) 47.33±11.10  

    †Scheffé test;

    ‡Excluded no response.

    Descriptive Statistics of Participants' Self-care Agency, Social Support and Self-care Practice (N=106)

    Variables Items Min Max M± SD Average M± SD
    Self-care agency 15 32 70 50.87±6.83 3.39±0.46
    Social support 24 27 120 83.86±15.11 3.49±0.63
    Family support 12 14 60 46.66±9.00 3.89±0.75
    Medical staff support 12 14 60 37.20±9.91 3.10±0.83
    Self-care practices 25 16 87 52.03±12.05 2.07±0.48
    Cardiovascular 4 0 14 6.58±2.94 1.64±0.74
    Genitourinary 4 2 15 8.38±2.73 2.09±0.68
    Neuromusculoskeletal 8 2 32 14.77±5.28 1.85±0.66
    Skin 7 1 27 16.40±4.93 2.34±0.70
    Psychosocial 2 0 8 5.91±1.99 2.95±0.99

    Self-care Practices Assessment Scores of Participants (N=106)

    Categories Item M± SD
    Cardiovascular I monitor my blood pressure regularly 2.03±1.67
    I attempt to reduce my heart disease risk factors 1.57±1.27
    I avoid smoking 1.56±1.33
    I eat limited amounts of fat and cholesterol 1.42±1.20
    Genitourinary I change my catheters as often as recommended 2.28±1.36
    I use an intermittent catheterization and stick to the recommended schedule 2.18±1.59
    I have episodes of bladder incontinence 2.05±1.57
    I use suppository for my regular bowel movement 1.87±1.44
    Neuromusculoskeletal If I notice the beginning of a contracture, I would know exactly what to do. 2.52±1.17
    I pay attention to my body position while sitting in a wheelchair. 2.25±1.28
    I exercise to put weights on my leg bones for increasing bone density about 3 times a week 2.06±1.39
    I pay attention to my body position while sleeping 2.06±1.24
    I perform range of motion daily for joint flexibility 1.73±1.31
    Muscle strengthening exercises are monitored by a therapist at least once a year 1.37±1.13
    I rest my shoulder joints when I feel pain from overusing 1.36±1.25
    I perform muscle strengthening exercise at least 3 times a week 1.16±1.28
    Skin I am knowledgeable of my wheelchair condition and time for repair 3.06±1.15
    I am careful with handling of hot liquids by not carrying them in my lap 2.92±1.28
    I am aware of the condition of wheelchair cushion 2.75±1.22
    I am careful with transfers so that my legs, feet, or buttocks are not injured 2.62±1.55
    I check my skin for redness or breakdown 2.33±1.27
    I wear something on my feet when out of bed 2.08±1.57
    I relieve pressure every 30 minutes while sitting in chair or driving 0.63±1.21
    Psychosocial I am able to get around in my house 2.99±1.15
      I am with or talk to others at least once a day 2.92±1.16

    Pearson Correlations among Self-care Agency, Social Support, and Self-care Practices (N=106)

    Variables Self-care agency Social support -total Social support -family Social support -medical staff
    r (p) r (p) r (p) r (p)
    Social support-total .36 (＜.001)      
    Social support-family .33 (.001) .78 (＜.001)    
    Social support-medical staff .25 (.011) .82 (＜.001) .28 (.004)  
    Self-care practices .40 (＜.001) .34 (＜.001) .31 (.001) .24 (.015)

    Influencing Factors on Self-care Practices

    Variables B SE β t R2 Δ R2 p
    (Constant) 6.92 8.49   0.82     .420
    Self-care agency 0.53 0.17 .30 3.23 .15 .15 .002
    Social support 0.20 0.07 .24 2.62 .19 .04 .010
    Monthly household income: 100~＜300(10,000 won/month) 4.53 2.15 .18 2.11 .22 .03 .040
      F=10.61, p＜.001
    Table 1. Difference of the Self-care Practice by Characteristics of Participants (N=106)

    Scheffé test;

    Excluded no response.

    Table 2. Descriptive Statistics of Participants' Self-care Agency, Social Support and Self-care Practice (N=106)

    Table 3. Self-care Practices Assessment Scores of Participants (N=106)

    Table 4. Pearson Correlations among Self-care Agency, Social Support, and Self-care Practices (N=106)

    Table 5. Influencing Factors on Self-care Practices

    Table 1.

    Table 2.

    Table 3.

    Table 4.

    Table 5.

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