We conducted a cross-sectional stigma survey of in-patients with stroke from demographic and social alienation. This study explored the effect of social alienation on stigma among in-patients with stroke and identified possible predictors. The most important finding was that stigma was associated with age and level of education. The level of stigma was moderate among in-patients with stroke. Significant correlations were found between stigma and social alienation. In-patients with sequelae of stroke who reported greater social alienation had a greater level of stigma.
In this study, we found that the majority of in-patients with stroke had a moderate level of stigma, which was similar to the results of Fred Stephen Sarfo et al.[19], which explored the stigma of consecutive stroke survivors in West Africa. The average score of stigma among these 198 patients was 47.36 ± 4.28. The results of this study showed that the score of self-perception was the highest. In clinical health education, we should focus on introducing related knowledge of stroke so that in-patients have a correct cognition of their condition, which may reduce their level of stigma[20]. In addition, the discrimination experience score in this study was found to be the lowest, aligning with the findings of Minfang Zhu et al.[18]. This observation may be related to the infrequent discrimination among doctors, nurses, and patients in hospital settings. Further research is needed to explore the varying experiences of discrimination among stroke patients in diverse settings. Notably, we found that the stigma level in different demographics differed. Younger patients had elevated levels of stigma[21], potentially attributable to their perception of experiencing stroke at an early age. Moreover, those who possess a graduate diploma are more likely to encounter social disapproval, which may be attributed to the impaired self-esteem experienced by patients who have transitioned from a previously convenient lifestyle to a more challenging one[22].
This study found that social alienation was associated with stigma among in-patients with stroke, which could be explained by Pearson correlation analysis of stigma and social alienation. Due to the impact of the novel coronavirus, the hospital had allowed one to two caregivers to take care of the patients to prevent infections among patients[23], which formed a great contrast between the hospital and the family atmosphere and reduced the social interaction of in-patients. In addition, patients had to endure the effects of stroke sequelae in this situation, which also increased the stigma of in-patients with stroke[24].
The results of multiple linear regression analysis showed that age, level of education, and social alienation had effects on the stigma of in-patients with stroke. Scholars had reported the influence of age on stigma, and the results of this study were consistent with the study of Li Chen et al.[9], indicating that age was related to the stigma of in-patients with stroke. Medical professionals should pay attention to the emotions of young stroke in-patients and give them timely psychological guidance, which can reduce their stigma. However, in terms of the level of education, the results of this study were contrary to those of Zixiu Zheng et al.[21]. Remarkably, the study conducted by Zixiu Zheng et al. found that stroke in-patients with a graduate diploma had the highest stigma scores, which aligns with the findings of our research. It is recommended to conduct a comprehensive study involving many centers and a large sample size to investigate further the influence of education level on stigma in stroke patients. Currently, there is a lack of studies regarding the effect of social alienation on the stigma experienced by in-patients with stroke. The results of this study showed that social alienation was positively correlated with the level of stigma, which was same as Wenjuan Yan et al.[25]'s. Patients suddenly change from normal life to sequelae of stroke, hospitalization and sequelae of stroke limit their daily activities and then make them reluctant to participate in social activities, which leads to social alienation[26]. In addition, less social interaction among in-patients during therapy was more likely to increase the occurrence of stigma[27].
Our study has certain limitations. First, we chose a rehabilitation center in Beijing exclusively for our study, resulting in a limited sample representation. Furthermore, the study was conducted using a cross-sectional design, limiting its ability to capture the dynamic trend in stigma and social alienation experienced by the particular population under investigation. Future recommendations include doing longitudinal research to establish causal inference.