Hope and social support in adults who are legally blind at a training center.
Article Type: Report
Subject: Blind (Social aspects)
Blind (Care and treatment)
Social networks (Influence)
Authors: Singletary, Caitlin
Goodwyn, Mary Ann
Carter, Alice P.
Pub Date: 08/01/2009
Publication: Name: Journal of Visual Impairment & Blindness Publisher: American Foundation for the Blind Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2009 American Foundation for the Blind ISSN: 0145-482X
Issue: Date: August, 2009 Source Volume: 103 Source Issue: 8
Topic: Event Code: 290 Public affairs
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 207944192
Full Text: Researchers have confirmed a relationship between social support and good health, lower mortality rates, and faster recoveries (Cohen & Syme, 1985; Hale, Hannum, & Espelage, 2005; Hurdle, 2001). Other researchers have focused on social support and its relationship to mental health. The promising prognoses found for physical health when adequate social support exists led to the assumption that strong social support aids in the reduction of depression, somatization (physical symptoms that arise from depression, for example), and other mental disorders. Cohen and McKay (1984), for example, theorized that social support acts as a buffer to protect individuals from the harmful physical and mental effects of stressful life events.

Social support for individuals with a disability became another focus for researchers because chronic conditions have the potential to have both physical and mental components (Levine & Blackburn, 1946; Seybold, 2005). Li and Moore (1998) investigated the social variables that help an individual accept his or her disability. They found that perceived social discrimination contributed to negative outcomes and that subsequent social integration improved an individual's psychological well-being. They concluded that to achieve social integration, an individual with a disability needs a strong and supportive social network.

Kef (2002) studied the effect of the size and composition of social support networks among adolescents with visual impairments. She explained that although they have smaller social networks than do sighted adolescents, adolescents who are visually impaired receive the majority of their support from family members and friends and are satisfied with this support. In a previous study, Kef (1997) found that parents provided the most important emotional support for all adolescents and that support from friends was more important to girls than to boys. She found little difference between the reported levels of social support perceived by adolescents who were blind, had low vision, or had moderate visual impairments.

Beach and Robinet (1995) and Tuttle (1984) studied self-esteem and adjustment in adults who were blind. Both sets of researchers found that higher self-esteem was related to higher levels of independence. The mission of training and rehabilitation centers for people who are blind includes instilling independence and competence in "blindness skills" in the people they serve. For this reason, the authors hypothesized that having received such training or the length of time spent at training centers would be associated with levels of self-esteem and hope of individuals with visual impairments.

One critical step in developing self-esteem, self-identity, and stable health is for an individual with a disability or chronic illness to achieve or regain hope. Miller (2000) discussed the hopelessness that afflicts many individuals with disabilities and identified critical factors, such as setting goals, having optimism, and finding meaning in life, that are required to reestablish a sense of hope.

Because initial and unexamined reactions to life-changing events or permanent disabilities are often negative, sometimes even debilitating, factors that help create positive change in the affected individuals' lives need to be examined. In the study presented here, we examined the relationship between levels of hope and social support in a sample of legally blind individuals who were actively engaged in blindness rehabilitation training. Social support from family members, friends, and a significant other were measured to examine the relationships among length of time spent at a training center, quality of social support networks, and levels of hope.

We hypothesized that hope and perceived overall social support would be positively correlated. In addition, we hypothesized that participants who had previously attended a training facility or school for persons who are blind would report higher levels of hope than would those who had not, and that levels of hope would be positively correlated with the length of time the individuals had been blind. The study was approved by the internal review board of Louisiana Tech University.

METHOD

Participants

The participants were recruited from the Louisiana Center for the Blind (LCB) in Ruston, a facility for training legally blind adults in the skills that are necessary for independent and productive living. Of the 28 students who were enrolled at LCB at the time of the study, 24 participated in the study (for a response rate of 82.76%). All the participants met the statutory definition of legal blindness, with visual acuities ranging from no light perception to 20/200 or a visual field restriction of less than or equal to 20 degrees. The majority of participants were male (70.8%) and Caucasian (83.3%). The participants ranged in age from 18 to 54 years, with almost half (45.8%) aged 18-20.

Measures

The Multidimensional Scale of Perceived Social Support (MSPSS; Zimet, Dahlem, Zimet, & Farley, 1988) was developed to assess an individual's perception of social support in his or her life. The scale includes 12 questions divided equally among 3 sources of perceived social support: family members, friends, and a significant other. Examples of questions from each social support domain include these: "My family is willing to help me make decisions," "I can count on my friends when things go wrong," and "There is a special person with whom I can share my joys and sorrows." A 7-point Likert scale provides the MSPSS response format, with 1 representing very strongly disagree and 7 representing very strongly agree. Zimet et al. determined that the scale has adequate internal consistency (r = .88) and "strong construct validity." A factor analysis of MSPSS we conducted revealed that the 3 support domains were clearly differentiated from one another.

The Miller Hope Scale (MHS; Miller & Powers, 1988) was developed to assess the critical elements of hope in individuals with chronic illnesses. The scale contains a mix of 40 positive and negative statements, including: "I look forward to an enjoyable future" and "I feel trapped, pinned down." A 6-point Likert scale provides the MHS response format, with 1 representing strongly disagree and 5 representing strongly agree. The MHS scale was normed or standardized using a "healthy" adult sample; scores ranged from 105 to 198 (M = 164.46, SD = 16.31). Miller and Powers reported high construct validity (r = .82) for the scale and high internal consistency (r = .93) of items.

Procedure

An informed-consent form was read to each participant with a witness present, after which questions were answered. After the researcher, the first author, emphasized that the participants could withdraw from the study at any time, each willing participant signed the consent form. To standardize the data-collection method for all the participants, the survey was read to each participant during a 20-minute interview. The survey began with demographic questions, followed by administration of MSPSS and then MHS. Additional questions were asked at the end of the survey regarding the participants' blindness, previous training experiences, and length of time already spent at the LCB.

RESULTS

Hope

The 40 questions and 6-point Likert response format of MHS provide a possible range of 40-240 for an individual's score. In the LCB sample, the scores ranged from 152 to 235, M = 188.71, SD = 22.68 (see Table 1).

Social support

The 12 questions and 7-point Likert response format of the MSPSS provide a possible range of 12-84 for an individual's score. In the LCB sample, the scores ranged from 36 to 84, M = 64.58, SD = 11.40. The three MSPSS domains (social support from friends, family members, and a significant other) each have a possible range of scores from 4 to 28. In the current sample, the participants' endorsement of social support from friends ranged from 12 to 28 (M = 23.13, SD = 3.90); from family members, the range was 8-28 (M = 18.79, SD = 5.70); and from a significant other, the range was 12-28 (M = 22.67, SD = 4.66) (see Table 1).

Tests of hypotheses

As hypothesized, a significant positive correlation was found between the hope and overall social support scores, r = .60, p = .00. Hope scores were also significantly positively correlated with scores from each of the three social support domains: hope with support from friends, r = .49, p = .01; hope with support from family members, r = .51, p = .01; and hope with support from a significant other, r = .42, p = .04.

Nonsignificant relationships were found between levels of hope and time since the loss of vision, amount of time spent at LCB, and whether or not the participants had received previous blindness rehabilitation training. Descriptive findings suggested the hypothesized differences (for example, MHS means of 198 and 184 for participants with and without previous training), but independent samples' t-test analyses did not substantiate the predictions.

DISCUSSION

The purpose of our research was to examine the relationships between legally blind individuals' social support networks and the levels of hope the individuals reported while at a training facility for people who are blind. The positive relationships that were found between hope and perceived social support in all measured domains (friends, family members, and a significant other) confirmed that high levels of hope were tied to strong social support networks in this sample. Further experimental replication with larger samples at similar training facilities and at facilities with different training models is needed to validate the universality of these findings.

The prediction that the longer someone is blind, the more he or she will be able to gain a solid sense of self and feet hopeful about his or her future was not confirmed in this small sample. More opportunities to encounter successful, self-reliant, and self-confidant role models exist over an extended period, and we believe that future research with larger samples could productively focus on the numerous factors that support the building of hope over time.

Kef (2002) found that perceived social support from family members is beneficial for a positive attitude and stable mental and physical health among people who are visually impaired. Our findings are inconsistent with hers in that the highest endorsements of social support in this sample were for friends and a significant other, and although substantial, social support endorsements were the lowest for family members. Future research is needed to determine if this is a widespread phenomenon and whether it changes with age or with feelings of competence and independence obtained during training.

All the participants in the study scored within the top half of the available range of MHS. We are eager to explore this finding further. Is hope elevated in individuals by specific training methods or identifiable philosophies within the LCB training facility or perhaps within training facilities in general? Or do already hopeful individuals choose to attend a training facility to learn the skills that will enhance their future opportunities? Research conducted with individuals who are blind or have low vision who have never attended blindness rehabilitation training facilities and those in training facilities that use different training methods may provide further information with regard to these questions. A quasi-longitudinal design is envisioned, with multiple measures taken of participants before they enter a training facility, during their training experience, and again upon the completion of training.

One possible explanation for the high levels of hope in the current sample is that this was the first training experience for 66.7% of the persons who were enrolled at LCB during the time the study was conducted. We suggest the possibility that a training environment encourages high hope in a way that some or many of these persons may not have encountered before. In addition, 70% of the participants had been legally blind for more than 15 years. The long-term blindness of these individuals may have bolstered their self-acceptance and adjustment to blindness, as suggested by Kef (1997).

Limitations of the study

The small sample size limits the generalizability of findings in this study, and non-significant subgroup differences may likely be due to the resultant lack of statistical power. For example, the differences in age, length of time since vision loss, and length of time at the LCB further subdivided the already small sample. Multiple training centers would have to be accessed to provide a sufficient sample size to adequately explore these and other individual factors related to levels of hope and social support.

References

Beach, J. D., & Robinet, J. M. (1995). Selfesteem and independent living skills of adults with visual impairments. Journal of Visual Impairment & Blindness, 89, 531-541.

Cohen, S., & McKay, G. (1984). Social support, stress and the buffering hypothesis: A theoretical analysis. In A. Baum, J. E. Stinger, & S. E. Taylor (Eds.), Handbook of psychology and health (Vol. 4, pp. 253267). Hillsdale, NJ: Lawrence Erlbaum.

Cohen, S., & Syme, S. L. (1985). Issues in the study and application of social support. In S. Cohen, & S. L. Syme (Eds.), Social support and health (pp. 3-22). Orlando, FL: Academic.

Hale, C. J., Hannum, J. W., & Espelage, D. L. (2005). Social support and physical health: The importance of belonging. Journal of American College Health, 53, 276-284.

Hurdle, D. E. (2001). Social support: A critical factor in women's health and health promotion. Health and Social Support, 26, 72-79.

Kef, S. (1997). The personal networks and social supports of blind and visually impaired adolescents. Journal of Visual Impairment & Blindness, 91, 236-245.

Kef, S. (2002). Psychosocial adjustment and the meaning of social support for visually impaired adolescents. Journal of Visual Impairment & Blindness, 96, 22-37.

Levine, J., & Blackburn, A. R. (1946). Rehabilitation of the newly blinded. Journal of Clinical Psychology, 2, 140-145.

Li, L., & Moore, D. (1998). Acceptance of disability and its correlates. Journal of Social Psychology, 138, 13-25.

Miller, J. F. (2000). Inspiring hope. In J. F. Miller (Ed.), Coping with chronic illness: Overcoming powerlessness (3rd ed., pp. 523-546). Philadelphia: F. A. Davis.

Miller, J. F., & Powers, M. J. (1988). Development of an instrument to measure hope. Nursing Research, 37(1), 6-9.

Seybold, D. (2005). The psychosocial impact of acquired vision loss--Particularly related to rehabilitation involving orientation and mobility. International Congress Series, 1282, 298-301.

Tuttle, D. W. (1984). Self-esteem and adjusting with blindness. Springfield, IL: Charles C Thomas.

Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 52(1), 30-41.

Caitlin Singletary, B.A., doctoral student, Department of Psychology and Behavioral Sciences, Louisiana Tech University, P.O. Box 10048, Ruston, LA 71272; e-mail: . Mary Ann Goodwyn, Ph.D., associate professor, Department of Psychology and Behavioral Sciences, Louisiana Tech University; e-mail: . Alice P. Carter, Ph.D., assistant professor, Department of Psychology and Behavioral Sciences, Louisiana Tech University; e-mail: .
Table 1
Scores on the Miller Hope Scale and the Multidimensional Scale of
Perceived Social Support.

                      Possible range     Sample range

Scale                Minimum  Maximum  Minimum  Maximum     M      SD

Hope                   40       240      152      235    188.71   22.68
Social support         12        84       36       84     64.58   11.40
  Friends               4        28       12       28     23.13    3.90
  Family                4        28        8       28     18.79    5.70
  Significant other     4        28       12       28     22.67    4.66
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