Multiple sclerosis (MS) is a chronic autoimmune central nervous system (CNS) disease that is associated with demyelination of axons in the brain and the spinal cord, leading to progressive neurological damage and a set of disabling symptoms (1–3). The results of previous studies show that 85% of individuals with MS have 15–50 years of age (4). Today, around 2.5 million people worldwide are affected by MS (5). In a study conducted by Etemadifar and Maghzi in 2010, the incidence of this disease in Isfahan, Iran, was reported to be 71.6 per 100,000 people. Therefore, Isfahan can be recognized as an area with a medium to high risk of MS (6). MS often leads to an early or overall reduction in physical, social, and cognitive functions of the individual, and affects the quality of life (QOL) of the patient and his/her family (7). One of the key factors affecting QOL is health status. Based on the definition provided by the World Health Organization (WHO), health has physical, psychological, social, and spiritual dimensions (8). Spiritual health is one of the fundamental concepts in chronic diseases and, as one of the health dimensions, causes its other dimensions to be integrated. In addition, by creating meaning and purpose in life, it is considered as an important approach to promoting general health and QOL (9). Some researchers have shown that spirituality has a meaningful relationship with a person's overall health, and that without spiritual health, the biological, psychological, and social dimensions cannot function correctly or reach their maximum capacity, and therefore, the highest level of QOL cannot be achieved (8). However, the results of the study of Allahbakhshian et al. in Isfahan showed that the spiritual health of MS patients is at a moderate level (9).
Social support is among the factors that seem to play an important role in maintaining individuals’ health and reducing the negative effects of many pressures from the environment and society (10). Social support is one of the most important forms of social relations, and its possession or lack of possession, perception of it, and the need for it can vary according to age, gender, personality, and even culture (11). Social support has been defined as an individual's understanding or experience of love, companionship, care, respect, attention, and assistance received by others, and mutual assistance and commitments of part of a social network (12). Social support, as an emotional coping method, can protect people by preventing stressful situations such as chronic diseases and help them to assess stressful events in such a way that it is less threatening (10). Using Durkheim’s hypothesis, researchers have tried to understand the relationship between social support and health. Their argument is that poor social unity has deprived individuals of social support and placed their health at risk, on the contrary, high levels of social support protects people from disease (13).
The existence of an accessible supportive system is essential and may include marital relationship and relationships with friends, family, colleagues, and professionals. An important issue on social support is the perception towards its adequacy and accessibility, and satisfaction with receiving it (10, 14). The perception and attitude of the patient towards the support received is more important than the amount of support received. Different sources believe that the perception of receiving social support can play an important role in the advanced stages of a chronic illness and protect the individual from disease-induced stresses and reduce the negative psychological outcomes caused by physical defects (15). Researchers have presented two theories on how perceived social support affects health; the buffer-stress and direct effects hypotheses. Based on the buffer-stress hypothesis, perceived social support affects individuals’ health by protecting them from the negative effects of severe stress. The direct effects hypothesis states that regardless of the amount of stress, perceived social support is beneficial for health, and individuals who enjoy a significant amount of social support have a higher sense of belonging and self-esteem. The positive attitude created by such a situation, regardless of the level of stress, may be beneficial for an individual, for example, by making him/her resistant to infection. Some evidence also suggests that high social support encourages people to choose a healthier lifestyle (16).
Although the issue of social support has been less discussed, it is one of the areas related to nursing that embraces a wide range of life aspects, plays a vital role in promoting adaptation to chronic diseases, including MS, and improves the healing outcomes. Nurses can act as a source of support for family caregivers in a variety of ways, such as facilitating economic supports for the families of patients, mobilizing the social support networks of the client, and establishing a relationship between the client and the relevant social resources. Nurses can provide informational support by providing clients with information about self-care or educating members of the client’s social network (17). Social support plays an important role in maintaining the health of individuals and contributes to reducing the negative effects of the high rate of stresses acquired from the environment and society. It also has a direct impact on QOL, and will reduce the individual's vulnerability to stress, depression, and different mental and physical illnesses (18). Studies show that the identification of perceived social support by patients can be effective in promoting their adaptive behaviors and provide appropriate community support (19). A review of studies showed that, in most studies, there was a significant relationship between perceived social support and mental and social well-being, meaning that perceived social support has a positive impact on mental, physical, and social health (19). Existence of social support in individuals, in addition to the reduction of blood pressure, neurotic headaches, gastrointestinal disorders, and etc., also enhances self-esteem and dignity in individuals (20).
In general, the above points show that social support and positive social relationships have positive effects on the physical, sociopsychological, and economic well-being of patients. They also reduce the severity of disease symptoms, improve the patient’s QOL, feeling toward life, and ability to cope with the disease, and create a better public evaluation of life. Moreover, perceived social support plays an important role in reducing the negative effects of the disease on the mental aspects of patients, is an important soothing factor for economic concerns, and is accompanied by less distress, a greater sense of control, improved self-esteem, decreased effects of negative events on life, and improved QOL (21). On the other hand, it was pointed out that the level of spiritual health is not high in patients with MS (9), and comprehensive attention to the health status of patients with MS is considered to be of the requirements of the health system of each country. Thus, in order to identify the factors related to spiritual well-being, considering the various effects of social support on various aspects of life, researchers tried to examine the relationship between these two concepts. A relationship that, if present, can be exploited to strengthen the spiritual well-being of patients with MS. Most nursing models emphasize on the holistic approach to care, and nurses are always urged to be committed to the concept of holistic care and, in addition to the physical, mental, emotional, and social needs of patients, to recognize their spiritual needs and support them. Thus, nurses can play a valuable role in this regard. Given the fact that MS affects the way the person lives, it causes many problems in all physical, mental, social, economic, and familial aspects, and causes patients to be dependent on others and less capable of supporting others. Moreover, they cannot participate in common social activities. All of these problems, along with long hospitalizations, frequent visits to the physician, and various treatments and their complications and high costs reduce the QOL of patients. Increased spiritual well-being in these patients can reduce their problems due to its positive effects. Therefore, the aim of this study was to investigate the relationship between spiritual well-being and perceived social support in patients with MS in Isfahan.