Close Introduction to the Lubben Social Network Scale The importance of social ties in the lives of older people is becoming increasingly recognized as strong associations have consistently been found between social support networks with physical and mental health outcomes. Increased awareness of the importance of social support networks for older adults has spurned the need for assessment tools to help flag these people during a comprehensive assessment of the elderly client. This growing interest in social networks has lead to a vast amount of research in this area which has lead to some inconsistencies in definitions and thus measures of social networks. For example, this construct has been given various labels such as social bonds, social supports, social networks, social integration, social ties, meaningful social contacts, confidants, human companionships, reciprocity, guidance, emotional support, and organizational involvement. The development of the LSNS was done in order to provide both clinical and research communities with a scale that offers improved administrative and psychometric properties. Lubben, J.
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Search Menu Abstract Purpose: There is a need for valid and reliable short scales that can be used to assess social networks and social supports and to screen for social isolation in older persons. Design and Methods: The present study is a cross-national and cross-cultural evaluation of the performance of an abbreviated version of the Lubben Social Network Scale LSNS-6 , which was used to screen for social isolation among community-dwelling older adult populations in three European countries.
Based on the concept of lack of redundancy of social ties we defined clinical cut-points of the LSNS-6 for identifying persons deemed at risk for social isolation. Results: Among all three samples, the LSNS-6 and two subscales Family and Friends demonstrated high levels of internal consistency, stable factor structures, and high correlations with criterion variables.
Implications: We conclude that abbreviated scales such as the LSNS-6 should be considered for inclusion in practice protocols of gerontological practitioners. Screening older persons based on the LSNS-6 provides quantitative information on their family and friendship ties, and identifies persons at increased risk for social isolation who might benefit from in-depth assessment and targeted interventions.
For more than 25 years, the World Health Organization has recognized that the prevention of social isolation is necessary for good health WHO, , The magnitude of health risk associated with social isolation is now deemed to be comparable with that of cigarette smoking and other major biomedical and psychosocial risk factors House, One instrument that has been widely used to assess social integration and to screen for social isolation among community-dwelling populations is the Lubben Social Network Scale LSNS.
The original version of the LSNS is a item scale. It has been translated into many languages e. Although these studies have generally reported good psychometric traits for the LSNS, there has not been a cross-group comparison of the performance of this scale. Lubben and Gironda , a , b recently reported revisions to the original LSNS, including the development of an abbreviated version. In the present study we appraise the performance of this abbreviated version as a social health screener among three European community-dwelling populations.
The LSNS was developed specifically for use among older adult populations Lubben, and subsequently has been widely used in both research and clinical settings e. It has been associated with a wide array of health indicators. Lubben and Gironda a cited improved psychometrics and ease of administration as the primary reasons for revising the original LSNS.
They also recounted that various researchers had developed abbreviated but inconsistent versions of the original LSNS. They suggested that the LSNS-6 would be more appropriate than longer instruments as a screener for social isolation in practice settings. The items that deal with kinship include the following: How many relatives do you see or hear from at least once a month? How many relatives do you feel close to such that you could call on them for help?
How many relatives do you feel at ease with that you can talk about private matters? These three items are repeated with respect to nonkin ties by replacing the word relatives with the word friends. A copy of the LSNS-6 including response options is found in the appendix. The total scale score is an equally weighted sum of the six items, with scores ranging from 0 to Lubben suggested that this cut point would facilitate identifying an at-risk population that could then be further assessed and for whom interventions might be developed.
Such cut points necessarily involve trade-offs addressing the competing goals of sensitivity and specificity of screening instruments. More specifically, if the clinical cut point is set too low, then some individuals truly isolated would be missed. If the cut point is set too high, then too large of a group is deemed at risk and is subsequently targeted for more extensive assessment and consideration of possible interventions.
Furthermore, to facilitate ease of administration in practice settings, a cut point should be easy to score and to comprehend. We decided to focus on the concept of lack of redundancy in social ties as the key criterion for determining a cut point for identifying individuals at risk for social isolation.
The selected cut point can be illustrated by two extreme representative cases. The first case is an older person with the same number of people available for each of the components of the family and friendship network.
If this representative person had two family members available for each of the three family components of social network, and in addition two friends available for each of the three friendship components, then we would consider this person to meet the minimal criterion of having a redundant social network.
The second extreme representative case is a person with a total lack of either family or friendship ties that is compensated by an abundance of the other type. For example, one might consider the case of an older person lacking family support, but enmeshed in a relatively large friendship network. We assumed that this person might be able to partly compensate for the lack of family support if the person had an extensive friendship network, with at least five individuals available for each of the three components of the LSNS-6 questionnaire, resulting in an LSNS-6 score of 12 points.
Similarly, the older person with a large family network might partially compensate for the lack of a friendship network. Thus, using this alternate approach, we found that a cut point of 12 seemed to be a cut point that could be justified by theoretical and practical considerations.
In a next step, we validated this proposed cut point of the LSNS-6 by using the present cross-national samples. We used two criteria for validation. First, we determined the proportion of older adults reported to be at high risk of social isolation by using the a priori defined cut point.
Second, we used statistical methods for evaluating the convergent validity of the newly defined cut point. We determined the correlation based on the Pearson correlation coefficient between the presence of social isolation according to the new cut point, and two variables measuring social support i. Finally, we used statistical methods for determining whether using an alternate cut point would have given better results. We conducted sensitivity analyses, and we repeated the prevalence and convergent validation analyses by using an LSNS-6 cut point of 10 and of 14, instead of Such a score implies that, on average, there are fewer than two individuals for the six aspects of social networks assessed by the LSNS Similarly, we consider those with scores of less than 6 on the three-item LSNS-6 Family subscale to have marginal family ties and those with scores of less than 6 on the three-item LSNS-6 Friends subscale to have marginal friendship ties.
One of the items asks how often the respondent has someone to love. Another item asks how often someone shows love and affection to the respondent, and the third item asks how often the respondent has someone to share worries with. The response options for all three of these items are on a Likert scale ranging from never to always.
In the present analysis we use baseline data from both intervention and control groups in each of the sites of the PRO-AGE study. Study groups were drawn from community-dwelling patients, 65 years or older, enrolled with participating general practitioners. Exclusion criteria included the following: living in nursing home, being dependent in basic activities of daily living, having a terminal disease, being cognitively impaired, and not speaking the regional language.
Participants in the PRO-AGE trial completed a page self-administered questionnaire that constituted a multidimensional assessment of risk factors for functional status decline. Although the three study sites are all located in Europe, and the large majority of study participants were of Caucasian ethnicity, there are important differences between the three sites Table 1. In Hamburg, participants were recruited from both urban and suburban neighborhoods with a relatively large proportion of individuals with higher educational levels.
In Hamburg, the proportion of women was much higher compared with the two other study sites because many men of this generation had died during the Second World War. Solothurn is a mainly rural Canton county with approximately , inhabitants. In this population, there are both residents with lower and higher educational levels. Most live in small villages or towns, and many were born and have lived most of their lives in the Solothurn area.
In the London area, the study sample included populations living mainly in the outer urban areas, with a high proportion of individuals of lower educational and income categories. Although all three sites have a majority of residents belonging to a Christian church, the religious orientation differs between the three sites.
First, we calculated summary statistics including simple counting, percentages, mean values, standard deviations, and frequency distributions to describe the demographic and clinical characteristics of the sample.
Comparisons among the three sites are based on an analysis of variance for continuous variables and on a chi-square test for dichotomous variables.
We took into account that, for each of the comparisons listed in Table 1 , three statistical tests were used. A factor analysis identified principal components factors with varimax rotation. We retained those factors with an eigenvalue greater than 1, and we determined the factor structure by factor loadings having an absolute value greater than 0.
To test factor invariance across sites, we calculated a correlation of rotated factor loadings. To check whether the mean LSNS-6 total score and the two LSNS-6 subscales discriminate between stratified subgroups, we performed t tests for mean scores of participants living with a partner or living alone, participating or not in group activities, and having marginal emotional support or low, moderate, or high emotional support Table 4.
We analyzed correlations of socioeconomic, clinical, and social characteristics with the LSNS-6, and we analyzed the two LSNS-6 subscales by using Pearson product—moment correlation coefficients. We did this by using both continuous scale scores Table 5 and using suggested clinical cut points for the LSNS-6 and two subscales Table 6.
Results Table 1 reports sample characteristics for the three sites. Except for vision and emotional support, significant differences were noted among the samples. Approximately two thirds of the individuals in the Hamburg sample were female, whereas older women constituted slightly more than half of the sample in the other two sites.
Hamburg respondents were also less likely to be living with a partner. There were other major differences between the three sites. Because of a strong tradition of group activities in Switzerland, most of the participants from Solothurn reported participating in social groups, whereas this was less frequent in Hamburg and London.
The Hamburg individuals consistently reported worse health status than did the individuals at the other two sites. Compared with these individuals, Hamburg respondents reported a greater incidence of poor self-perceived health, IADL difficulties, mental health problems, and health care utilization. The Hamburg respondents were also more apt to report deficiencies in various aspects of their social support networks than their counterparts in Solothurn and London.
In sum, the three sites reflect important intergroup differences among a number of domains. A reliability score higher than 0. The subscales also demonstrated quite consistent Cronbach alpha scores across all three sites. The Family subscale ranged from 0. These Cronbach alpha values are all well within the acceptable parameters suggested by Streiner and Norman for health measurement scales. The three items dealing with family all load heavily on that factor, and the three nonkin items also load heavily on the nonkin factor.
There are no discernible cross-loadings. The eigenvalues suggest a very strong principle component. Correlations of rotated factor loading among the three sites gave us the opportunity to examine factor invariance. If the correlation of rotated factor loadings between two samples is greater than.
All rotated factor loading comparisons in the present study were. Item—Total Scale Correlations Item—total scale correlation analyses Table 3 reveal coefficients ranging from. The pattern of LSNS-6 item—total scale correlations across the three sites is quite similar.
The item-subscale correlations with total subscale scores range are necessarily higher, reflecting the greater homogeneity of the three items that constitute a given subscale when compared with the six items that constitute the LSNS Correlation coefficients of a specific subscale item to its given subscale total range from. These correlation coefficients values are well within the acceptable range suggested by Kline These data are consistent across all three sites and in the direction anticipated.
Those individuals living with a partner and those participating in group activities consistently reported higher average LSNS-6 scores, whereas those who reported lower emotional support also reported lower LSNS-6 scores.
School of Social Work
Introduction to the Lubben Social Network Scale