The relationship between social support and health related quality of life (HRQoL) in widowed older people: A mixed methods study

Background
Widowhood is a major life transition in later life that may significantly alter social relationships and health-related quality of life (HRQoL). Social support is widely recognised as a protective factor for health in older age; however, evidence regarding its relationship with HRQoL following spousal loss remains limited, with a lack of mixed-methods investigations. This thesis examined the relationship between social support and HRQoL among widowed older adults and explored the lived experiences underlying this association.
Method
The thesis comprises a systematic review followed by a sequential explanatory mixed-methods design informed by the review. The quantitative phase involved a cross-sectional survey of 188 widowed adults aged ≥50 years, using the Multidimensional Scale of Perceived Social Support (MSPSS) and the RAND 36-Item Health Survey (RAND-36) to measure perceived social support and health-related quality of life. Associations were examined through correlation, hierarchical, and moderated regression analyses. The qualitative phase included semi-structured interviews with a purposive subsample of 12 participants, analysed using thematic analysis, with findings integrated through triangulation.
Results
The systematic review identified a limited and heterogeneous evidence base with inconsistent findings. Triangulation revealed that perceived social support was differentially associated with physical and mental HRQoL. Friend-based support was positively associated with physical functioning, whereas support from significant others showed a negative association with physical but a positive association with mental HRQoL. Integration of findings was complementary for the social support–mental HRQoL association, convergent for physical HRQoL, and context-dependent divergent regarding the moderating role of social support.
Conclusion
Physical and mental HRQoL in widowhood appear shaped by partly distinct social processes. Peer and community-based support may provide an important pathway for maintaining HRQoL when family support is limited. Findings highlight the need for interventions expanding accessible peer-focused opportunities and for longitudinal research to clarify causal pathways and changes over time.