Social Networks & Social Support

HBSS 5110 Determinants of Health BehaviorTeachers College, Columbia University

Professor Ray MarksFebruary 22, 2012

Presented by Darrin Pearson, Ketsia Sadler, Patricia Iovine, & Sherisse M. Butler

Introduction

The Foundation of Interpersonal Theory

What are Social Networks and Social Support?

Video: Families Dealing with Childhood Cancer

Key Definitions and Terminology

◦Social Network- is a theoretical construct useful in the social science to study relationships between individuals.

◦Social Support- feeling that one is cared for by and has assistance available from other people and that one is part of a supportive social network.

The Beginnings of Social Networks and Social Support

J.A. Barnes , 1952-1953, catalyst work in western Norwegian presented the first concept of social network that describes social relations patterns.

In J.A. Barnes' day, a "community" referred to a specific geographic location and studies of community ties had to do with who talked, associated, traded, and attended church with whom.

John Cassel, explained that social support is the key psychosocial protective factor that reduce “individual” vulnerability to the effects of stress on health.

Video: Care Circles Helping Singles With Sickness

Processes of Social Relationships

◦Social networks and social support is the starting point or initiator of a causal flow toward health outcomes.

◦Social networks and social support can enhance an individual’s ability to access new contacts and information and to identify and solve problems.

◦Social Network: person-centered web of social relationships

Social Networks Characteristics

◦Reciprocity ◦Intensity◦Complexity◦Density◦Homogeneity ◦Geographic dispersion◦Formality◦Directionality

Social Networks Types

◦Social Support◦Emotional Support◦Instrumental Support◦Informational Support◦Appraisal Support

Social Networks Function

◦Social Capital◦Social Influence◦Social Undermining◦Companionship◦Social Support

Video: Prostate Cancer Support Group

Background of the Theory I

◦ J.A. Barnes: 1954-pioneering work in a Norwegian village first presented the concept of a social network to describe patterns of social relationships no easily explained by traditional social units such as extended families or work groups early work on social networks: exploratory and descriptive

close-knit networks: exchange more affective and instrumental support, exert more social influence on members to conform to network norms

homogeneous networks, networks with more reciprocal linkages and networks with closer geographical proximity were also more effective in providing affective and instrumental support

Background of the Theory II

◦ John Cassel: 1976-epidemiologist who did numerous animal and human studies; social support served as a key psychosocial “protective” factor that reduced individuals vulnerability to the deleterious effects of stress on health; psychosocial factors such as social support were

likely to play a nonspecific role in the etiology of disease; social support may influence incidence and prevalence of wide array of health outcomes

social network and social support are concepts that describe the structure, processes and functions of social relationships

Relationship of Social Networks and Social Support to Health

◦ Empirical Evidence Individual studies are usually open to alternative

interpretations, patterns of results across full range of studies strongly suggests that social relationships, social networks and social support have important causal effects on health, exposure to stress, and the relationship between stress and health (House 1987)

Intimate ties and the emotional support provided by them increase survival rates among people with severe cardiovascular disease (Berkman and Glass, 2000)

Social support mobilized to help a person cope with a stressor reduces the negative effects of the stressor on health (Cohen and Wills, 1985; Thoits, 1995)

Relationship of Social Networks and Social Support to Health II

◦Buffering Effect social support and social networks have direct and

buffering effects and the predominance of one over the other depends on the target population, the situation being studies, and the ways in which the social relationship concept is measured (Cohen & Wills, 1985; House, et al 1988, Krause, 1995; Thoits, 1995)

effect of social relationships on health is not specific to any one disease process; positive role for affective support in the processes of coping with and recovering from serious illness has been consistently documented (Spiegel and Diamond, 2001; Wang et al, 2005)

Relationship of Social Networks and Social Support to Health III

◦ Having at least one strong intimate relationship is an important predictor of good health (Michael et al, 1999)

◦ Social network’s reciprocity and intensity were consistently linked to positive mental health (Israel, 1982; House et al 1988)

◦ Networks characterized by few ties, high intensity relationships, high density, and close geographical proximity maintained social identity and the exchange of affective support

◦ During time of transition and change, networks that are larger, more diffuse, and composed of less intense ties may be more adaptive (Granovetser, 1983)

Relationship of Social Networks and Social Support to Health IV

◦Size and density of social networks that endorse risk-taking norms are associated with higher levels of risk-taking behaviors (Berkman and Glass, 2000)

◦Demographically defined subgroups maintain qualitatively different social networks and experience health benefits from those networks, (House et al, 1988)

◦Gender differences in the link between social support and physical health (Shumaker and Hill, 1991) Weaker health-protective effect for women than men;

women 50+ experienced positive association between high levels of social support and mortality

Women maintain more strong ties, more likely to be both providers and recipients of social support, more responsive to life events of others than men

[Exercise] Coat of Arms

[Video] Personal Health Plan Depends on Social Network

Translating Theory Into Practice

◦Epidemiological studies have clearly documented the beneficial effects of social networks/supports on health. Intervention’s research, however, is still needed to address: What are the most potent causal agents and critical time periods for social networks’ enhancement?

◦Specifically, the intervention’s research must address the following: Who? What? When?

Translating Theory Into Practice: Who?? I

◦WHO?? The research in this area addresses the difference between personal networks and formal networks.

Personal networks: supervisors, family, friends …

Formal networks: professional helper’s ….. Long term assistance Short term assistance

Translating Theory Into Practice: Who?? II

◦Research Conducted by Gottlieb and Wagner (1991) People in close relationships are often

distressed by the same stressors and therefore the support providers are distressed themselves

Affected by the stressors, helpers are therefore likely to have a negative reaction if the help is not received well

Providers often cannot provide information needed but can provide emotional support. (professional helpers are available to provide support but not on long term basis, very often)

Translating Theory Into Practice: What??

◦What?? Wethington and Kessler in 1986: perceptions of support recipients rather than objective behaviors are linked to health and well being (correlation is modest between behaviors and well being)

Perceptions by recipients are often linked to previous experience with the helper. It is important that such are explored.

Translating Theory Into Practice: When??

When??

Social networks and support have been found to enhance wellbeing according to the age and developmental stage of the recipient ◦Example: spouse dies

At first, spouse benefits from close knit, dense social network

Over time, the spouse may need more generalized support to address the need for new social ties

Activity: Who? Whom? What? When? Build an intervention

Let us now break up into four groups and explore ways to utilize the concepts from the previously discussed theories of Gottlieb and Wagner and Kessler and Wethington to explore ways to intervene effectively?.......

Activity: Who? Whom? What? When? Build an intervention

◦A 45 year old married female is recently diagnosed with breast cancer and resides with her two children and husband in an isolated area in Ohio. She has recently returned home from  the hospital after having surgery to treat her cancer.

◦A 20 year old female addicted to opioid pain medication lives with her mother and two sisters in an apartment in NYC. She has been misusing her medication for the past two years. She reports that she cannot manage her pain and that she has lost control over her pain pill consumption.   

Activity: Who? Whom? What? When? Build an intervention

◦A 51 year old male presents to hospital emergency room with acute chest pains; heart attack is ruled out revealing that he has been having repeated panic attacks since the death of his 15 year old son to cancer.  His son died four months ago. Prior to his son’s death, this male was the primary care taker for his son at home. He is not married.

◦A 38 year old female is living with her elderly mother with Alzheimer’s. Although the female has two sisters  living close bye, they have not been helpful to her or her mother. She was recently in trouble at work for missing two many days due to attempting to care for her mother.         

Video: Women Self-Help Groups

SOCIAL NETWORK AND SOCIAL SUPPORT INTERVENTIONS

◦Four types of interventions identified in our text

Enhancing existing social network linkages Developing new social network linkages Enhancing networks through indigenous helpers

Enhancing networks at community level through problem solving

Enhancing Existing Network Ties

Method: Attempt to change attitudes and behaviors of support recipients, support providers or both. Include activities to build skills for effective support mobilization, provision, receipt

Challenges: Identifying existing network members who are committed to providing support and have resources to do so Identifying changes in attitudes and behaviors that will result in increased perceived support Intervening in ways that are consistent with established norms and styles of interaction

Examples: Training of network members in skills for providing support; Training focal individuals in mobilizing and maintaining social networks; Family/marital counseling/therapy; Support groups for spouses, family members

Developing New Social Network Linkages

Methods: When existing networks cease to exist, "burned out", or ineffective new social network linkages become necessary. When an individual undergoes major life transitions and stress such as sickness, injury, death of family member, or social isolation, specialized assistance may be necessary. Those who have prior experience with a particular situation may be effective. Reciprocity and mutuality.

Examples: Mentors, advisors, self-help groups, buddy systems for smoking cessation or weight loss . (Internet based groups are known to be effective)

Use of Indigenous Natural Helpers & Community Health Workers

Methods: Natural helpers are those members of a community to whom members naturally seek advice, comfort, support or referral. They are the nexus to bringing members of the community together as well as a referee, able to refer members to outside resources that may be helpful.

Examples: Identification of CHWs; Analysis of natural helpers existing networks, training in health topics and community problem-solving strategies.

Community Capacity Building & Problem Solving

Methods: Community organizing techniques are utilized to (1) enhance the ability of the community to solve its own problems--community development (2) increasing the community's role in making decision that have important implications for community life (3) resolving specific problems. New networks are formed and existing networks are strengthened

Examples: Community assessment determines who people gain information, resources and support and identify problems & solving them. Examine how existing network overlap aids the dissemination of information within the community.

Combining Strategies

The combination of these four strategies often maximizes the potential impact of the program.

Examples: Combining CHWs with community organizing and problem solving; Programs can help to enhance existing networks while also building new social ties e.g. Bereavement Programs

Health Education and Health Behavior Applications

Enhancing Recovery in Coronary Heart Disease Patients Study (ENRICD)◦ Recall: Coronary Heart Disease is the number cause of death

here in the US, especially with women. Social support is vital to patients who have been

diagnosed with Coronary Heart Disease. Studies have shown that patients without adequate support are at higher risk for cardiac death and higher morbidity rates.

◦ Aim of Study: The ENRICHD study was a randomized trial that sought to determine how effective increased social support was on CHD patients. Patients who had previously had a heart attack and presented with depression and a insignificant social support network were recruited for the study.

ENRICD Study

Results: 2,481 patients qualified for the control: 39% suffered from depression; 26% had low perceived social support; 34% met both criteria. Following 6 months, the patients who participated in the intervention were reported to have had a greater increases in social support and also through the 3 year follow-up. Unfortunately, there was no decrease in recurrent heart attacks and cardiac deaths.

Health Education and Health Behavior Applications II

King County Health Homes Project

◦Asthma: most common chronic childhood disease, disproportionately affecting low-income child and children of color.

◦Goal: Improve the asthma-related health status of low-income children.

Health Education and Health Behavior Applications II

Method: reduce exposure to allergens and irritants in homes.

Community Health workers with insider perspective were hired. More empathic understanding and were credible sources of information; culturally appropriate linkage

CHWs made home visits to families participating in project. They provided the information, resources, and support to empower families to take action for themselves. Each family develop home action plan based on home environment assessment. CHWs visited homes of participants 5 to 9 times a year. They used caring and empathic approach. Proving instrumental, informational, and emotional support.

Results: After one year, the children in the high intensity group had a larger decrease in number of days with limited activity by asthma

Final Thoughts

Social network interventions should be tailored to the needs and resources of participants; No generic intervention will be effective for everyone.

Participatory Needs Assessment: individuals and communities evaluate strengths and weaknesses--in order to structure intervention to be more effective

Social network interventions are more likely to be effective if developed within an ecological framework.

Develop & evaluate social network interventions that include strategies across multiple units of practice. (Individual, family, and community)

Final Thoughts II

Evaluate both processes and outcomes: ◦Carefully describe intervention activities ◦Monitor the effects of these activities on the

amount an quality of social support delivered and received

◦Assess changes in knowledge, health behaviors, community capacity, and health status

People who maintain strong social support are healthier and live longer

In Short◦Who should provide what to whom and when?

Ecological Model

Video: Social Support for a Stage 4 Cancer Patient

Thank You!

THANK YOU for your attention!

Questions and Answers??