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Describe the Ecological Model for Health Promotion Interventions.
What is the core idea relating interpersonal variables and health?
Persons with strong social relationships have been observed to have better health.
Observed in many epidemiologic studies (difficult to tell using 1 point in time)
“Strong” social relationships measured in many ways, including numbers of ties, group memberships etc.
How does this come about? -- Cause & effect dilemma
Can it be facilitated?
Describe the trend in survivorship after breast cancer diagnosis and level of social connectedness.
Higher social connectedness scores (frequency of contacts with family and friends, attendance of religious services, and participation in community activities) was associated with a 15–28% reduced risk of death from any cause (p-trend=0.02).
Define Social Integration.
Existence of social ties
Define Social Networks.
- Patterns of linkages
- The pipeline through wich support and social influence flows
Define Social Support.
Functional content of relationships, generally conceptualized as positive
Define Social Undermining.
- Negative content of relationships
- Missing relationship, abuse, nitpicky friends
Many studies do not clearly distinguish social support from social network
They may measure support as "number of connections"
What are the two types of social support?
What are the 4 types of Supportive Behaviors?
- Emotional support
- Instrumental support
- Informational support
- Appraisal support
Describe emotional support.
Describe instrumental support.
drive to appointment, babysit
Describe informational support.
Get information from friends you didn't have before
Read an article
Describe appraisal support.
What does social network analysis illustrate?
- Relationships between individuals (but not quality)
- Nodes = individuals
- Connections between individuals can be many or few
- Central vs. edge
Social support, influence "flow" through
- Emotional, instrumental, informational, appraisal support
- Beliefs, social influences, role modeling
- As a result, health behaviors and health outcomes “flow” through the network also
- Nicholas Christakis - The hidden influence of social networks
Glanz shows some pathways by which social support and social networks may affect health
- Social networks & social support
- Individual coping resources (problem solving abilities, access to new contacts/information, perceived control/self-efficacy)
- Organizational and community resources (community empowerment and competence)
- Physical, Mental and Social Health
- Health Behavior
There are a number of ways that social network/support can interact and influence health.
List way support may influence health.
- Direct effects on health – physiologic response to having need for affiliation, belonging, met
- Improved coping, due to instrumental support, informational support
- Improved self efficacy for coping (“because I have help, I can cope with this”)
- Improving coping using community resources
- “Stress buffering”
- Change exposure to stressors
- Effect on health behavior
Describe how social networks/support can be used as a "change theory" rather than just "explanatory".
Predictions for behavior:
- Increased quantity of social connections leads to improved health outcomes.
- Increased quality of social support leads to improved health outcomes.
- Increased quantity/quality of social support leads to improved health outcomes only when stressors are present (stress buffering).
- Improved quantity or quality of social connections leaders to improved health behaviors.
Can the predictive variable be manipulated?
How do you increase quantity of connections?
- Buddy interventions
- Peer interventions (lay helpers, community health workers, peer teachers, etc.)
- Support groups
Results are ambiguous; may be most influential for "isolates"; dependint onf situation (having one is important, but more may not be)
How do you increase the quality of interactions?
- Train supporters in more appropriate actions (supporting rather than criticizing, nagging)
- Little impact
- Recipient doe not always "perceive" support in the same what the observer rates it
What are two important concepts about social networks/support?
- Observational work strong and important
- Experimental work ambiguous; not clear when and how social connections and interactions can be changed
Describe Social Capital.
- Resources available because of the existence of a social network, due to norms of reciprocity, trust, sharing
- Is a property of the who community, rather than of the individual (but often measured as individual)
- Shared "connectedness" of the community
- More of a collective concept than social support or social networks
List the social connections within social capital.
Connections between people in a social group
Connections across social groups
Groups with more internal bonding and more bridging to others are though to facilitate helath and other outcomes. Provide an example.
Outreach person - I know someone who does what you want, I'll connect you.
How can social capital be measured?
- Pronyk article
- "Structural" social capital - asked about group membership, level or intensity
- "Cognitive" social capital - similar to social support
What did the IMAGE intervention consist of?
How did it attempt to increase social capital?
- Microloans - group members became responsible for each others' loans
- Took on an issue within the community - working as a group to improve
- Perceived reciprocity and community support (increase reciprocity)
- Perceived solidarity in crisis (increase trust
- Taken part in a collective action (Sister for life, gender roles, wider community mobilization)
What was the outcome of the study with regard to social capital?
- Comparison women from other villages didn't have microfinance group
- After 2 years, positive change on social capital measures
What did the qualitative data reveal about the development of "bonding" and "bridging" social capital?
- Unexpected outcomes
- Comments - getting opportunities
- Knowledge - brave in facing children