1. Social Networks
& Social Support
HBSS 5110 Determinants of Health
Behavior
Teachers College, Columbia University
Professor Ray Marks
February 22, 2012
Presented by Darrin Pearson, Ketsia Sadler,
Patricia Iovine, & Sherisse M. Butler
4. 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.
5. 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.
7. 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
12. 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
13. 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
14. 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)
15. 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)
16. 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)
17. 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
20. 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?
21. 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
22. 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)
23. 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.
24. 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
25. 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?.......
26. 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.
27. 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.
29. 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
30. 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
31. 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)
32. 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.
33. 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.
34. 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
35. 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.
36. 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.
37. 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.
38. 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
39. 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)
40. 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?
