Browsing by Subject "Social support"

Background: South African adolescents living with HIV (ALWH) experience elevated risk for poor HIV-related outcomes due to challenges associated with HIV disease management. While previous research suggests that social support may mitigate poor HIV-related outcomes, we know little about the specific types of family social support that help ALWH achieve better health outcomes or how this support might be better facilitated. This study aimed to address this gap by characterizing the types of social support provided by family members to assist ALWH in their HIV care management.Methods: We conducted fifty-nine in-depth, semi-structured interviews with ALWH (n=20), their caregivers (n=19), and community stakeholders (n=20) in Cape Town, South Africa. Using deductive and then inductive thematic methods, we triangulated data from these three groups in NVivo to qualitatively analyze family social support. Results: We identified four types of family social support: instrumental support, appraisal support, emotional support, and informational support. Families provided crucial instrumental support through treatment reminders and attending clinic appointments with ALWH. Families also acted as strong sources of appraisal support to help ALWH reflect upon the importance of medication adherence by promoting future orientation and HIV normalization. Similarly, families facilitated adherence through emotional support, such as motivating ALWH and demonstrating interest in their health. Lastly, families offered informational assistance to educate adolescents about managing HIV treatment challenges, such as side effects. Conclusion: In characterizing family social support, our findings highlight sources of struggle and possible solutions to the challenges that ALWH face in their HIV care. Our results suggest that ALWH and providers rely heavily on families to distribute these four types of support in HIV care, emphasizing the importance of exploring how to better facilitate and replicate this support. Understanding these types of social support is a crucial step to identifying potential gaps in care and possible intervention strategies. As such, future research should inquire about the efficacy of incorporating these types of social support into interventions to assist ALWH in their HIV care management.

In the context of rapid global aging, cognitive decline among older adults has become a major public health and social issue. A better understanding of the risk factors for cognitive decline is important for developing interventions to preserve cognitive function among older adults. Knowledge gaps still exist in understanding the impact of sensory loss (i.e., hearing loss and vision loss) and psychosocial factors (i.e., social support and loneliness) on cognitive function and cognitive decline. This dissertation aims to fill these knowledge gaps by (1) examining the relationship between psychosocial factors and cognitive function in a unique population: community-dwelling Chinese older adults in the United States (U.S.); (2) understanding the longitudinal relationship between sensory loss and cognitive decline among community-dwelling older adults in the United States; and (3) exploring the mechanisms that accelerate or decelerate cognitive decline by examining the inter-relationships between sensory loss, psychosocial factors, and cognitive decline. The primary study conducted for this dissertation used structural equational modeling (SEM) to model the potential moderation or mediation effect of psychosocial factors on the relationship between sensory loss and cognitive decline over time. Findings from this dissertation deepen our understanding of the important roles that social support, loneliness, and sensory loss can play in cognitive function and decline among community-dwelling older adults. Findings from this dissertation also highlight the importance of adequately addressing the physical and psychological challenges encountered by older adults. Subsequent recommendations are provided to health providers and policy makers to help better preserve and promote cognitive health among older adults using a more holistic approach.

Emerging adulthood, specifically the transition to college, is often marked by changing social networks, increased responsibility, and separation from the parental home environment. Educators, researchers, and those dedicated to the healthy development of young people are invested in understating how and why social support is important for students’ adjustment, wellbeing, and their ability to cope with the daily stressors that accompany this notable transition. In particular, parents are believed to be a key source of both perceived (stable) and enacted (immediate) support. Strong parental relationships predict students’ overall achievement and adjustment in the first year of college. Less is known about how parental relationships may impact students’ daily wellbeing and whether parents can provide helpful enacted support through daily communication. With the rapid ubiquitous rise in mobile technologies, students and their parents are now communicating more frequently during this transition; however, very little is known about whether daily virtual parental communication can help students cope with daily stressors. This study contributes to the existing literature by 1) describing students’ daily in-person and virtual communication with parents during the beginning of college, 2) examining whether students' daily virtual parental communication is associated with their same-day wellbeing, 3) testing whether daily virtual communication (i.e., enacted support) buffers daily responses to stressors, 4) examining the specificity of parental support (versus other sources of support), and 5) exploring whether the strength of students’ parental relationships (i.e., perceived support) is associated with students’ ‘reactivity’ to daily stressors. This dissertation consists of three studies that used daily assessments (i.e., ecological momentary assessments: EMA) and experimental manipulation to understand the momentary interplay between exposure to stressors, parent-child virtual communication, and students’ wellbeing during the transition to college.

Study 1, a 7-day EMA study of 136 first and second year college students, found that texting with a parent moderated the same-day associations between daily stressors and affect. Although daily parental virtual communication was not directly associated with same-day affect, on days when students reported a stressor and texted with a parent, they had lower negative and higher positive affect compared to stressor days when they did not text with a parent. Extending research by Gross (2009), Study 2 used an experimental paradigm in which 101 first year college students completed a virtual social exclusion stressor task (i.e., Cyberball) and then were assigned to text a parent, text a stranger, or play a solitary computer game. Students who ‘reached out’ via text message to parents or strangers demonstrated faster recovery in self-esteem following the experimentally induced stressor compared to students assigned to the no contact control. Study 3 followed the same 101 first year students with a 10-day EMA study. On days when students reported a stressor and called/texted with their parents (versus days without virtual parental contact), they reported lower negative affect and slept longer that night, as monitored objectively with a wearable wristband. Analyses testing for specificity across the three studies found that only virtual communication with parents or romantic partners, but not other texting patterns (number of texts or contacts) or partners (texting with acquaintances, siblings, roommates, or friends), moderated the daily associations between stressors and wellbeing. In addition, students with higher reported maternal relationship quality were less ‘reactive’ to stressors, such that in both experimental and naturalistic settings students with lower (versus higher) maternal relationship quality had steeper increases in negative affect when they experienced a stressor. Overall, the three studies found converging evidence that daily virtual communications with parents may aid students in dealing with daily stressors, especially for reducing negative affect. Possible explanations, ideas for future research, and implications are discussed.

Background: Young black men who have sex with men (YBMSM) are a particularly vulnerable group for HIV infection. HIV-positive YBMSM often suffer from mental health challenges as a result of discrimination based on their HIV status, race, and sexual preferences. Potential associations among HIV self-disclosure, social support, and mental health have been reported in several studies. The aim of this study is to explore the associations among self-disclosure, social support and mental health, including depression and anxiety. Methods: Cross-sectional secondary data, with a sample size of 199 HIV-positive YBMSM, was retrieved from the baseline data of an on-going study. Qualitative interviews were conducted at three sites in North Carolina. Linear regression and content analysis were used in the quantitative and qualitative analysis respectively to explore the associations among self-disclosure, social support, and mental health. Results: In linear regression models for depression and anxiety, social support was significantly associated with depression (p<0.01) and anxiety (p<0.05). Self-disclosure was not significantly associated with depression or anxiety in regression analyses. Qualitative analysis showed connections between social support and mental health as well as self-disclosure and mental health. Conclusions: Both self-disclosure and social support could affect mental health in YBMSM. Further research is needed to better understand the mechanisms linking self-disclosure, social support, and mental health to develop effective and tailored mental health interventions for this marginalized population.

Problem:

Type 2 diabetes (T2D) is increasing in incidence and prevalence in the United States, and T2D remains the 7th leading cause of death. Consistent T2D self-management delays the onset of co-morbidities associated with this disease; however rates of self-management in adults living with T2D remain sub-optimal. The literature indicates that frequent and sustained social interaction between an individual living with T2D, and other peers living with T2D and a healthcare provider, helps sustain critical self-management behaviors. Yet, an individual living with T2D may experience challenges in obtaining this helpful interaction and support due to temporal, geographical, or physical limitations.

Computer mediated environments (CMEs; programs via the Internet) facilitate the exchange of T2D-specific information and support, and may ameliorate limitations to obtaining support and information. CMEs facilitate the creation of an online community in which individuals can choose their participation and the amount of personal information they reveal to other individuals. These personal narratives facilitate the exchange of support and reinforcement as individuals reveal personal challenges and successes encountered during daily T2D self-management. Yet, interventions via CMEs aimed at increasing self-management in individuals living with T2D, have shown mixed results for sustained behavior change. One way to improve disease-specific CMEs is to understand how individuals interact with others in these CMEs.

This study used Strong/Weak Ties Theory and Social Penetration Theory to describe the frequency and content of social interaction and support in a CME. In Strong/Weak Ties Theory, tie strength is defined as time in which the relationship can develop and occur, the intensity of emotions within that relationship, the breadth and depth of intimacy, and whether the relationship is reciprocal and mutual. Social Penetration Theory purports that the perceived value of a relationship influences the breadth (number of topics discussed) and depth (degree of intimacy and personalization of discussed topics) of a relationship. This study defined social support using the four types of support commonly identified in the literature: emotional, instrumental, appraisal, and informational. Therefore, the overall purpose of this study was to develop knowledge to advance the science of social relationships in CMEs, with a focus on characterizing social interaction and social support as they relate to self-management in a chronic disease. In particular, knowledge was developed about how social interaction and social support among adults living with T2D was exchanged in a CME.

Materials:

This study was a secondary analysis of qualitative data collected from the Second Life Impacts Diabetes Education & Self-Management (SLIDES) study. The SLIDES study provided self-management knowledge and support via a CME to individuals living with T2D. These data included recorded synchronous (i.e., real-time) and asynchronous (i.e., delay present) conversations among study participants (n = 20) and diabetes educators and study investigators (n = 4). Diabetes educators offered two education sessions and one support session per week, and these sessions were opportunities for participants to ask questions, learn about T2D, and interact with other participants who had T2D. During the study, all conversational data (i.e., synchronous conversations and text-chat; asynchronous emails and discussion board posts) among study participants, diabetes educators, and study staff within the CME were recorded to MP3 files and stored on a secure server at the University.

The conversational data used in the analysis was prepared over a period of several months; this attention to detail enabled a rich description of social interaction and support in a CME. The researcher listened to the MP3 files and then transcribed several files (n = 164) in order to gain knowledge of the SLIDES CME. A professional transcription service transcribed the remaining MP3 files (n = 697). The researcher cleaned all transcribed conversations by simultaneously listening to the MP3 files (n = 861) and reading the transcribed text to verify accuracy. Then, a systematic approach was used to link each spoken word to a SLIDES participant by voice recognition or reference to names to determine which participants contributed to, and how much each participant engaged in, a conversation. Once the researcher reviewed all MP3 files and transcribed text for accuracy, the Microsoft Word document (n = 1,537 pages) was imported into Atlas.ti to support coding and analysis.

Methods:

The primary study used a qualitative study design to comprehensively describe conversational data from participants who engaged in a CME that focused on T2D. Qualitative content analysis guided the description of social interaction and social support. The researcher developed inductive and deductive codes to describe social interaction and social support based upon the guiding framework. A research team comprised of a PhD candidate and two research experts reviewed all emergent codes and themes during first and second level coding.

Results:

Findings from the primary study describe social interaction and social support among individuals who interacted in a CME. Four characteristics of a social interaction in a CME developed: (1) communication techniques, or how participants interact in real-time communication in a CME; (2) expressions of self-management, or the content of participants’ self-management discussions; (3) depth of conversation, or intensity of personal information shared; and (4) breadth of conversation, or the number of topics discussed among participants in a conversation. The findings illustrate that the four types of social support are present in a CME: (1) instrumental support, or the exchange T2D-specific tangible goods in the CME; (2) appraisal support, or the exchange of affirmational support for T2D self-management behaviors; (3) informational support, or the exchange of T2D-specific information; and (4) emotional support, or the exchange of empathy among participants in a conversation. Additionally, the findings illustrate the elicitation behaviors (i.e., prompts that individuals used to obtain support) and the support responses (i.e., the support provided) to further describe social support.

A social interaction in a CME is a multidimensional construct because the communication medium (i.e., the CME) influences the communication techniques individuals’ use when talking amongst themselves to exchange information and support. The findings indicated that participants will reveal personal information about themselves in a CME, and most of the topics discussed are salient to T2D. The primary study indicated that strong/weak ties between individuals exist in CME relationships, and these ties develop over time with the sharing of personal information. The ties developed among (1) diabetes educators and individuals living with T2D, and (2) individuals living with T2D. The findings from this study indicate that social interaction and social support are exchanged among peers and providers in a CME.

Conclusion:

Computer-mediated environments enable persons living with T2D to obtain valuable interaction and support at times and locations that are convenient. Type 2 diabetes self-management is person-specific and dynamic, which highlights the need for social support that is personalized and timely. One way participants received personalized support and information was through interactions with the diabetes educators and other participants. The interactions in a CME mirrored those in a face-to-face environment as participants asked questions of each other, responded to other participants, talked about personal challenges, and provided information. This study began to characterize the social interactions among persons living with T2D who interacted in a CME. Future research on the characterization of social interactions in a CME should focus on analyzing social interactions in a larger, more diverse sample that includes men and women of diverse ages, races, ethnicities, education levels, and income levels.

This cross-cultural study investigates the challenges affecting HIV+ women in rural Kenya and Durham, North Carolina. Examining the linkages between social support and coping, the study finds that many experiences with social support and coping are shared across countries, despite differences in education, occupation status, and cultural identities. Age, education, and employment status were not found to be statistically significant determinants of total COPE or treatment-specific social support scores for either population. Religion was a recurring theme in both contexts, both in the quantitative and qualitative sets of data. It was a statistically significant determinant of total treatment-specific social support and also mentioned many times throughout the interviews as a preferred coping method. Most of the women expressed that support from their family and friends as well as health professionals helped them to positively cope with their disease and gave them hope for prolonged life.

Background: Sickle cell disease (SCD) is a debilitating genetic blood disorder that seriously impacts the quality of life of affected individuals and their families. With 85% of cases occurring in sub-Saharan Africa, it is essential to identify the barriers and facilitators of optimal outcomes for people with SCD in this setting. This study focuses on understanding the relationship between support systems and disease outcomes for SCD patients and their families in Cameroon and South Africa.

Methods: This mixed-methods study utilizes surveys and semi-structured interviews to assess the experiences of 29 SCD patients and 28 caregivers of people with SCD across three cities in two African countries: Cape Town, South Africa; Yaoundé, Cameroon; and Limbe, Cameroon.

Results: Patients in Cameroon had less treatment options, a higher frequency of pain crises, and a higher incidence of malaria than patients in South Africa. Social support networks in Cameroon consisted of both family and friends and provided emotional, financial, and physical assistance during pain crises and hospital admissions. In South Africa, patients relied on a strong medical support system and social support primarily from close family members; they were also diagnosed later in life than those in Cameroon.

Conclusions: The strength of medical support systems influences the reliance of SCD patients and their caregivers on social support systems. In Cameroon the health care system does not adequately address all factors of SCD treatment and social networks of family and friends are used to complement the care received. In South Africa, strong medical and social support systems positively affect SCD disease burden for patients and their caregivers. SCD awareness campaigns are necessary to reduce the incidence of SCD and create stronger social support networks through increased community understanding and decreased stigma.

Religious observance has been reliably shown to improve a wide variety of health outcomes across the lifespan. Significant work has already been done to find mediating processes that explain this relationship, but as yet no studies have been published that attempt to integrate these mediators into a single model to see if they all work together. The current study presents three possible mediators of the religiosity-health link: social support, self-control, and reliance on others. Participants were recruited from Amazon.com’s Mechanical Turk worker system (N = 112) for a 14-day diary study in which all relevant constructs were measured on a daily basis, with daily health behaviors being the outcome. Social support, self-control, and reliance on others were all found to be simultaneous partial mediators of the religiosity-health link, though some questions remain as to the causal flow between religiosity and each of these mediators. It is concluded that each of these mechanisms is related to religiosity and in turn aid in the pursuit of superior health.