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THE RELATIONSHIPS AMONG THREE DIFFERENT TYPES OF SOCIAL SUPPORT ACCESSED BY SCI SURVIVORS. Gregory Murphy, Ph. D. School of Public Health La Trobe University. This exploratory study examined: The types and level of social support available to survivors of traumatic spinal cord injury (SCI).
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THE RELATIONSHIPS AMONG THREE DIFFERENT TYPES OF SOCIAL SUPPORT ACCESSED BY SCI SURVIVORS
Gregory Murphy, Ph. D.
School of Public Health
La Trobe University
Although social support is generally understood as the support and assistance provided by others, the research literature lacks consensus over its operationalisation (Chronister et al., 2006).SOCIAL SUPPORT: DEFINITION AND MEASUREMENT
Perceived social support
Actual social support
Structural social support
Although conceptually interconnected, few studies have examined their empirical relationship to each other (Barrera, 1986).THE SOCIAL SUPPORT CONSTRUCT
Social support has been implicated in the successful response to chronic illness (Walker, 2001).
Social support exerts a powerful influence on rehabilitation outcomes following traumatic SCI (Murphy et al., 2009; Murphy & Young, 2006).
Social support provides protection from arthritis, depression, alcoholism, low birth weight and death (Cobb, 1976).
Social support moderates the detrimental effect of unemployment on mental health (Wethington & Kessler, 1986; McKee et al., 2005).PREDICTED BENEFITS
The use of ad-hoc or global measures of social support, which have not been rigorously tested, has contributed to the sometimes conflicting results obtained for the effectiveness of social support on rehabilitation outcomes (Schwarzer & Leppin, 1992).
Social support needs change over the post-injury adjustment process, therefore, different aspects of social support will be more relevant to successful rehabilitation outcomes at different points in time (Wilcox et al., 1994).CAVEATS
Perceived social support is generally considered to be the “crux” of the social support system (Sarason, et al., 1987).
Of the three major types of social support, perceived social support has the strongest relationship to adaptation following adverse health outcomes (Schwarzer & Leppin, 1991).
Therefore, perceived social support may be even more important than actual social support (Antonucci & Israel, 1986).PERCEIVED SOCIAL SUPPORT
Actual social support involves the objective measurement of the frequency and nature of social interactions
Actual social support is thought by some to capture the true meaning of social support (Chronister et al., 2006).
However, actual social support can also be negative in nature. Negative social interactions (e.g. disputes, privacy invasion, embarrassment) can be detrimental to health, particularly for chronic health conditions (Rook, 1984, 1992).ACTUALSOCIALSUPPORT
A high number of active social ties indicates greater social embeddedness while a lack of social ties results in social isolation (Schwarzer & Leppin, 1991).
Two major types of structural social support exist, however, their scope differs.
Social integration refers to relationships with family, friends, romantic partners, business associates (Whiteneck et al., 2001)
Community Integration refers to more formal interactions at the community group level (Dalgard, 2009).STRUCTURALSOCIALSUPPORT
Actual social support is assumed to be positive but it may be overwhelming in frequency (McDowell, 2006) or profuseness (Sarason et al., 1987), and may reinforce behaviours antithetical to successful rehabilitation.
Structural social support provides an index of potential sources of social support. However, not all sources are able or willing to provide social support (see Barrera, 1986) or appropriate support (Wilcox et al., 1994).LIMITS TO EACH TYPE OF SOCIAL SUPPORT
Cross-sectional study design
Final sample of 20 participants, who were not dissimilar to the Australian traumatic SCI population in terms of key injury and demographic factors (see Cripps, 2009).METHOD & DESIGN
Inclusion Criteria: medically stable post-SCI; workforce age (16-65 years); persisting neurological loss.
Exclusion Criteria: require 24-hour ventilation support; significant brain impairment; severe psychiatric co-morbidity.PARTICIPANTS
Perceived Social Support Scale (PSS) (Sarason et al., 1983) which measures perceived social support.
RAND Social Health Battery (Donald & Ware, 1982) which measures actual social support.
Community Integration Measure(CIM) (McColl et al., 2001) and the Social Integration Measure (SI) (Whiteneck et al., 1992) which measure two key aspects of structural social support.SOCIAL SUPPORT INSTRUMENTS
The number of people to whom a person can turn in specified situations (i.e. availability of social support).
The level of satisfaction with the social support provided.
(Higher scores on the PSS scale indicate higher levels of perceived social support).PERCEIVED SOCIAL SUPPORT (PSS)
Evaluates the level of social support and frequency of different types of social interactions
Unlike other instruments, it acknowledges the negative impact of excessive social interactions as well as the beneficial aspects of social interactions (McDowell, 2006).
(Higher scores on the RAND indicate higher levels of actual social support).ACTUAL SOCIAL SUPPORT
Community Integration Measure (CIM) assesses the extent of community participation and integration (McColl et al., 2001). Unlike other measures, it does not posit an hierarchical view of the importance of different types of community interactions (Radomski & Latham, 2007).
(Higher scores on the CIM scale indicate higher levels of community integration).STRUCTURAL SOCIAL SUPPORT 1
The social integration scale assesses participation in, and maintenance of, an array of social relationships including family, housemates, friends, business associates and strangers (Whiteneck, 2001).
(Higher scores on the SI scale indicate higher levels of social integration).STRUCTURAL SOCIAL SUPPORT 2
The level of structural social support differed according to network type: social integration levels were high but community integration levels were low. Thus, social support from closer networks (friends and family) seems more salient in the early stages of rehabilitation while the more distant and formal community networks are not.LEVEL OF SOCIAL SUPPORT AMONG SCI SURVIVORS
(r=-.26, p>.05, n=20, 2-tailed).BIVARIATEANALYSES2
Measures of both may be called for in certain situations.RESULTScont.
However, as the sample was quite representative and effect sizes were large, results may be fairly robust.
Design (the timing of the measurement of social support - shortly after discharge).
However, the intention was early identification of those at risk of social isolation (which is a frequent sequela of SCI), and to map the stability of social support needs over the first 12-months.LIMITATIONS
To effectively match SCI survivor needs, the types of social support that best predict successful rehabilitation outcomes need to be identified.
The exponential growth in e-communications has opened another form of structural social support. Research could examine the role of e-networks (i.e. virtual communities) on rehabilitation outcomes, either as a distinct form of structural support or an adjunct to either social or community integration.FUTURE DIRECTIONS
Theoretically, these results suggest that actual social support influences the two main opposing models used to explain the relationship between social support and well-being; the Stress Buffering Model (for perceived social support) and the Main Effect Model (for structural social support or embeddedness) (Cohen & Wills, 1985).CONCLUSIONS
Barrera, M. (1986). Distinctions between social support concepts, measures and models. American Journal of Community Psychology, 14, 413-445.
Chronister, J. A., Johnson, E. K., & Berven, N. L. (2006). Measuring social support in rehabilitation. Disability and Rehabilitation, 28, 75-84.
Cobb, S. (1976). Presidential address – 1976. Social support as a moderator of life stress. Psychosomatic Medicine, 38, 300-314.
Cohen, S., & Wills, T.A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98, 310-357.
Cripps, R. (2009). Spinal cord injury, Australia, 2006-07. Catalogue No. INJCAT 119. Canberra: AIHW.
Dalgard, O. S. (2009). Social support definition and scope. Accessed 19 November, 2009. www.euphix.org
Donald, C. A., & Ware, J. E. (1982). The quantification of social contacts and resources. (R-2937-HHS). Santa Monica, CA: RAND Corporation.
Gore, S. (1978). The effect of social support in moderating the health consequences of unemployment. Journal of Health and Social Behavior, 19, 157-165.
McColl, M., Davies, D., Carlson, P., Johnston, J., & Minnes, P. (2001). The community integration measure. Archives of Physical Medicine & Rehabilitation, 82, 429-434.
McDowell, I. (2006). Measuring health: A guide to rating scales and questionnaires (3rd ed). New York: Oxford University Press Inc.
McKee-Ryan, F. M., Song, Z., Wanberg, R., & Kinicki, A. J. (2005). Psychological and physical well-being during unemployment: a meta-analytic study. Journal of Applied Psychology, 90, 53-76.
Murphy, G. C., & Middleton, J., Quirk, R., De Wolf, A., & Cameron, I. D. (2009). Prediction of employment status one year post-discharge from rehabilitation following traumatic spinal cord injury. Journal of Rehabilitation Medicine, 41, 1074-1079.REFERENCES
Gregory Murphy, Ph. D.
School of Public Health
La Trobe University