The contribution of Social Networks to the Health and Self-Management of Patients with Long-Term Conditions: A longitudinal study
Social networks have been seen as playing a potentially important but relatively unspecified role in providing self-management support for long term conditions and this study was motivated by the idea that these provide people with long term conditions access to relationships and resources which can support them in managing their condition(s).
Findings from the study indicate that: social involvement with wider resources (e.g. community groups) supports personal self-management and physical and mental well-being; the support work undertaken by personal networks expands in accordance with health needs and that this helps people cope practically and emotionally with their condition but does not impact on health per se; and network support substitutes for formal care and can produce substantial savings in traditional health service utilisation costs.
The study provides some helpful context, highlighting how a social network perspective on condition management re-orientates the focus away from an individual's personal self-management actions to allow broader consideration of all the resources available to help support someone with a long-term illness.
With regard to social involvement, being connected to voluntary and community groups was related to key dimensions of self-management (self-monitoring and skill and technique acquisition, as measured by the HEIQ), as well as to better physical health and emotional well-being. Significantly, social involvement was also associated with the maintenance of healthy behaviours over time, with these behaviours declining in patients who had no links to community groups or organisations. The association of help given to others with better self-management and physical health scores highlights the importance of activities which are reciprocal as well as altruistic in promoting good self-management.
The research also found that people with poorer health or less healthy behaviours tended to have more children living nearby. A plausible interpretation for these relationships is that networks respond to poorer health by providing more support. The dominant factor here is the network responding to the patient's health status such that family and network members may ‘rally around’ patients in poorer health by increasing levels of support, including moving closer in order to do so. When controlled for degree of illness burden further relationships emerged: for patients at similar levels of disease burden those receiving more 'illness work' through their network did not show better physical health, but did show greater ability to self-manage, better emotional health and more healthy behaviours. Thus although greater network support did not improve physical health per se, it did improve patients' ability to cope with their condition(s), both practically and emotionally.
The third main finding was of associations between network characteristics and health economics outcomes. Greater social involvement was associated with increased quality adjusted life years over a 12 month period. However, of potentially more importance, was the relationship between levels of illness work provided by the members of a patient's network and the cost demands a patient makes on the health service. In general, health service costs for patients receiving the highest levels of illness work were nearly half the costs for patients receiving the lowest levels, and most of the cost saving was due to a reduction in hospital bed days. A possible mechanism here is that patients receiving higher levels of network support were more able to be looked after at home and so discharged earlier. This result clearly needs validation in further studies but if correct, the implication is that considerable health service cost saving could accrue from investing in increasing the illness support people receive from their personal networks.