The contribution of Social Networks to the Health and Self-Management of Patients with Long-Term Conditions: A longitudinal study

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This research was designed to determine how the social networks of people with long-term conditions (diabetes and heart disease) are associated with health-related outcomes and changes in outcomes over time.  

The research indicated that: social involvement with a wider variety of people and groups supports personal self-management and physical and mental well-being; support work undertaken by personal networks expands in accordance with health needs helping people to cope with their condition; network support substitutes for formal care and can produce substantial saving in traditional health service utilisation costs. It concludes that there is a need for a greater focus on harnessing and sustaining the capacity of networks and the importance of social involvement with community groups.

Based on research involving 300 people with chronic heart disease registered with 19 GO practices in the north of England, the researchers found:

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 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 research showed that independently of relationship type, network members who are female, live nearby, or contact more frequently, provide the highest levels of illness work, as do denser networks (ie where more members know each other).

The research also showed 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.

The authors conclude that it is evident that social networks are adaptable and responsive to levels of health need, and that the overall support provided by the network is more salient than the particulars of the individual members, whilst involvement in social organisations and reciprocal or altruistic activities provides additional, independent, health benefits. They argue that the findings show the need for a greater focus on harnessing and sustaining the capacity of networks and the importance of social involvement with community groups and resources as a means of achieving desirable policy outcomes and a more cost-effective way of supporting long term illness management.

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