How Social Participation Benefits the Chronically Ill: Self-Management as a Mediating Pathway

Changing relationships between social contact, social support and depressive symptoms during the COVID-19 pandemic

Objectives

Given the longstanding consensus that social contact can promote older adult well-being, many have focused on how social contact changed during the pandemic. Less is known, however, about whether the link between social contact and health changed during the pandemic. This study sought to understand how associations between social contact, social support, and depressive symptoms changed during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

Data from 2 waves of the Health and Retirement Study were used. Respondents reported both virtual and in-person social contact, as well as perceived positive and negative social support. Path models were used to estimate relationships between social contact, social support, and depressive symptoms. Bootstrapping was used to estimate the change in associations between 2016 and 2020.

Results

Estimates show that associations between positive social support and depressive symptoms, as well as between in-person social contact and depressive symptoms, attenuated during the pandemic. Virtual social contact played a relatively minor role in determining outcomes such as social support and depressive symptoms, compared to in-person social contact.

Discussion

Findings suggest that researchers and policymakers should not only focus on the changing quantity of social interactions when events such as the COVID-19 pandemic happen, but also the changing content and efficacy of the social interactions that remain.

Social Engagement and Urban-Rural Disparity in Self-Management Behaviors: Study of Middle-Aged and Older Chinese Hypertension Patients

BACKGROUND

This study examines the effect of social engagement on urban-rural disparities in self-management behaviors (medication use, self-monitoring, physical activity, and tobacco and alcohol avoidance) among middle-aged and older Chinese patients with hypertension.

METHODS

Data from 2011 to 2018 were extracted from the four latest waves of the China Health and Retirement Longitudinal Study. Chi-square tests and t-tests were performed to examine urban-rural gaps in self-management behaviors. Random-effects panel logit regression models were adopted to confirm the effect of social engagement on urban-rural disparity in self-management behaviors and to explore whether this effect has narrowed or widened with "bilateral flow" between urban and rural residents. A Fairlie decomposition technique was also used to calculate the extent to which social engagement reflects urban-rural disparities.

RESULTS

There was significant urban-rural disparity in medication use and tobacco avoidance behaviors among the sampled patients. Medication use behavior (p < 0.001) among urban middle-aged and older patients was significantly better, whereas tobacco avoidance behavior (p < 0.05) was significantly lower compared with the rural population. Social engagement significantly enlarged the urban-rural gap in tobacco avoidance behavior (p < 0.01), but significantly narrowed the urban-rural gap in medication use behavior (p < 0.001). The Fairlie decomposition revealed that ~75.000% and 29.412% of the explained urban-rural gap in tobacco avoidance and medication use, respectively, could be attributed to social engagement. The negative effect of social engagement on urban-rural disparity in medication use increased when urban residents moved to rural areas (p < 0.05).

CONCLUSIONS

The urban-rural disparities in self-management behaviors of middle-aged and older Chinese hypertensive patients were mainly manifested in medication use and tobacco avoidance behaviors. The gaps in these two behaviors partly changed with social engagement, while the migration of urban population to rural areas weakens the positive role of social engagement in narrowing the urban-rural gap in medication use behavior. The insights of this paper on social engagement and urban-rural disparity in self-management behaviors, and the effect of urban-rural migration thereof, deserve the attention of health policymakers and researchers.

Three-year effects of neighborhood social network intervention on mental and physical health of older adults

OBJECTIVES

Although neighborhood is considered to be a crucial source of social network to promote health among older adults, current findings are mostly derived from observational study designs. This study examined whether participations in event-based community programs could increase neighborhood social network and whether such increase could lead to desirable changes in mental and physical health among older adults.

METHOD

This study employed quasi-experimental design. A baseline questionnaire survey was sent to residents of Tsurukabuto community aged 60 years or more (n = 1769); 1,068 responded. Community events were implemented approximately once a month for three years. Then, a three-year follow-up survey questionnaire was sent to the respondents of the baseline survey. The total number of respondents in the latter survey was 662; of the total, 173 participated in the intervention. Strong and weak ties with neighbors, mental well-being (Ikigai-9), health-related quality of life (HRQOL), and instrumental activity of daily living (IADL) were measured in the surveys.

RESULTS

The path analysis revealed that intervention participation was significantly associated with changes in strong ties (standardized path coefficient = 0.12) and changes in strong ties were associated with those in Ikigai-9 scores (standardized path coefficient = 0.15). The total and indirect effects of intervention participation on Ikigai-9 scores were significant. Significant intervention effects were not observed for HRQOL and IADL scores.

CONCLUSION

This study found that participation in our event-based intervention could indirectly and positively influence older adults' mental well-being through their strong ties with their neighbors.

Willingness to engage in and current status of social participation among Chinese merchant sailors

China has the largest population of sailors in the world, but little is known of their social participation. This study examined Chinese merchant sailors' social participation using a nationwide survey. Across 12 Chinese provinces, 7,296 merchant sailors completed the questionnaire on sailor' willingness to engage in and status of social participation. The results showed that most Chinese merchant sailors were willing to participate in social affairs, but few of them reported having joined relevant social organizations, over half of sailors reported never having participated in public affairs, and half of them chose to ignore when they faced with an obvious mistake in shipping-related information in the media. Most of sailors reported unknowing the role of the labor union related to Chinese seafarers and NGO related to navigation well, and their evaluation of these organizations were mostly negative. Chinese merchant sailors reported higher expectations of services in terms of protection of rights, providing information and technology, and providing employment opportunity. We conclude that Chinese merchant sailors have willingness to social participation although the reality is not positive and discuss implications for improving the social participation of Chinese merchant sailors.

Social participation is an important health behaviour for health and quality of life among chronically ill older Chinese people

BACKGROUND

Health behaviours (physical activity, maintenance of a healthy diet and not smoking) are known to be beneficial to the health and well-being of chronically ill people. With China's ageing population and increased prevalence of people with chronic diseases, the improvement of unhealthy behaviours in this population has become crucial. Although recent studies have highlighted the importance of social participation for health and quality of life (QoL) among older people, no study to date has included social participation along with more traditional health behaviours. Therefore, this study aimed to identify associations of multiple health behaviours (social participation, physical activity, maintenance of a healthy diet and not smoking) with health and QoL outcomes (including cognitive and physical function) among chronically ill older adults in China.

METHODS

For this nationally representative cross-sectional study, wave 1 data from the World Health Organization's Study on global AGEing and adult health (China) were examined. In total, 6629 community-dwelling older adults (mean age, 64.9 years) with at least one chronic disease were included. Multivariate linear regression analyses were used to evaluate associations of health behaviours with health and QoL outcomes while controlling for background characteristics.

RESULTS

Greater social participation was associated with better QoL [β = 0.127, standard error (SE) = 0.002, p < 0.001], cognitive function (β = 0.154, SE = 0.033, p < 0.001) and physical function (β = - 0.102, SE = 0.008, p < 0.001). Physical activity was associated with better QoL (β = 0.091, SE = 0.015, p < 0.001) and physical function (β = - 0.155, SE = 0.062, p < 0.001). Sufficient fruit and vegetable consumption was associated with better QoL (β = 0.087, SE = 0.015, p < 0.001).

CONCLUSIONS

Our findings suggest that social participation is an important health behaviour for quality of life and cognitive function among chronically ill older people in China. Health promotion programmes should expand their focus to include social participation as a health behaviour, in addition to physical activity, maintenance of a healthy diet and not smoking.