Perceived social support and characteristics of social networks of families with children with special healthcare needs following the COVID-19 pandemic

Background

Children with special healthcare needs (CSHCN) require more support than the average of their peers. Support systems for CSHCN were particularly affected by pandemic control measures. Perceived social support is a resource for health and wellbeing for CSHCN and their families. Associations of social support, mental health and socioeconomic status (SES) have been described. This study aims to (1) assess perceived social support in families with and without CSHCN; (2) describe structure and types of social networks of families with and without CSHCN; and (3) explore associations between perceived social support, disease complexity, child and caregiver mental health, and SES.

Methods

This is the third of a sequential series of cross-sectional online surveys conducted among caregivers of children ≤ 18 years in Germany since the beginning of the COVID-19 pandemic, administered between 1st December 2022 and 10 March 2023. The Brief Social Support Scale (BS6) assessed perceived social support. Child and parental mental health were assessed using the Strengths and Difficulties Questionnaire (SDQ) and WHO-5 Wellbeing index. The CSHCN-Screener identified CSHCN. Descriptive statistics and linear regression modeling assessed associations between perceived social support, parent-reported child mental health problems, disease complexity, caregiver mental wellbeing and SES.

Results

The final sample included 381 participants, among them 76.6% (n = 292) CSHCN. 46.2% (n = 176) of caregivers reported moderate, i.e., at least occasional social support. Social support was largely provided by informal social networks consisting of partners, relatives and neighbors/friends. Linear regression modeling revealed associations of lower perceived social support with higher disease complexity of the child, lower caregiver mental wellbeing, lower SES and increasing caregiver age.

Conclusion

The results of this study describe inequalities in perceived social support according to disease complexity of the child, caregiver mental health and socioeconomic status. They highlight the importance of social support and support networks as a resource for wellbeing of caregivers and CSHCN. Moving on from the COVID-19 pandemic, recovery strategies should focus on low-threshold interventions based in the community to improve social support for families with CSHCN and actively involve caregivers in identifying needs and co-creating new approaches.

Thinking of Learning Communities? Here Are Some of the Ways They May Benefit Your Medical Students

Learning communities are designed to bring together students, faculty, and potentially other healthcare professionals, to learn with and from each other formally in teaching activities but also in the social domain. In recent years, learning communities have gained some recognition as an effective educational strategy but their use is still not widely seen in all medical schools. Numerous benefits of learning communities have been reported and these include improved academic performance, enhanced critical thinking and problem-solving abilities, increased student confidence, and improved communication skills. Learning communities also provide opportunities for personal growth, mentorship, and self-reflection, all of which contribute to a students' professional development.

Religion, support and self-care experiences: A qualitative descriptive study with Indonesian adults with the chronic disease living in Montreal, Canada

AIM

To explore and describe the chronic illness self-care experiences of Indonesian immigrants living in Montreal, Canada and to gain a better understanding of how religion and support shaped these experiences.

DESIGN

Qualitative description.

METHODS

Data were collected from January to March 2020 via semi-structured interviews. Eight men and women participated. The data were thematically analysed.

RESULTS

Major themes identified were (1) religion, (2) being helpful to others, (3) family support, (4) transnational family support, (5) community support and (6) being in Indonesia versus Canada. Religion and faith were sources of motivation for self-care and provided guidance and strength to heal and accept the illness, mainly through the practice of prayer. 'Being helpful to others' (collectivism), including aiding others to avoid getting sick or giving 'health tips', and also just generally taking care of family also contributed to overall well-being. Spouses were the main source of assistance with disease monitoring and management and health maintenance, whereas support from the Indonesian community was minimal and mostly consisted of informational and social support. Transnational relationships with family members in Indonesia, however, provided an additional means for obtaining emotional support, advice and access to traditional medicines. Overall, there was little expectation that family or the community offer or provide support with self-care. These low expectations may partially be explained by the different cultural and social contexts in Canada compared with Indonesia.

CONCLUSION

Religious, cultural, social and family factors may be carried over from the home country and/or may be altered post-migration, and this may impact how Indonesian immigrants with chronic illness engage in self-care.

IMPACT

Cultural factors (collectivism, traditional medicines), religious beliefs and support networks, both locally and transnationally should be assessed and considered during care to better support and promote self-care among immigrants living with chronic diseases.

PATIENT OR PUBLIC CONTRIBUTION

Two Indonesian community organizations facilitated recruitment and data collection.

Self-reliance, Social Norms, and Self-stigma as Barriers to Psychosocial Help-Seeking Among Rural Cancer Survivors With Cancer-Related Distress: Qualitative Interview Study

Background

Even when technology allows rural cancer survivors to connect with supportive care providers from a distance, uptake of psychosocial referrals is low. Fewer than one-third of participants in a telemedicine intervention for identifying rural survivors with high distress and connecting them with care accepted psychosocial referral.

Objective

The purpose of this research was to examine the reasons for which rural cancer survivors did not accept a psychosocial referral.

Methods

We utilized a qualitative design to address the research purpose. We interviewed participants who had been offered psychosocial referral. Semistructured interviews were conducted 6 weeks later (n=14), and structured interviews were conducted 9 months later (n=6). Data were analyzed descriptively using an inductive approach.

Results

Ultimately, none of the rural cancer survivors (0/14, 0%) engaged with a psychosocial care provider, including those who had originally accepted referrals (0/4, 0%) for further psychosocial care. When explaining their decisions, survivors minimized their distress, emphasizing their self-reliance and the need to handle distress on their own. They expressed a preference for dealing with distress via informal support networks, which was often limited to close family members. No survivors endorsed public stigma as a barrier to accepting psychosocial help, but several suggested that self-stigma associated with not being able to handle their own distress was a reason for not seeking care.

Conclusions

Rural cancer survivors’ willingness to accept a psychosocial referral may be mediated by the rural cultural norm of self-reliance and by self-stigma. Interventions to address referral uptake may benefit from further illumination of these relationships as well as a strength-based approach that emphasizes positive aspects of the rural community and individual self-affirmation.

How Race and Gender Stereotypes Influence Help-Seeking for Intimate Partner Violence

This qualitative study investigated how stereotypes affect help-seeking behaviors for women in abusive relationships. It consisted of in-depth interviews of 15 female victims of intimate partner violence (IPV): five White and 10 African American women. It compared and contrasted the ways in which internalized stereotypes affected the IPV-related help-seeking of African American women and White women. The findings indicated that African American women were affected by the "strong Black woman" stereotype, did not utilize formal institutions for help, and instead, turned to close family and friends for support. White women were affected by stereotypes about IPV victims, felt less strain associated with utilizing formal support systems, and also utilized informal support networks. Results are interpreted and recommendations are developed through an intersectional Black feminist criminological theoretical framework.

"Thrown Into the Deep End": Mapping the Experiences of Young People Living in a Family Affected by a Neurological Condition

In this case study research, we investigated the impact that having a parent with a neurological condition can have on young adults' experiences of growing up and the nature of their support networks. The work was informed by models of interface of chronic conditions and the family. Stroke (n = 6), multiple sclerosis (n = 14), and dementia (n = 11) were selected as discrete cases. Within each case, the researcher (a) carried out semi-structured interviews with young adults (16-25 years) living in families affected by this condition and (b) organized a workshop in which all participants reviewed preliminary themes and reflected on their support networks. A thematic analysis identified four themes: the condition has shaped me, thrown into the deep end, I need to talk about this, and they don't understand. A model of networks and support for these young adults was generated reflecting the need to increase their visibility and their access to support.

Support for rural practice: female physicians and the life-career interface

INTRODUCTION

The need for family physicians in rural areas across the USA and Canada is a longstanding issue that has been well documented. Since family physicians constitute the largest population of rural practitioners, the problem has been exacerbated by a sharp decline in medical students' interest in the field of family medicine and the aging of the current rural workforce. Previous research has shown that female physicians in rural areas need strong support networks to maintain a healthy work-life balance. The purpose of this study was to better understand the types of support they need and how they find it, as well as how their needs change over time.

METHODS

Twenty physicians from the same rurally focused family medicine residency were interviewed over a 3-month period using a semi-structured format. Physicians ranged in experience from 1 year out of residency to 25 years out of residency. Using a phenomenological approach, interviews were transcribed and then coded and analyzed by three members of the research team, one of them an experienced qualitative researcher, who met periodically to reflect on the process of coding. Emergent subthemes and themes were discussed by the multidisciplinary team.

RESULTS

The participants discussed in detail the types of support they relied on and the continuing challenges of maintaining a healthy work-life interface. Main themes included the need to select carefully one's life partner and practice partners and the difficulties in setting up practice in an area without family, friends or professional mentors nearby. Although forming boundaries was important, so was developing close relationships with patients and their families. The one thing that sustained all of the physicians was a meaningful relationship with their patients. The doctor-patient connection is what brings joy and helps every one of them cope with the harder aspects of life in rural areas.

CONCLUSION

The general consensus of respondents was that the career-life interface varies across individuals, changes over time and is always a work in progress. Rural female physicians think of their work in relational terms, and it involves a great deal of emotional labor. Support systems mitigate the psychological effects of this labor and help physicians develop resilience in managing both career and life. Educators can better prepare female physicians by discussing the costs and benefits of emotional labor and the necessity of support networks, as well as how to negotiate a contract that is consistent with one's values, practice style and family life.

Ethnic identity and substance use in multiracial youth: the moderating role of support networks

Background: Substance use in multiracial adolescents exceeds rates identified in the general population. Despite this fact, there is limited research examining risk and protective factors for multiracial substance use. Objectives: The current study examined the moderating effect of social support on the relationship between ethnic identity and substance use in a sample of multiracial adolescent youth. Methods: Multiracial youth (N = 523) completed a survey that asked questions related to their ethnic identity, perceived social support, and substance use. A series of path analyses were conducted to test the hypothesized relationships between ethnic identity, social support, and substance use. Results: Analyses indicated that ethnic affirmation was negatively related to frequency of, but not quantity of substance use. Teacher support was negatively related to both frequency and quantity of substance use, while parent support was only related to frequency. Further, teacher and parent support emerged as moderators of ethnic affirmation and frequency and quantity of substance use respectively. Conclusions/Importance: Our findings add to the current understandings of the relationship between ethnic identity, social support, ethnic identity, and substance use among the understudied multiracial adolescent population.

Social implications of children's smartphone addiction: The role of support networks and social engagement

Background and aims Most studies have regarded smartphone addiction as a condition stemming from individuals' psychological issues, so research has rarely examined it in relation to a lack of social resources and its social impacts. However, this study reinterprets smartphone addiction as a social problem stemming from a lack of offline social networks and resulting in a decline of social engagement. Methods This study drew on a survey of 2,000 children in Korea consisting of 991 males and 1,009 females with an average age of 12 years old. Using the STATA 14 structural equation modeling program, this study examined the relationships between children's lack of social networks, smartphone addiction, and social engagement. Results Social network variables, such as formal organizational membership, quality of relationship with parents, size of the peer group, and peer support, decrease smartphone addiction. Simply having good relationships and reciprocal feelings with peers do not have any influence on the smartphone addiction. The more the children become addicted to smartphones, the less they participate in social engagement. Discussion and conclusions This study provides a new understanding of smartphone addiction by focusing on its social aspects, augmenting prior studies that have addressed psychological factors. Findings suggest that children's lack of social networks may inhibit comfortable social interactions and feelings of support in the offline environment, which can heighten their desire to escape to smartphones. These children, unlike non-addicts, may not take advantage of the media to enrich their social lives and increase their level of social engagement.

Ethnic and Gender Differences in Family Social Support among Black Adolescents

This study examines black adolescents' reports of the most helpful types of social support that they receive from and provide to family members, and whether family support exchanges vary by ethnicity (African American vs. Black Caribbean) and gender. Data for this study are from the National Survey of American Life Adolescent Supplement (NSAL-A), a national, probability sample of African American and Black Caribbean youth (ages 13-17). Overall, youth reported financial support, followed by emotional assistance and practical support as the most helpful types of support that they received. Practical and emotional assistance characterized the most commonly reported types of support that they provided to family members. Black Caribbean adolescents were more likely than African American adolescents to report financial and practical assistance as the most helpful types of support that they received from family members; no ethnic differences were observed in the provision of support to relatives. There were no significant gender differences in the receipt of support, but adolescent girls reported greater involvement in providing emotional support and caregiving than adolescent boys. The results of this paper reveal that African American and Black Caribbean adolescents are involved in a complex pattern of reciprocal support exchanges with their extended family members. Study findings also reinforce the importance of research focused on racial/ethnic and gender differences in family support exchanges in order to develop a more nuanced understanding of family support behaviors within these groups.

Factors Associated with Exclusive Breastfeeding Practice among Nursing Mothers in rural areas of Enugu State and its Implications for Social Work Practice in Nigeria

This study investigates factors that influence exclusive breastfeeding practice. Focus group discussions involving 60 nursing mothers from selected rural areas of Enugu State, Nigeria, was adopted. Thematic analysis was adopted in analyzing data collected. Findings show that nursing mothers in the study area are yet to fully accept the 6 months' practice of exclusive breastfeeding. Issues relating to culture, economic hardship, and support networks were revealed to exercise gross influence on practice of exclusive breastfeeding. The study concluded that professional support from social workers is very vital to achieving conformity to the practice. This can be done through awareness creation that would accommodate support networks, while adopting exclusive breastfeeding campaign models that have proven successful in other African nations.

Neighborhood support network, perceived proximity to community facilities and depressive symptoms among low socioeconomic status Chinese elders

OBJECTIVES

Depressive symptoms are common in older people; most previous research on elderly depression focused on individual-level characteristics or neighborhood socioeconomic status. Modifiable neighborhood characteristics of older people dwelling in low-income communities are under-studied. This study aims to identify potentially modifiable social and physical neighborhood characteristics that influence depressive symptoms independent of individual-level characteristics among older Chinese.

METHOD

Data came from a cross-sectional survey conducted in four low-income public rental housing estates in Hong Kong in 2012. We interviewed a total of 400 elderly residents. The structured questionnaire covered demographics, activities of daily living, recent fall history, neighborhood support networks, and perceived proximity by walk to community facilities. Multiple regression was used to test whether inclusion of neighborhood factors in addition to individual characteristics increases model fit in explaining depressive symptoms in elders with low socioeconomic status.

RESULTS

At individual level, activities of daily living and income significantly predicted depressive symptoms. Receiving support from friends or neighbors is associated with fewer depressive symptoms. However, participants who received organizational support had a 1.17 points of increase on the 15-item Geriatric Depression Scale (GDS-15). At-ease walkable proximity to medical facilities was positively associated with a better GDS score.

CONCLUSION

Neighborhood support networks and perceived proximity by walk to community facilities contribute significantly to depressive symptoms among low-income elders. Programs and policies that facilitate neighborhood support and commuting or promote facility accessibility may help ameliorate depressive symptoms common among low-income elders.

A personal perspective from the UK: ageing and psychiatrists

OBJECTIVE

Psychiatrists appointed to National Health Service (NHS) consultant posts in the United Kingdom before a specific date in 1995 qualified for early retirement and this has implications for workforce planning.

METHODS

The author reflects on the implications this has for ageing psychiatrists and for relationships between psychiatrists and patients and families using mental health services, from the perspective of a psychiatrist who took advantage of the opportunity to retire early from a consultant post in the NHS and to develop a new career.

RESULTS

Older psychiatrists continuing to practise after retirement from consultant roles may bring disadvantages and advantages.

CONCLUSIONS

Older psychiatrists may be a valuable resource for future mental health services, and they may be in a position to try out new ways of working which might be relevant to their younger colleagues in the uncertain future faced by mental health services at a time of austerity.

Social ties and psychological well-being in late life: the mediating role of relationship satisfaction

OBJECTIVE

The current paper examines whether quantitative aspects of social support (i.e., support network characteristics) indirectly influence psychological well-being via older adults' qualitative perceptions of support (i.e., satisfaction with social relationships).

METHODS

A sample of 416 adults aged ≥60 was drawn from the Social Integration and Aging Study, a community-based survey conducted in a small US (Midwestern) city. The survey assessed social networks, social support, and physical and mental health among older adults.

RESULTS

Bootstrapping was used to examine mediation models. Greater support network size predicted lower perceived stress, fewer depressive symptoms, and better life satisfaction, yet this association was fully mediated by relationship satisfaction. For support network composition, greater proportion kin was associated with lower stress and better life satisfaction, though not depressive symptoms, however, relationship satisfaction did not mediate this link.

DISCUSSION

Findings highlight the complex interplay of support network characteristics and satisfaction, and suggest the greater import of support satisfaction for older adults' psychological well-being.

Perceptions of Support Networks During the Graduate-Assistant Athletic Trainer Experience

CONTEXT

The graduate-assistant position can be a highly influential experience because it is often the first time novice athletic trainers (ATs) are practicing autonomously.

OBJECTIVE

To gain an understanding of how graduate-assistant ATs (GAATs) perceive professional socialization and mentorship during their assistantships.

DESIGN

Semistructured phone interviews.

SETTING

Graduate-assistant ATs in various clinical settings.

PATIENTS OR OTHER PARTICIPANTS

Twenty-five GAATs (20 women, 5 men) studying in 1 of 3 academic tracks (postprofessional athletic training = 8, athletic training-based curriculum = 11, non-athletic training-based curriculum = 6). Median age was 24 years.

DATA COLLECTION AND ANALYSIS

Phone interviews were digitally recorded and transcribed verbatim. Data analysis used principles of the general inductive approach. Credibility was maintained using peer review, field notes, and intercoder reliability.

RESULTS

Participants identified peer support throughout their experiences, in both academic and clinical settings. The GAATs frequently relied on other GAATs for support due to shared experiences and understanding of workloads. Participants described difficulty receiving supervisor support from full-time staff ATs due to the supervisors' workload and time constraints, limiting their availability for mentoring. Guidance from academic support personnel occurred only in athletic training-centered academic programs. Communication emerged as helpful for incoming GAATs; the previous GAATs provided formal mentorship via job descriptions highlighting role responsibilities and expectations. Differences between assistantship types were noted only in terms of receiving balanced mentorship between the academic and clinical staffs, such that students studying in postprofessional athletic training programs perceived more balanced support.

CONCLUSIONS

Our results confirm the literature regarding the GAAT's pursuit of continued formal mentoring. The GAATs perceived less support from full-time AT staff members due to limited availability. Therefore, GAATs leaned on their peers for support during the graduate experience.

A support network typology for application in older populations with a preponderance of multigenerational households

This paper considers the support networks of older people in populations with a preponderance of multigenerational households and examines the most vulnerable network types in terms of loneliness and isolation. Current common typologies of support networks may not be sensitive to differences within and between different cultures. This paper uses cross-sectional data drawn from 590 elders (Gujaratis, Punjabis and Sylhetis) living in the United Kingdom and South Asia. Six variables were used in K-means cluster analysis to establish a new network typology. Two logistic regression models using loneliness and isolation as dependent variables assessed the contribution of the new network type to wellbeing. Four support networks were identified: ‘Multigenerational Households: Older Integrated Networks’, ‘Multigenerational Households: Younger Family Networks’, ‘Family and Friends Integrated Networks’ and ‘Non-kin Restricted Networks’. Older South Asians with ‘Non-kin Restricted Networks’ were more likely to be lonely and isolated compared to others. Using network typologies developed with individualistically oriented cultures, distributions are skewed towards more robust network types and could underestimate the support needs of older people from familistic cultures, who may be isolated and lonely and with limited informal sources of help. The new typology identifies different network types within multigenerational households, identifies a greater proportion of older people with vulnerable networks and could positively contribute to service planning.

Acceptance in the domestic environment: the experience of senior housing for lesbian, gay, bisexual, and transgender seniors

The social environment impacts the ability of older adults to interact successfully with their community and age-in-place. This study asked, for the first time, residents of existing Lesbian, Gay, Bisexual, and Transgender (LGBT) senior living communities to explain why they chose to live in those communities and what, if any, benefit the community afforded them. Focus groups were conducted at 3 retirement communities. Analysis found common categories across focus groups that explain the phenomenon of LGBT senior housing. Acceptance is paramount for LGBT seniors and social networks expanded, contrary to socioemotional selectivity theory. Providers are encouraged to develop safe spaces for LGBT seniors.

A Changing Landscape: Implications of Pregnant Women's Internet Use for Childbirth Educators

Internet use among pregnant women is common and frequent, while attendance at childbirth education classes appears to be on the decline. This article explores why women turn to the Internet in pregnancy and how Internet use may affect their knowledge, attitudes, and behaviors. It suggests strategies for engaging women's interest in the Internet and describes how doing so may help increase the effectiveness of "traditional" childbirth education while mitigating the potentially overwhelming and confusing aspects of Internet use.

Approaches to family-friendliness at the Medical Faculty of Tübingen (MFT)

The feminization of the medical profession, demographic change with an impending shortage of physicians, Generation Y - these issues are new challenges for medical schools in terms of their social responsibility and the training of the next generation of highly qualified scientists. This study, conducted by the University Hospital of Ulm throughout Baden-Württemberg via an online survey provides a valuable data basis which can be used to optimise support activities.

A disproportionately high percentage of students with children in Tübingen must, as an additional challenge, cope with a lower than average monthly income. Students with children need organisational support in this doubly challenging situation. The Dean's Office can provide valuable assistance as an advocate (contact with the departments/institutions), provide organisational help (course guidance, individual support) and infrastructure (childcare/changing rooms, etc.). In Tübingen, high intrinsic motivation (willingness to engage in self-managed care networks) is also found amongst students, something that needs to be integrated into the development of the existing support networks.