Getting to the heart of social support:

Abstract 

Purpose: Several epidemiological studies have identified social support as an important determinant of survival and quality of life among patients with coronary artery disease. However, there are still significant gaps in our understanding of the intervening mechanisms through which social support functions. The purpose of this study was to identify intermediary processes that social support might influence to promote positive health among this population.

Methods: During a three-month study period, patients admitted with a diagnosis of myocardial infarction or angina were identified upon admission and invited to participate in individual interviews. Patients were asked to list the types of modifications that they have had to make in their lives in order to remain healthy. Patients were then asked to describe in an open-ended manner, activities performed by members of their social network that they perceived as being most supportive in helping them to make these modifications and to stay healthy. Using qualitative techniques, responses were grouped into similar categories. From these categories, themes describing processes through which social support may function were derived.

Results: Of the 63 patients interviewed: the mean age was 69 years, 40% were female, 17% were African-American, 14% were Latino-American, 56% were married, and 80% had completed high school. Approximately 44% of patients had a previous diagnosis of myocardial infarction. Commonly cited modifications that patients felt they have had to make in order to stay healthy included: making changes in their diet, keeping more doctors appointments, taking their medications, increasing physical activity, and reducing stressful responsibilities at home. Activities performed by social network members that were perceived as being most supportive in helping patients make these modifications fell into the following categories: preparing healthier meals, suggesting recipes of healthy meals, grocery shopping for the patient, accompanying patients to medical visits, going to the pharmacy for the patient, encouraging participation in exercise programs, not smoking or drinking in the presence of the patient, and doing strenuous chores such as lifting, gardening, and shoveling snow. Underlying themes that emerged as potential mechanisms of social support included facilitating adherence, facilitating access to medical care, and minimizing exposure to stress.

Conclusions: We have identified potential mechanisms through which social support functions to impact health. Social support may facilitate adherence to dietary, medication, and exercise regimens; it may facilitate access to medical care; it may also minimize exposure to potential stressors such as strenuous chores. These results may provide guidance in developing educational programs which help family, friends, and health care professionals provide more effective social support as well as serve as a theoretical framework for developing and testing social support interventions.

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