The Role of Social Support in Multiple Morbidity: Self-Management among Rural Residents

Social support generally is considered a valuable asset that may compensate for health service deficiencies among rural populations. Employing a mixed methods approach, we explored how vulnerable rural residents described social support in the context of self-management for multiple chronic conditions. Participants generally felt support was available, though emotional/informational support was perceived as less available than other types of support. Participants did not rely heavily on informal support to help them manage their multiple morbidities, preferring to call on their doctor and their own resources. We discuss implications of these findings for meeting this vulnerable population's self-management needs.

[1]  McIntosh Wa,et al.  Social support, stressful events, strain, dietary intake, and the elderly. , 1989 .

[2]  B. J. Mcculloch,et al.  The relationship of family proximity and social support to the mental health of older rural adults: The Appalachian context , 1995 .

[3]  Kelly A. Dorgan,et al.  The mountains hold things in: the use of community research review work groups to address cancer disparities in Appalachia. , 2007, Oncology nursing forum.

[4]  E. Harner,et al.  An Analysis of Disparities in Health Status and Access to Health Care in the Appalachian Region Executive Summary September 2004 , 2005 .

[5]  Eve A Kerr,et al.  The impact of comorbid chronic conditions on diabetes care. , 2006, Diabetes care.

[6]  An Analysis of the Financial Conditions of Health Care Institutions in the Appalachian Region and their Economic Impacts Final Report December 2002 , 2003 .

[7]  B Downe-Wamboldt,et al.  Content analysis: method, applications, and issues. , 1992, Health care for women international.

[8]  C. Stadtländer Improving Aging and Public Health Research: Qualitative and Mixed Methods , 2008 .

[9]  H. Goodman In-Depth Interviews , 2001 .

[10]  N. Woods,et al.  Social support for women during chronic illness: the relationship among sources and types to adjustment. , 1990, Research in nursing & health.

[11]  Bruce Behringer,et al.  Appalachia: Where Place Matters in Health , 2006, Preventing chronic disease.

[12]  C. Sherbourne,et al.  Social support and stressful life events: age differences in their effects on health-related quality of life among the chronically ill , 1992, Quality of Life Research.

[13]  C. Sherbourne,et al.  The MOS social support survey. , 1991, Social science & medicine.

[14]  A. Anderson,et al.  In-depth Interviewing , 2011 .

[15]  K. Fiandt,et al.  Determinants of Health‐Promoting Lifestyle Behaviors in Rural Older Women , 2001, Family & community health.

[16]  A. Bushy Rural women. Lifestyle and health status. , 1993, The Nursing clinics of North America.

[17]  R. Kessler,et al.  Perceived support, received support, and adjustment to stressful life events. , 1986, Journal of health and social behavior.

[18]  K. Kelsey,et al.  Is Social Support Beneficial for Dietary Change? A Review of the Literature , 1997 .

[19]  E. Merwin,et al.  De Facto Mental Health Services in the Rural South , 1995, Journal of health care for the poor and underserved.

[20]  Sheldon Cohen,et al.  Social support theory and measurement. , 2000 .

[21]  K. Belanger,et al.  The social service divide: service availability and accessibility in rural versus urban counties and impact on child welfare outcomes. , 2008, Child welfare.

[22]  M. Engle Book Review: Qualitative Data Analysis: An Expanded Sourcebook (2nd Ed.) , 1999 .

[23]  J. Strong,et al.  The concept of well-being in a rural setting: understanding health and illness. , 1997, The Australian journal of rural health.

[24]  Anne M. Tomolo,et al.  Association of contextual factors and breast cancer screening: finding new targets to promote early detection. , 2007, Journal of women's health.

[25]  Marilyn L. Mitchell,et al.  In-Depth Interviews , 2013 .

[26]  D. Revicki,et al.  Strain, social support, and mental health in rural elderly individuals. , 1990, Journal of gerontology.

[27]  P. A. Shifflett,et al.  Social Support, Stressful Events, Strain, Dietary Intake, and the Elderly , 1989, Medical care.

[28]  Patricia D. Beaver Rural Community in the Appalachian South , 1986 .

[29]  M. W. Riley Aging From Birth To Death: Interdisciplinary Perspectives , 1979 .

[30]  J. House Social support and social structure , 1987 .

[31]  Harry Specht,et al.  Social Support, Social Networks, Social Exchange, and Social Work Practice , 1986, Social Service Review.

[32]  D. Rowland,et al.  Triple jeopardy: rural, poor, and uninsured. , 1989, Health services research.

[33]  K. Huttlinger,et al.  Health care in Appalachia: a population-based approach. , 2004, Public health nursing.

[34]  T. Ricketts The changing nature of rural health care. , 2000, Annual review of public health.

[35]  R. Lazarus,et al.  The health-related functions of social support , 1981, Journal of Behavioral Medicine.

[36]  Sandra L. Hofferth,et al.  Social Capital in Rural and Urban Communities1 , 1998 .

[37]  D. Gustafson,et al.  Perceived helpfulness and impact of social support provided by family, friends, and health care providers to women newly diagnosed with breast cancer , 2007, Psycho-oncology.

[38]  C. Berkey,et al.  Social networks, stress and health-related quality of life , 1998, Quality of Life Research.

[39]  Matthew B. Miles,et al.  Qualitative Data Analysis: An Expanded Sourcebook , 1994 .

[40]  Benjamin H. Gottlieb,et al.  Social support measurement and intervention: A guide for health and social scientists. , 2000 .

[41]  David Hartley,et al.  Rural health disparities, population health, and rural culture. , 2004, American journal of public health.

[42]  N. Krause,et al.  Social class differences in social support among older adults. , 1995, The Gerontologist.

[43]  P. A. Hayes Home Is Where Their Health Is: Rethinking Perspectives of Informal and Formal Care by Older Rural Appalachian Women Who Live Alone , 2006, Qualitative health research.

[44]  D. Taylor,et al.  A Systematic Approach for Using Qualitative Methods in Primary Prevention Research , 1990 .

[45]  William F Lawrence,et al.  Mortality: What Are the Roles of Risk Factor Prevalence, Screening, and Use of Recommended Treatment? , 2005 .

[46]  F. Bryant We're All Kin: A Cultural Study of a Mountain Neighborhood , 1981 .

[47]  J A Knottnerus,et al.  Multimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases. , 1998, Journal of clinical epidemiology.

[48]  R. T. Coward,et al.  Residential differences in attitudes about barriers to using community-based services among older adults. , 1998, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[49]  P. Dykstra Aging and social support , 2007 .

[50]  B. Penninx,et al.  Social Network, Social Support, and Loneliness in Older Persons with Different Chronic Diseases , 1999, Journal of aging and health.

[51]  Hsiu-Fang Hsieh,et al.  Three Approaches to Qualitative Content Analysis , 2005, Qualitative health research.

[52]  J. B. Edwards,et al.  The relationships among gender, perceived financial barriers to care, and health status in a rural population. , 1996, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[53]  William D. Marder,et al.  Multiple Chronic Conditions: Prevalence, Health Consequences, and Implications for Quality, Care Management, and Costs , 2007, Journal of General Internal Medicine.

[54]  Linda K Heitman,et al.  The Influence of Social Support on Cardiovascular Health in Families , 2006, Family & community health.

[55]  S Gore,et al.  The effect of social support in moderating the health consequences of unemployment. , 1978, Journal of health and social behavior.

[56]  K. Jackson,et al.  Social support, coping, and medication adherence among HIV-positive women with depression living in rural areas of the southeastern United States. , 2007, AIDS patient care and STDs.

[57]  Nancy L Kondracki,et al.  Content analysis: review of methods and their applications in nutrition education. , 2002, Journal of nutrition education and behavior.

[58]  H. Bernard Research Methods in Anthropology: Qualitative and Quantitative Approaches , 1988 .

[59]  S. Keefe Southern Appalachia: Analytical models, social services, and native support systems , 1986, American journal of community psychology.

[60]  Anthony F Jerant,et al.  Patients' perceived barriers to active self-management of chronic conditions. , 2005, Patient education and counseling.

[61]  L. Resick,et al.  Health beliefs, health care, and rural Appalachian subcultures from an ethnographic perspective , 1990 .

[62]  C. Sherbourne,et al.  Marital status, social support, and health transitions in chronic disease patients. , 1990, Journal of health and social behavior.

[63]  J. Flaskerud,et al.  Conceptualizing vulnerable populations health-related research. , 1998, Nursing research.

[64]  Martin Fortin,et al.  Prevalence of Multimorbidity Among Adults Seen in Family Practice , 2005, The Annals of Family Medicine.

[65]  J. Potter,et al.  Predictors of cancer prevention attitudes and participation in cancer screening examinations. , 1994, Preventive medicine.

[66]  G. Rowles,et al.  Persistent Elderly Poverty in Rural Appalachia , 1993 .

[67]  E. Serrano,et al.  Self-efficacy and health behaviors toward the prevention of diabetes among high risk individuals living in appalachia , 2007, Journal of Community Health.

[68]  J. Phillip Thompson,et al.  Social Capital and Poor Communities , 2003 .

[69]  G. Duncan,et al.  Does neighborhood and family poverty affect mothers' parenting, mental health, and social support? , 1994 .

[70]  John F. Steiner,et al.  Descriptions of Barriers to Self-Care by Persons with Comorbid Chronic Diseases , 2003, The Annals of Family Medicine.

[71]  P. Thoits,et al.  Stress, coping, and social support processes: where are we? What next? , 1995, Journal of health and social behavior.

[72]  Eugene J Lengerich,et al.  Cancer incidence in Kentucky, Pennsylvania, and West Virginia: disparities in Appalachia. , 2005, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[73]  M. Casper,et al.  Geographic disparities in heart disease and stroke mortality among black and white populations in the Appalachian region. , 2002, Ethnicity & disease.

[74]  M. Gallant The Influence of Social Support on Chronic Illness Self-Management: A Review and Directions for Research , 2003, Health education & behavior : the official publication of the Society for Public Health Education.

[75]  M. Patton Qualitative research and evaluation methods , 1980 .

[76]  A. Tickamyer,et al.  Poverty and Opportunity Structure in Rural America , 1990 .

[77]  C. Murray,et al.  Eight Americas: new perspectives on U.S. health disparities. , 2005, American journal of preventive medicine.

[78]  L. George,et al.  Religious involvement, social ties, and social support in a southeastern community , 1994 .

[79]  C. Leukefeld,et al.  Qualitative Differences Among Rural and Urban Intimate Violence Victimization Experiences and Consequences: A Pilot Study , 2003, Journal of Family Violence.

[80]  Ronnie J. Evans A Comparison of Rural and Urban Older Adults in Iowa on Specific Markers of Successful Aging , 2009, Journal of gerontological social work.

[81]  D. Blazer,et al.  Health services access and use among older adults in North Carolina: urban vs rural residents. , 1995, American journal of public health.

[82]  Susan Bolick-Aldrich,et al.  Cancer in Appalachia, 2001–2003 , 2008, Cancer.

[83]  Seth Sanders Demographic and Socioeconomic Change in Appalachia LABOR MARKET PERFORMANCE, POVERTY, AND INCOME INEQUALITY IN APPALACHIA , 2004 .