What is support and its types

Social support

Peter Franzkowiak


The term and concept of social support originate from stress and network research in social epidemiology, medical sociology and community psychology. Since the 1950s, there has been a great deal of empirical evidence that stressful social situations, limited or lack of social integration, and lack of social support can promote disease. Conversely, social resources, i.e. help and support that come from a person's social network, act like a psychosocial immune system and can promote health, positive health behavior and maintenance of health, as well as improved coping with illnesses. Social support is a central term from the models for stress and stress management and forms the core of the “collective coping options”. The concept is fundamental to understanding social resources for mental and physical health.

Definition: Social support is a collective term. It encompasses expecting and receiving social services of help and support that people need to cope with challenging and stressful situations. Badura's pioneering early definition defines social support as that “external help that is accessible to the individual through relationships and contacts with his or her social environment and which contribute to maintaining health or avoiding illnesses, overcoming psychological and somatic stresses without harm to health and coping with the consequences of illness ”(1981, 157). The extent of social support that individuals experience depends on the forms of social contact, the degree of familiarity with other people and on earlier exchange processes of social support.

It is provided and maintained in social networks (social capital) and describes their function of mediating helpful transactions between network members. A social network is a complex web of social relationships and symbolic references between individuals. Community relationships in networks are usually characterized by spatial proximity, emotional ties and cultural homogeneity. Personal networks describe structures and interactions of supportive relationships that are related to a person or a specific group. They consist of existing relationships of a primary nature (e.g. work colleagues, neighbors, club members, other references in cultural and religious communities).

For the extent of expected, received or granted social support, it is important to what extent and in what quality people in different networks have beneficial social relationships, how they can subjectively evaluate them and, if necessary, also implement them (Fig. 1).

Components and differentiations: Social support is a multidimensional construct with five essential components:

  • informational support (giving information and tips for solving problems, practical everyday help);
  • instrumental and material support (guidance, help with completing tasks, financial aid and benefits in kind);
  • emotional support (affection, understanding, consolation, discussion, stabilization of self-esteem; social get-together and interaction, belonging and attachment);
  • positive social contact, social integration, relationship security and support;
  • Evaluative, assessment and assessment support (orientation, clarification, problem solving, assessment and confirmation as well as help to assess oneself or one's own situation, skills, needs in a way that promotes coping, thereby strengthening the experience of control).

Social support for smaller everyday problems differs qualitatively and quantitatively from social support in connection with critical life events and crises. When dealing with difficult life situations and critical life events, the following support modalities are particularly effective: social support, loyal compassion, self-esteem support, emotional and cognitive support, socially mediated distraction as well as advice, information and concrete everyday practical help.

A distinction must always be made between expected (perceived) and actual (received) support. It is not only decisive how many social contacts and network options a person has. It is just as important how high and reliable the subjective conviction of this person is that they will actually be supported or can receive support if necessary. Embedding in a network of family and friends is an effective stress resource - even if there is no or not yet objectively helpful interactions. The protective effect consists in the feeling of belonging and the option of being able to mobilize the network in the event of a crisis. Overall, social integration seems to have a rather risk-reducing effect.

Health effects and their explanatory models: Social relationships and bonds can have a health-preserving and health-promoting effect in several ways. On the one hand, they can shield, buffer or neutralize psychosocial stress for those affected. At the same time, helpful social support makes it easier to cope with such burdens successfully or to make it easier to bear them. Four complementary explanatory concepts determine the current scientific discussion (Fig. 2).

Direct Effects Model

Regardless of the extent of the stress experience, social support has a positive effect on health and mental well-being, e.g. by increasing self-esteem and feeling for control as well as promoting health-relevant behavior: social support does not only come into effect when a person is in a stressful situation

Buffer model

People who are already in a stressful situation can cope better with the problem thanks to social support: social support facilitates stress coping, promotes affect regulation and thus buffers negative aspects of stress

Trigger model

People activate social support specifically and effectively only immediately before or in stressful situations

Shield and prevention model

Social support keeps potential and real burdens (largely) away from a person: adequate social integration and involvement in a social network act as a "protective shield" for the occurrence of stressful situations, or they reduce the extent of the stress; Mutual responsibility and obligations also increase the acceptance of socially acceptable and health-promoting behavior

Fig. 2: Approaches to explaining the effectiveness of social support

The nature, extent and quality of people's social relationships are of fundamental importance for their quality of life and their physical and mental health. If there is a sufficient level of generally supportive social relationships, this has a direct positive influence on the well-being, physical and social performance, mental robustness and physical immune potential. However, the health impact depends on the relationship structure between recipient and donor. It may be that the same kind of help is easily accepted and accepted by one person, while another person judges it as unacceptable. Who has to provide what kind of social support or by whom it is regarded as sufficient is determined by normative behavioral expectations, by expectations of reciprocity and by the level of emotional relationships.

In the Anglo-American region, a model has been widespread for decades that links social support against the effects of stressors with individual coping resources, setting-related and community / community resources, multidimensional health and individual (and collective) health behavior. In this dynamic system of interactions, five possible pathways of social support are identified. These have scientific explanatory value, but can also serve as the basis and priorities for effective interventions (see Fig. 3).

Functions of social networks: Social support in interpersonal networks has high instrumental importance in every phase of life for regulating emotions, constructing reality and quality of life. It forms an essential resource for being able to constructively cope with acute or chronic stressors (i.e. stressful personal, family, work-related, economic and socio-cultural challenges and living conditions) (resilience and protective factors, salutogenic perspective). The more a person is involved in a diverse social relationship with important caregivers, supportive and advising people and accepts and appreciates them as a transaction partner, the better this person can deal with unfavorable social conditions, critical life events and ongoing stresses. Symptoms of being overwhelmed are less likely to occur. The extent of psychophysical disorders, illnesses and the consequences of illness is reduced. Social networks can therefore be referred to as “social immune systems”.

Relationships of varying intensity and closeness are required in an optimal social support network. Not only do close relationships have to be sufficiently available, a functioning network also includes a range of less close social relationships. However, the extent and intensity of the primary, i.e. the closest and most close ties, have proven to be the most important predictors of life expectancy - regardless of age, gender or health risk factors. The Strength of tight networks, especially the small family, lies in their sustained help with constant stress. Close and stable primary relationships with a reliable high contact density are particularly important in early childhood and in the last phase of life as resources for avoiding stress, coping with stress and for creating identity and meaning.

Ambivalence of concept and effects: Social support can produce not only positive but also negative effects. According to Leppin and Schwarzer, the term should therefore be defined as “ambivalent”. The stressful aspects of negative support include:

  • unwanted or inadequate support;
  • disappointed support expectations;
  • excessive help and intrusive behavior;
  • problematic relationships between those involved with hostile-aggressive and derogatory behavior;
  • Intensification of stress reactions through additional emotionalization;
  • load-related ineffectiveness.

Such burdens are caused by obligations, power imbalances, conflicts and burdens that, objectively or subjectively, represent more effort than benefit for one or both sides. Stressful relationships are often closely linked to certain roles, which are particularly present in contacts that are not chosen voluntarily (e.g. relatives) or inevitable (e.g. generational, neighborly or collegial) contacts. They cannot be ended with this, or only with considerable social and emotional effort. In research there is still a lack of complex analyzes of this mutual dependency of beneficial and negative effects in close social relationships - especially in the case of inadequate or failed attempts at support, problematic support relationships or overloading of helping people (health promotion and care).

Supportive components can mix with other pressures, tensions and conflicts. Self-esteem can be threatened in social contacts, or peer pressure can force problem behavior (for example, substance-related trying and risk behavior in the youth phase). Problem relationships in couple relationships or family systems can directly or indirectly promote the emergence of health impairments: e.g. in the emergence and maintenance of addiction risks, psychosomatic disorders or early childhood attachment and interaction disorders (early help). Even if a satisfactory job has a significant health impact on wellbeing, work can be a source of numerous and protracted health risks. The respective health gain from social support depends on the respective health attitudes of a network.

Social inequality: Like other forms of health-related action, social support is subject to restrictions due to social inequality and cultural-ethnic differences (health promotion for people with a migration background). It is known from medical-sociological research that there is a disproportion between a particularly high level of social stressors and particularly low options for social and personal resources in the lower social classes and in educationally disadvantaged population groups. Objectively existing social support is also subjectively perceived worse or not at all, which means that it is used less well. The less available coping strategies are less effective. Protective factors such as self-efficacy and control are less developed than among members of the middle and upper classes.

Measuring social support in epidemiological studies: “The indicator of social support was recorded in the RKI study GEDA 2014/2015-EHIS through the self-declaration of the respondents in a written or online questionnaire. The degree of perceived social support was measured using the Oslo 3 Items Social Support Scale. Specifically, the following questions were asked: "How many people are so close to you that you can rely on them when you have serious personal problems?" (Answer options: none, 1 to 2, 3 to 5, 6 or more), " How much sympathy and interest do other people show in what you do? ”(Answer options: very much, much, neither much nor little, little, none) and“ How easy is it for you to get practical help from neighbors when Do you need them? ”(Answer options: very simple, easy, possible, difficult, very difficult). The scale measures the subjectively perceived availability of social support. By adding the individual point values ​​from the three questions, an index was formed that can have values ​​between 3 and 14 points. The range from 3 to 8 points is classified as low support, from 9 to 11 points as medium support and from 12 to 14 points as strong support. "(Borgmann et al 2017, 118 - without references there)

The GEDA surveys in 2012 and 2014 by the Robert Koch Institute confirm these trends for the German population. It is true that more than four fifths of Germany's adult population have, according to their own perception, social ties and networks from which they receive medium to strong support. However, there is a demonstrable educational gradient in the self-perceived availability of social support. The proportion of poorly supported men and women increases with a falling level of education and permanent inactivity. In particular, population groups that are more frequently affected by health problems can only access this (coping) resource to a lesser extent. Furthermore, the proportion of men and women who have little access to social support increases gradually with age.

Gender differences in the mobilization and perception of social support are significant, which additionally intensify such status-related differences: Women tend to have larger social networks, especially more close caregivers, seem to be more willing to actively seek social support and, above all, they feel comfortable Middle-aged people are also more strongly supported - especially when it comes to forms of emotional support.

Open questions, new fields and research needs: After decades of intensive psychological, sociological, health science, neurobiological and immunological research and intervention, there are still many open questions, in particular about the social, demographic and psychobiological moderator variables. The editorial of a special issue of the specialist journal "Health Psychology" published in 2014 on the role of social networks in adult health named the most important current and future research tasks:

  • the acquisition and deepening of knowledge about the health significance and effects of social changes in the network area (e.g. shrinking of social networks with advancing age; effects of personal or professional transitions on the establishment and maintenance of supportive social relationships; decrease in the number and proximity of social reference persons through individualization and singularization processes in the baby boomer generation and their successors; differentiated meaning of voluntary vs. involuntary / forced change processes in reference networks);
  • Obtaining data and developing reliable explanatory models for the importance of socio-economic status, gender, relationship and partnership status as well as ethnic-cultural framework conditions with regard to the restrictions or limitations of social support networks and ties and their health-related effects.

Internationally, studies on the validity and transfer potential of the results and models of previous network health research have increased in recent years virtual social networks as well as checking the effectiveness of “ehealth online social support groups / communities” in the context of internet-based wikis, blogs or social network sites. An exemplary question was: "Does social support through" facebook friends "bring real, measurable health benefits?"

Ngenye / Wright (2018) summarize the current international status with a focus on mutual helpful support in coping with health / disease problems and disabilities (“individuals coping with health concerns”). The various differentiations of virtual social networks and their (potential) health effects and the current relevance as well as connectivity for health promotion are discussed in the key term social media: Health promotion with digital media as of 2017.

Central nervous mechanisms of social support operate at the cardiovascular, endocrine, and immune system levels. Research into mediating neuro- and psychobiological mechanisms for direct and indirect protective effects of social support on physical stress reactivity is therefore gaining increasing importance and scope - both in experimental laboratory and in empirical field studies.

Practical relevance: The stress-coping concept, the network perspective and the social support category, which is central in both models, are core areas of the socio-epidemiological and psychological foundation of the health sciences. The research results are increasingly used for the conceptual justification of health-promoting interventions and their evaluation. The knowledge about the effectiveness of social support is important for practical strategies of health promotion such as health-related community work, self-help promotion or organizational development as well as company health promotion and occupational safety. Network support strengthens existing and develops new network connections, examines questionable structures and resolves them if necessary. It integrates the helpers into the everyday environment of the community, neighborhood and workplace and gives recipients of support options. Practice-related networking is integrative psychosocial work.

Literature:

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Badura B (ed.), Social Support and Chronic Illness, Frankfurt / M. 1981;
Badura B / Knesebeck Ovd, Sociological Foundations of Health Sciences, in: Hurrelmann K / Razum O (Hg), Handbook of Health Sciences, Weinheim 2012, 187-220;
Borgetto B / Kälble K, medical sociology, Weinheim 2007;
Borgmann LS / Rattay P / Lampert T, Social Support as Resource for Health, in: Journal of Health Monitoring, 4, 2017 (2), 117-123 (DOI 10.17886 / RKI-GBE-2017-120);
Bruns W, Health Promotion through Social Networks, Wiesbaden 2013 - in particular chap. 4 (89-124);
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Ngenye L / Wright K, Online Social Support Groups / Communities: Implications of Theoretical and Empirical Findings for Individuals Coping with Health Concerns, in: Sekalala S / Niezgoda BC (eds), Global Perspectives on Health Communication in the Age of Social Media, Hershey PA 2018, 1-23;
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Uchino B, Understanding the Links Between Social Support and Physical Health, in: Perspectives on Psychological Science, 2009 (4), 3, 236-255

References:

Evaluation, early help, health-related community work, health promotion and migration background, health promotion and prevention in care, organizational development as a method of health promotion, resilience and protective factors, salutogenesis, self-help, self-help groups and self-help promotion, social media / health promotion with digital media, social inequality and health / Illness, social capital, stress and stress management