CHAPTER 2: Literature Review
2.12 Family and Social support
study by Ford et al, limits the transferability of this study to the study population.116 The study by Costal et al is limited by recall bias as the methodology in this study entailed patients having to recall facts about their family members that related to the care necessary to control their blood pressure.21 Since the studies by Lubaki et al and Flynn et al were qualitative in design and focus group interviews were used, the findings of these studies may also not be generalize able to the entire population.115,117
2.12.1 The role of family in health and diseases.
The family is the primary social context in which health promotion and disease prevention takes place. The World Health Organization characterized the family as the “primary social agent in the promotion of health and well-being”.129 The family is a primary health referring and referral source and the cooperation of the family is often necessary in fulfilling medical treatment prescribed by a physician. Lifestyle behaviour (smoking, exercise, diet) and health care influenced by family members. Also, behaviours are usually developed, maintained, or changed within the family setting. Family members, particularly a spouse, appear to be the most important source of social support, and account for most of the association between social support and health.129
Health outcomes associated with good social support include lower susceptibility to disease, lower cardiovascular reactivity, enhanced immune function, better adjustment to recovery from illness, lower rates of mortality, and increased psychological well-being.130
Adetunji et al in South west Nigeria observed better glycaemic control in patients with type 2 diabetes mellitus who had high perceived family support.131 In the same region of Nigeria, Adebisi et al. observed that poor family support was associated with longer duration of illness, treatment and poor quality of life in patients with schizophrenia.132 Aggrawal et al. discovered that low social support especially from the family member leads to poor dietary adherence thus increasing the risk of cardiovascular disease (CVD).133 Patients with stronger social relationships were also described to have 50% increased likelihood of survival in a meta-analytical review by Holt-Lunstad et al.126
2.12.2 Relationship between family support and blood pressure control
The family can be the source of inherited cardiovascular risk for development of hypertension.
The family activities which also cause stress and anxiety for hypertensive patients have been identified to aggravate their health condition.118 Poor social network and relationship has also been associated with higher blood pressure figures in patients with hypertension than
hypertensive patients with wider social networks and the race difference among those without social support was larger compared to those with social support.134 Hence, social support improves blood pressure control.
Good family support also increases patient’s adherence to treatment. Family members can provide many kind of social support, however, instrumental support (i.e observable actions that make it possible or easier for an individual to perform healthy behaviours) has been most strongly associated with adherence to therapy.135’ 136 Magrin et al found that therapy adherence is strongly related with family support provided to the hypertensive patient in a meta-analysis on social support and adherence to treatment in hypertensive patients.135 Likewise, families with less organization or less cohesion are also predictive of poor adherence to the therapeutic regimen and thus results in poor blood pressure control. This is consistent with findings by DiMatteo et al. in a meta-analysis on social support and adherence to medication where adherence was 1.7 times higher in patients from cohesive families and 1.5 times lower in patients from families in conflict.136
2.12.3 Relationship between psychological well-being and blood pressure
Morbidities such as hypertension have been linked with increased mental and emotional distress.137 Depressive symptoms and high stressful life events are linked with low adherence and uncontrolled blood pressure.138 a cross-sectional study on elderly Mexican-Americans done in Texas showed that high positive emotions caused reduction in blood pressure with or without usage of antihypertensives.139 In another study on the effect of loneliness and blood pressure in middle-aged and older adults, Hawkley et al. reported greater increase in systolic blood pressure with loneliness over a 4 year period. This effect was independent of age, gender, race/ethnicity, cardiovascular risk factors, medications, health conditions, and the effects of depressive symptoms, social support, perceived stress, and hostility.140
2.12.4 Relationship between family support and psychological well-being.
The evidence available from literature agree that when examined as an independent variable, social support is found to affect health and well-being directly and indirectly by buffering stress, changing affective state, increasing self-efficacy and influencing change in negative health behaviours.127 Two main models have been proposed to describe the link between social support and health: the buffering hypothesis and the direct effect hypothesis.127
The direct effect hypothesis, also known as the “main” or “deterring effect” suggests that social support is beneficial all the time to health and well-being by enhancing self-esteem and by fostering positive health outcome among people who believe that others count on them. This effect has been observed in the study of physical health, such as done by Uchino.130 The
“buffering effect” of social support refer to the interaction of support with stress or variables.
Studies of the buffering effect have shown that social support can reduce the impact of life events and chronic status on health and well-being. The more the social support, the better the well-being and mental health, regardless of the level of stress, and the best buffer for stress identified was emotional support.141 This suggests that perceived support has a greater impact on well-being because the association between social support and well-being is cognitively mediated.
Social support is associated with increased psychological well-being and reduced psychological distress.142 Conversely, studies have found that elderly people who were providers rather than recipients of social support have higher rates of mental disorder of varying patterns.143 The
“empty nest syndrome” was also reported in china to be associated with poor mental health and life satisfaction.144