"I Could Never Tell My Parents": Barriers to Queer Women's College Sexual Assault Disclosure to Family Members

Queer women are at high risk of college sexual victimization, but they face barriers to formal support services. As a result, informal support is critical. This study uses data from 40 open-ended interviews to explore family members' reactions to queer women's disclosures and examine whether their family is a reliable source of informal support. Findings indicate that family reactions are often more harmful than helpful. In comparison to research focused on heterosexual survivors, we find family reactions to be more extreme and disparaging of queer survivors' sexual identities. In fact, family members' negative reactions may pose barriers to accessing formal services.

‶You look really good, I don't know why you came here″: persons with multiple sclerosis´ perspectives on social support

The aim of this qualitative study is to gain insight into the perspectives of persons with multiple sclerosis on social support. Semi-structured interviews were conducted with eleven persons with multiple sclerosis. The results on informal support for persons with multiple sclerosis reveal perceived support and the lack of support from different persons. The results on formal support for persons with multiple sclerosis show perceived support from healthcare professionals, professionals working outside healthcare and social care systems, and associations of persons with MS, but also inadequate support from healthcare professionals and social workers. Close emotional relationship, empathy, knowledge and understanding are the basis for provision of all types of support from informal support system, while perceived support from formal support system is based on professionals´ empathy, their professionalism and knowledge. Persons with multiple sclerosis need accurate and timely emotional, informational, practical and financial support.

Support as described by fathers with intellectual disabilities

BACKGROUND

Many fathers with intellectual disabilities experience some difficulties in fulfilling their parenting role due external factors. The quality of their parenting depends on various factors, including the availability and adequacy of support. The aim of this study was to understand the lived experiences associated with social support of fathers with intellectual disabilities.

METHOD

The organisation of the research and data analysis were carried out in accordance with Interpretative Phenomenological Analysis. Semi-structured interviews were conducted with 20 fathers with intellectual disabilities.

RESULTS

In the analysis, three interrelated themes emerged: Discrepancies between needs and provision of support; Discriminatory practices and feeling (dis)empowered; and Recognition of support.

CONCLUSIONS

Fathers described negative aspects of their experiences that were not conducive to strengthening paternal competences and led to a sense of loneliness. Positive aspects also emerged, indicating that fathers were determined to fulfil their role despite the lack of adequate support for their needs.

Older Korean Americans' Perceived Burdensomeness to Their Healthcare Partners: An Egocentric Network Assessment

Objectives: The objective is to examine how older Korean Americans' perceived burdensomeness to their healthcare partners is associated with the characteristics of older adult participants (egos) and their healthcare partners (alters). Methods:Surveys of 2150 participants in the Study of Older Korean Americans provided ego data. Participants were also asked to list up to three individuals whom they usually asked for help on health-related matters or healthcare use, which generated 3402 alters. Multilevel modeling was conducted to examine the role of the characteristics of egos and alters, as well as their cross-level interactions. Results: Perceived burdensomeness was negatively associated with English-speaking ability and residence in a low Korean density area. Perceived burden was also lowered when emotional support was received from the alters, and this pattern was pronounced among those with multi-comorbidity. Discussion: By identifying older immigrants prone to the sense of burdensomeness, the study suggests strategies to promote their health and healthcare use.

Lessons Learned From an Effectiveness Evaluation of Inlife, a Web-Based Social Support Intervention for Caregivers of People With Dementia: Randomized Controlled Trial

BACKGROUND

Informal care for people with dementia not only affects the well-being of the primary caregiver but also changes their roles and interactions with the social environment. New online interventions might facilitate access to social support. Recently, an online social support platform, Inlife, was developed in the Netherlands and aims to enhance social support and positive interactions in informal support networks.

OBJECTIVE

This study aimed to evaluate the effectiveness of Inlife for caregivers of people with dementia.

METHODS

A randomized controlled trial with 96 caregivers of people with dementia was performed. Participants were randomly assigned to the Inlife intervention or the waiting list control group. After 16 weeks of Inlife use, the waiting list control group could start using Inlife. Effects were evaluated at baseline (T₀), 8 weeks (T₁), and 16 weeks (T₂). The 16-week follow-up assessment (T₂) served as the primary endpoint to evaluate the results for the primary and secondary outcome variables evaluated with online self-report questionnaires. The primary outcomes included feelings of caregiver competence and perceived social support. The secondary outcomes included received support, feelings of loneliness, psychological complaints (eg, anxiety, stress), and quality of life.

RESULTS

No significant improvements were demonstrated for the intervention group (n=48) relative to the control group (n=48) for the primary outcomes (feeling of carer competence: b=-0.057, 95% CI -0.715 to 0.602, P=.87; perceived social support: b=-15.877, 95% CI -78.284 to 46.530, P=.62) or any secondary outcome. This contrasts with our qualitative findings showing the potential of Inlife to facilitate the care process in daily life. Adherence was not optimal for all Inlife users. Additional per-protocol and sensitivity analyses also revealed no beneficial results for high active Inlife users or specific subgroups. Inlife users were more active when part of a larger network.

CONCLUSIONS

Researchers should be modest regarding the effectiveness of online caregiver interventions in terms of quantitative measures of well-being and quality of life. Nevertheless, online tools have the potential to facilitate the caregiver process in daily life. Lessons learned include the importance of harnessing the power of human interaction in eHealth, making use of the user's social capital, and the need to develop research methods that can identify benefits in daily life that are ecologically valid for caregivers.

TRIAL REGISTRATION

Netherlands Trial Register NTR6131; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6131.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s13063-017-2097-y.

Examining the Relationship between Paternal Mental Health and Informal Support Networks: Reflections on the Impact of the COVID-19 Pandemic

Paternal mental health remains an under-researched area in the UK. Consequently, father-focused formal and informal support provisions fail to address the complex emotional and psychological wellbeing needs of fathers. Drawing on data from twenty semi-structured interviews with fathers in the York area, this study seeks to better understand how access to and participation in informal support networks is influenced by gendered perceptions and the impact hegemonic perceptions of masculinity have on fathers' access to support prior and during the COVID-19 pandemic. The findings demonstrate that fathers internalise stereotypical masculine tropes, such as stoicism, which prevent them from actively seeking support. While fathers value informal support network, they generally struggle to engage in mental health talks. The COVID-19 lockdown exacerbated fathers' struggles to access informal support or prioritise their mental health. Fathers felt the pandemic presented a unique challenge that only people that became parents at the time understood. This meant that fathers could not rely on their parents or other parents who did not have similar experiences of the COVID-19 pandemic. This paper aims at challenging structural and cultural barriers that inhibit fathers' participation in informal support networks, and to promote more meaningful, supportive engagement with peer groups.

Coping with the stress of providing mental health-related informal support to peers in an LGBTQ context

Many lesbian, gay, bisexual, trans or gender diverse, or queer-identifying (LGBTQ) people provide informal support to peers experiencing mental ill health. This reflects both the high prevalence of mental ill health in their communities - often a product of discrimination - and barriers to accessing formal services. In this article, we explore how LGBTQ people who help peers with their mental health seek to cope with the stress of providing such support. Drawing on interviews with 25 LGBTQ people in Melbourne, Australia, we consider how community members being 'leant on' engage in self-care practices and seek help from their communities to cope with the stress of their support roles. We demonstrate that participants' ways of coping, even when similar, can vary in effectiveness and often come with limitations. Thus, we conclude that LGBTQ people providing informal support to peers should be better assisted to do so, in ways that acknowledge the diversity of support provided in LGBTQ communities.

Integrating Natural Language Processing and Interpretive Thematic Analyses to Gain Human-Centered Design Insights on HIV Mobile Health: Proof-of-Concept Analysis

BACKGROUND

HIV mobile health (mHealth) interventions often incorporate interactive peer-to-peer features. The user-generated content (UGC) created by these features can offer valuable design insights by revealing what topics and life events are most salient for participants, which can serve as targets for subsequent interventions. However, unstructured, textual UGC can be difficult to analyze. Interpretive thematic analyses can preserve rich narratives and latent themes but are labor-intensive and therefore scale poorly. Natural language processing (NLP) methods scale more readily but often produce only coarse descriptive results. Recent calls to advance the field have emphasized the untapped potential of combined NLP and qualitative analyses toward advancing user attunement in next-generation mHealth.

OBJECTIVE

In this proof-of-concept analysis, we gain human-centered design insights by applying hybrid consecutive NLP-qualitative methods to UGC from an HIV mHealth forum.

METHODS

UGC was extracted from Thrive With Me, a web app intervention for men living with HIV that includes an unstructured peer-to-peer support forum. In Python, topics were modeled by latent Dirichlet allocation. Rule-based sentiment analysis scored interactions by emotional valence. Using a novel ranking standard, the experientially richest and most emotionally polarized segments of UGC were condensed and then analyzed thematically in Dedoose. Design insights were then distilled from these themes.

RESULTS

The refined topic model detected K=3 topics: A: disease coping; B: social adversities; C: salutations and check-ins. Strong intratopic themes included HIV medication adherence, survivorship, and relationship challenges. Negative UGC often involved strong negative reactions to external media events. Positive UGC often focused on gratitude for survival, well-being, and fellow users' support.

CONCLUSIONS

With routinization, hybrid NLP-qualitative methods may be viable to rapidly characterize UGC in mHealth environments. Design principles point toward opportunities to align mHealth intervention features with the organically occurring uses captured in these analyses, for example, by foregrounding inspiring personal narratives and expressions of gratitude, or de-emphasizing anger-inducing media.

Informal support and obligation contribute to fewer child behavior problems over time

OBJECTIVE

This study used longitudinal data from a sample of low-income mothers and their children to examine how informal support and obligation, or informal networks, contribute to children's behavior. We also tested the potential mediating role of maternal parenting stress.

BACKGROUND

Many studies document the importance of informal support for maternal stress and child behavior to offset the negative impact of poverty for low-income families. Evidence suggests the importance of also considering the obligations that such informal support access may impart.

METHOD

Using data from the Welfare, Children, Families Study, a longitudinal study of diverse, low-income, urban mothers in three cities (n = 2,142), we used a parallel process latent growth curve model approach to examine how informal support and obligation contributed to maternal stress and child behavior.

RESULTS

Models indicated that mothers with healthy safety nets, including informal support and manageable obligations, had children with fewer behavior problems, and parenting stress partially accounted for the positive effects.

CONCLUSIONS

Results highlight the importance of considering reciprocity norms among low-income mothers; one-sided support or obligation can be problematic for both maternal stress and child behavior problems.

IMPLICATION

Results suggest the merit of empirically supported interventions to teach relationship skills and facilitate healthy relationships among low-income mothers.

"Walking on Eggshells:" A Qualitative Study of How Friends of Young Women Experiencing Intimate Partner Violence Perceive Their Role

Young women who experience intimate partner violence (IPV) are most likely to turn to their friends for help. Although friends can play a critical role in providing support, there is little research that examines friends' experiences. In this qualitative study, we explored how friends of young women experiencing IPV perceived their role in responding to IPV in the context of friendship. We held in-depth interviews with 15 friends of young women who had experienced IPV and used reflexive thematic analysis to develop key themes from the data. We developed two overarching themes that reflected participants' perceptions of the roles they had played or considered as a friend in responding to IPV: "taking action" (which included "providing an outsider's view," "being an advisor or coach," "being a protector," and "taking a stand"); and "being there" (which included "being a listener," "being a companion" and "being an ally"). Their perceptions were shaped by friendship expectations, as well as by understandings of IPV. However, deciding what role to play in supporting their friend was constructed as challenging due to conflicting expectations that arose in the context of friendship. It involved balancing a perceived responsibility to do what they thought was best for their friend's well-being, a need to promote honesty and mutuality in the friendship, along with a competing obligation to respect their friend's choices, maintain her trust and ensure equality in the friendship. Being friends with the abuser as well as with the victim created additional complexities. Based on our findings, we identify key areas to address in developing interventions to assist friends to respond to young women experiencing IPV. These could guide friends on how to play an effective support role while also maintaining the friendship and managing the significant emotional impacts of providing help.

Valuable Informal Bereavement Support Strategies for Bereaved Parents of Stillborn, Young Children, and Adult Children: A Scoping Review

Background: Informal support of a bereaved parent is common after the loss of a child (stillborn, young or adult child); however, it is not clear which aspects of informal support were perceived to be helpful by the bereaved parent. The aim of this scoping review is to clarify from the standpoint of bereaved parents what are considered helpful and unhelpful characteristics of informal support given by the support network of bereaved parents. Methods: A comprehensive search of databases from 2000 to April 20, 2020 was conducted for clinical studies published in English on informal bereavement support of adult bereaved parents of stillborn to adult children; 52 articles met criteria for the scoping review. The databases included Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, Ovid PsycINFO, and Scopus. Results: Specific supportive strategies reported by parents as helpful more frequently included talking with other supportive persons felt to be supportive, meeting another person with a similar type of loss, and a loss-specific peer support group. Other support included peer support groups in general, tangible aid, talking with the spouse about the child who died and/or accepting each other's different grieving styles, and remembrance gestures. Specific supportive strategies reported by parents as unhelpful more frequently included feeling of stigma or blame due to type of death or feeling that the type of death was not considered equal to other deaths and platitudes & insensitive comments. Other unhelpful support included talking with others felt to be unsupportive about discussing the loss, others stating a time limit to grief, others actively avoiding or stopping all communication with the bereaved parent, and one spouse not accepting the grieving style of the other or the spouse not willing to discuss the loss. Conclusion: Support focused on supportive verbal and nonverbal communication towards the bereaved parent and tangible aid were noted to be helpful informal support. Feeling stigma for or judged by others due to the type of death or the death not being considered equal (such as in deaths due to suicide and stillborn deaths) to other types of deaths as well as informational support (utilization of clichés/platitudes, advice giving, statements about the process and end point of grieving) were noted to be unhelpful informal support.

Gender and family structures affecting intergenerational support from adult children to older parents: A cross-national study in a developing country

In Latin America, informal support from adult children to their older parents ("upward support") is crucial with an aging population and insufficient coverage of social protection systems. This article examines variables associated with upward support, distinguishing by gender of parents and their children. The research design is quantitative, correlational, and cross-sectional. It is based on primary survey data collected by the authors for the study. The authors hypothesized that upward support depends on children's opportunities to provide support and on the needs of parents. The results show that upward support depends more on children's opportunities than on parents' needs, although upward support is higher for parents with poorer health. Daughters are more supportive than sons, but sibling characteristics do not moderate associations between children's gender and receipt of support. Cohabiting with the parent, receiving support from the parent, and having a good relationship were also associated with greater upward support. Therefore, policies should consider the gender of adult children when allocating resources to older people.

Exploring experiences of supports for suicide bereavement in Ireland: protocol for a national survey

Background A suicide death impacts upon the wellbeing of close family members and friends but has also been shown to affect many people outside of this immediate circle. This will be the first large-scale national study of adults bereaved or affected by suicide in Ireland, using a cross-sectional online survey. The overarching aim will be to gain insight into the experiences of supports received by people bereaved or affected by suicide and to identify the barriers to engagement following their loss. Methods A cross-sectional survey will be conducted among adults in Ireland who have been bereaved or affected by suicide. This project will seek to represent people with different demographics and backgrounds in the Irish population using a multifaceted approach to survey recruitment. A range of validated measures will be used to examine participants' current wellbeing and grief experience. A combination of closed and open-ended questions will provide participants the opportunity to share their individual experiences, the services and supports available to them, and barriers and enablers to accessing supports. Results Quantitative data will be analysed using descriptive statistics. Chi-squared tests will be used to compare subgroups within categorical data items, and multivariable regression models will be used to examine differences in psychosocial and physical wellbeing across key groups. Qualitative content analysis will be used for qualitative responses to open-ended questions. Conclusions The survey will provide an in-depth understanding of the psychosocial and mental health impacts of suicide bereavement in Ireland; insight into the range of informal and formal supports accessed; and will identify unmet needs and challenges of accessing appropriate and timely supports. The findings will inform current national actions aimed at ensuring the standardisation and quality of the services and supports for those bereaved or affected by suicide.

Patterns of stress and support in social support networks of in-home hospice cancer family caregivers

Family caregivers of home hospice cancer patients often experience burden and distress, which can be mitigated by perceived social support. However, less attention has been paid to the non-family sources of support within social networks, or to how sources of support may also be sources of stress. We describe support and stress in social networks of hospice family caregivers and identify caregiving characteristics associated with classes identified in our data. We collected demographic and psychosocial self-report data from family caregivers providing in-home hospice care for advanced cancer patients (N = 90). Caregivers also reported perceived support and stress from specific family and non-family relationships. We identified three classes with unique patterns of stress and support within caregivers' support networks using a latent class analysis. Classes include: 1) high support, low stress across family and non-family network members ("supportive"; 53% of caregivers); 2) high support, high stress across family and non-family network ("ambivalent maximizers"; 26%); and 3) high support, high stress across family network only ("family-focused ambivalent"; 21%). Caregivers in the ambivalent maximizer class reported more burden than caregivers in the supportive class (p = .024). This is one of the first studies to systematically explore the role of non-family support, as well as how stress and support co-occur within relationships and across networks. As informal support networks of hospice family caregivers are complex and multifaceted, understanding the patterns of support and stress across various network members is essential to offer services to more effectively manage caregiver burden.

Accentuate the Positive: The Association Between Informal and Formal Supports and Caregiving Gains

Background: To promote resilience among caregivers for persons living with dementia (PLWDs), we examine how formal and informal supports are linked to caregiving gains, and whether gender moderates the association between supports and gains. Method: Using the National Health and Aging Trends Study and associated National Study of Caregiving, sources of informal (emotional support, practical support, and help with the PLWD) and formal support (respite care, training program, support group) are considered as predictors of caregiving gains, with gender as a moderator of these associations. The sample included 707 caregivers for 502 PLWDs. Results: Greater caregiving gains were significantly associated with emotional support from friends/family (β = 0.14, SE = 0.09, p = .03). Furthermore, attending a caregiver training program was only associated with increased caregiving gains among men (β = 0.11, SE = 0.08, p = .02). Conclusion: Emotional support from family/friends appears particularly consequential for caregiving gains, and male caregivers may benefit most from programs that emphasize skill building.

Social Reactions Received by Survivors of Intimate Partner Violence: A Qualitative Validation of Key Constructs From the Social Reactions Questionnaire

The majority of intimate partner violence survivors tell at least one person about the abuse, and the reactions of these support providers can have a profound impact on survivors' recovery. In recent years, the Social Reactions Questionnaire (SRQ) has become the predominant measure of social reactions toward intimate partner violence survivors, but the SRQ was developed based on the experiences of sexual assault survivors only. To determine how well intimate partner violence survivors' descriptions of social reactions from informal support providers align with constructs in the SRQ, we examined qualitative interview data about survivors' interactions with informal support providers obtained from a larger study with 113 female survivors of intimate partner violence. Excerpts were coded inductively, and a total of 12 types of social reactions emerged. Seven of these social reactions aligned with existing social reactions in the SRQ: (a) emotional support, (b) tangible aid, (c) blame, (d) took control, (e) treated differently, (f) egocentric reactions, and (g) distraction. An additional six reactions emerged as separate constructs, including (h) minimization, (i) told to leave, (j) advice, (k) interventions, and (l) indifference. These findings highlight the need for direct interventions with friends and family members to improve social reactions toward intimate partner violence survivors.

Who cares for the bereaved? A national survey of family caregivers of people with motor neurone disease

BACKGROUND

Although Motor Neurone Disease (MND) caregivers are most challenged physically and psychologically, there is a paucity of population-based research to investigate the impact of bereavement, unmet needs, range of supports, and their helpfulness as perceived by bereaved MND caregivers. Methods: An anonymous national population-based cross-sectional postal and online survey of bereavement experiences of family caregivers who lost a relative/friend to MND in 2016, 2017, and 2018. Recruitment was through all MND Associations in Australia. Results: 393 valid responses were received (31% response rate). Bereaved caregiver deterioration in physical (31%) and mental health (42%) were common. Approximately 40% did not feel their support needs were met. Perceived insufficiency of support was higher for caregivers at high bereavement risk (63%) and was associated with a significant worsening of their mental and physical health. The majority accessed support from family and friends followed by MND Associations, GPs, and funeral providers. Informal supports were reported to be the most helpful. Sources of professional help were the least used and they were perceived to be the least helpful. Conclusions: This study highlights the need for a new and enhanced approach to MND bereavement care involving a caregiver risk and needs assessment as a basis for a tailored "goodness of fit" support plan. This approach requires continuity of care, more resources, formal plans, and enhanced training for professionals, as well as optimizing community capacity. MND Associations are well-positioned to support affected families before and after bereavement but may require additional training and resources to fulfill this role.

Disclosure Recipients' Social Reactions to Victims' Disclosures of Intimate Partner Violence

Prior research indicates that victims of intimate partner violence (IPV) are most likely to disclose their victimization experiences to an informal support (e.g., friend, family), and that IPV disclosures are often met with both positive (e.g., empathic support) and negative (e.g., victim blame) reactions. However, research on social reactions to disclosure largely has neglected the perspectives of disclosure recipients. Guided by the attribution framework, the current study extends prior research by assessing factors (i.e., situation-specific, individual, relational, attributional, and emotional response) related to positive and negative reactions from the perspective of disclosure recipients (N = 743 college students). Linear regression analyses indicated that positive social reactions were related to the victim being a woman, greater frequency of IPV victimization by the victim, greater frequency of IPV victimization by the disclosure recipient, less accepting attitudes toward IPV, a closer relationship with the victim, a less close relationship with the perpetrator, lower perceptions of victim responsibility, more empathy for the victim, and more emotional distress experienced by the disclosure recipient during the disclosure. Negative social reactions were associated with more accepting attitudes toward IPV, greater frequency of IPV victimization by the disclosure recipient, a less close relationship with the victim, higher perceptions of victim responsibility, and more emotional distress experienced by the disclosure recipient. Results suggest that programs to improve responses to victim disclosure should focus on decreasing IPV-supportive attitudes, increasing empathy, and assisting disclosure recipients in managing difficult emotional responses effectively.

Informal Support among Low-income Mothers Post Welfare Reform: A Systematic Review

The vulnerability and instability of low-income mothers situated in a context with a weak public safety net make informal social support one of few options many low-income mothers have to meet basic needs. This systematic review examines (a) social support as an empirical construct, (b) the restricted availability of one important aspect of social support-informal perceived support, hereafter informal support-among low-income mothers, (c) the role of informal support in maternal, economic, parenting, and child outcomes, (d) the aspects of informal support that influence its effects, and (e) directions for future research. Traditional systematic review methods resulted in an appraisal of 65 articles published between January 1996 and May 2017. Findings indicated that informal support is least available among mothers most in need. Informal support provides some protection from psychological distress, economic hardship, poor parenting practices, and poor child outcomes. To promote informal support and its benefits among low-income families, future research can advance knowledge by defining the quintessential characteristics of informal support, identifying instruments to capture these characteristics, and providing the circumstances in which support can be most beneficial to maternal and child well-being. Consistent measurement and increased understanding of informal support and its nuances can inform intervention design and delivery to strengthen vulnerable mothers' informal support perceptions thereby improving individual and family outcomes.

User Requirements for Technology to Assist Aging in Place: Qualitative Study of Older People and Their Informal Support Networks

Background

Informal support is essential for enabling many older people to age in place. However, there is limited research examining the information needs of older adults’ informal support networks and how these could be met through home monitoring and information and communication technologies.

Objective

The purpose of this study was to investigate how technologies that connect older adults to their informal and formal support networks could assist aging in place and enhance older adults’ health and well-being.

Methods

Semistructured interviews were conducted with 10 older adults and a total of 31 members of their self-identified informal support networks. They were asked questions about their information needs and how technology could support the older adults to age in place. The interviews were transcribed and thematically analyzed.

Results

The analysis identified three overarching themes: (1) the social enablers theme, which outlined how timing, informal support networks, and safety concerns assist the older adults’ uptake of technology, (2) the technology concerns theme, which outlined concerns about cost, usability, information security and privacy, and technology superseding face-to-face contact, and (3) the information desired theme, which outlined what information should be collected and transferred and who should make decisions about this.

Conclusions

Older adults and their informal support networks may be receptive to technology that monitors older adults within the home if it enables aging in place for longer. However, cost, privacy, security, and usability barriers would need to be considered and the system should be individualizable to older adults’ changing needs. The user requirements identified from this study and described in this paper have informed the development of a technology that is currently being prototyped.

Materialities of mundane care and the art of holding one's own

The focus of this special issue is on how everyday or mundane materialities actively mediate health and care practices. This article extends this concern with the mundane to care itself and explores how specific materialities, such as shared spaces and everyday objects, not only mediate mundane care but enable it to happen. Our focus is on mundane help in the context of ill health, between people who are not immediate family, such as neighbours, acquaintances and others with whom we interact in our daily lives. Drawing on recent empirical studies of low-level support in two different parts of the UK, we show how the materialities of care can mediate the affective risks associated with receiving such help. Specifically, we investigate how materialities help people to balance the expression of their vulnerability with a need to retain their dignity, a practice referred to as 'holding one's own'. In doing so, we argue that materialities are not just the conduits for care - what care passes through - or things that mediate care. We suggest instead that materialities are part of how relationships of mundane care are constituted and maintained.

Long-term cost of spouses' informal support for dependent midlife stroke survivors

OBJECTIVES

Stroke is a major global disease that requires extensive care and support from society and relatives. The aim of this study was to identify and quantify the long-term informal support and to estimate the annual cost of informal support provided by spouses to their stroke surviving partner.

METHOD

Data were based on the 7-year follow-up of the Sahlgrenska Academy Study on Ischemic Stroke. One-third of the spouses stated that they provided support to their stroke surviving partner. The magnitude of the support was assessed with a study-specific time-diary and was estimated for independent and dependent stroke survivors based on the scores of the modified Rankin Scale. To deal with skewed data, a two-part econometric model was used to estimate the annual cost of informal support.

RESULT

Cohabitant dyads of 221 stroke survivors aged <70 at stroke onset were included in the study. Spouses of independent stroke survivors (n = 188) provided on average 0.15 hr/day of practical support and 0.48 hr/day of being available. Corresponding figures for spouses of dependent stroke survivors (n = 33) were 5.00 regarding practical support and 9.51 regarding being available. The mean annual cost of informal support provided for independent stroke survivors was estimated at €991 and €25,127 for dependent stroke survivor.

CONCLUSION

The opportunity cost of informal support provided to dependent midlife stroke survivors is of a major magnitude many years after stroke onset and should be considered in economic evaluations of health care.

Whom Do Centenarians Rely on for Support? Findings From the Second Heidelberg Centenarian Study

This paper provides a detailed picture of the sources and types of informal support available to centenarians, depending on their housing and care arrangements. Participants were 112 centenarians and 96 primary contacts of centenarians enrolled in the population-based Second Heidelberg Centenarian Study. Findings indicate that children of centenarians were their primary source of support in daily life. Those without living children had overall less help. Most frequently reported was help with administrative tasks, regardless of centenarians' residence or living arrangement. All other types of help (e.g., with activities of daily living and housework) were reported by about one-third and were mostly provided by children; centenarians without children were more likely to have friends/neighbors involved in some of these tasks. The one category reported by a third of the centenarians regardless of residence, living arrangements, or presence of a child was help with socializing/companionship. Findings constitute an important step toward identifying and meeting the support needs of centenarians and their families. Policy implications are discussed.

How To Build an Integrated Neighborhood Approach to Support Community-Dwelling Older People?

BACKGROUND

Although the need for integrated neighborhood approaches (INAs) is widely recognized, we lack insight into strategies like INA. We describe diverse Dutch INA partners' experiences to provide integrated person- and population-centered support to community-dwelling older people using an adapted version of Valentijn and colleagues' integrated care model. Our main objective was to explore the experiences with INA participation. We sought to increase our understanding of the challenges facing these partners and identify factors facilitating and inhibiting integration within and among multiple levels.

METHODS

Twenty-one interviews with INA partners (including local health and social care organizations, older people, municipal officers, and a health insurer) were conducted and subjected to latent content analysis.

RESULTS

This study showed that integrated care and support provision through an INA is a complex, dynamic process requiring multilevel alignment of activities. The INA achieved integration at the personal, service, and professional levels only occasionally. Micro-level bottom-up initiatives were not aligned with top-down incentives, forcing community workers to establish integration despite rather than because of meso- and macro-level contexts.

CONCLUSIONS

Top-down incentives should be better aligned with bottom-up initiatives. This study further demonstrated the importance of community-level engagement in integrated care and support provision.

National Guard service members' perceptions of informal and formal supports: an exploratory study

Much of the research on military families has focused on active duty service members. Little is known about informal and formal supports that National Guard service members use. Using an ecological systems perspective, this exploratory pilot study assessed awareness, access, use, satisfaction, and perceptions of effectiveness of informal and formal supports in a small group of National Guard service members. Results indicate that although service members are aware of many formal and informal supports, use of many of the supports is limited. Additionally, satisfaction and perceptions of effectiveness of many supports is neutral. The implications of these results are discussed.

Disclosure of intimate partner violence to informal social support network members: a review of the literature

This article presents a review of the published literature to date on rates, experiences, and correlates of victims' disclosure of or help seeking for intimate partner violence to informal social support network members (e.g., friends, family, classmates, and coworkers). Research indicates that the majority of individuals disclose to at least one informal support and that victims' disclosure is associated with a number of demographic (e.g., victims' sex, age, race), intrapersonal (e.g., victims' feelings of shame/embarrassment, perception of control over abuse), and situational (e.g., violence frequency and severity, if abuse is witnessed) factors. Following disclosure, victims experience a wide range of positive (e.g., believing the victim's reports, validating the victim's experiences) and negative (e.g. disbelieving, blaming the victim) social reactions, with positive reactions rated as the most common and most helpful forms of support by victims. Finally, a review of psychological correlates associated with reactions to disclosure indicates that positive social reactions are associated with more psychological health benefits and fewer negative health symptoms, whereas negative social reactions were associated with increased negative psychological health symptoms. Future research methodologies and implications for violence prevention, intervention, and policy are discussed.

Help to Family and Friends: Are There Gender Differences at Older Ages?

This paper uses recent data from the Wisconsin Longitudinal Study (N = 5,220) to explore gender differences in the extent to which adults in their 50s and 60s provide informal help to their adult children, elderly parents and friends We find that both men and women report very high levels of helping kin and nonkin alike, though women do more to assist elderly parents and women provide much more emotional support to others than do men. Men provide more assistance than do women with "housework, yard work and repairs." As they retire from the workforce, married men become significantly more involved in the care of their grandchildren, virtually eliminating any gender difference by the time they are in their 60s.