Measurement issues in research on social support and health.
OBJECTIVE
The aims were: (1) to identify methodological problems that may explain the inconsistencies and contradictions in the research evidence on social support and health, and (2) to validate a frequently used measure of social support in order to determine whether or not it could be used in multivariate analyses of population data in research on social support and health.


METHODS
Secondary analysis of data collected in a cross sectional survey of a multistage cluster sample of the population of the United States, designed to study relationships in behavioural, social support and health variables. Statistical models based on item response theory and graph theory were used to validate the measure of social support to be used in subsequent analyses.


METHODS
Data on 1755 men and women aged 20 to 64 years were available for the scale validation.


RESULTS
Massive evidence of item bias was found for all items of a group membership subscale. The most serious problems were found in relationship to an item measuring membership in work related groups. Using that item in the social network scale in multivariate analyses would distort findings on the statistical effects of education, employment status, and household income. Evidence of item bias was also found for a sociability subscale. When marital status was included to create what is called an intimate contacts subscale, the confounding grew worse.


CONCLUSIONS
The composite measure of social network is not valid and would seriously distort the findings of analyses attempting to study relationships between the index and other variables. The findings show that valid measurement is a methodological issue that must be addressed in scientific research on population health.
Dean
K
K
Institute of Social Medicine, University of Copenhagen, Panum Institute, Denmark.
Holst
E
E
Kreiner
S
S
Schoenborn
C
C
Wilson
R
R
D000328:Adult; D015986:Confounding Factors, Epidemiologic; D003430:Cross-Sectional Studies; D004522:Educational Status; D004651:Employment; D004812:Epidemiologic Methods; D005260:Female; D006302:Health Services Research / Q000379:methods*; D006304:Health Status; D006801:Humans; D007182:Income; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D015203:Reproducibility of Results; D012944:Social Support; D014481:United States