title: Social networks and secondary health conditions: the critical secondary team for individuals with spinal cord injury.
abstract: OBJECTIVE
  To describe the structure of informal networks for individuals with spinal cord injury (SCI) living in the community, to understand the quality of relationship of informal networks, and to understand the role of informal networks in the prevention and management  of secondary health conditions (SHCs).
  
  
  METHODS
  Mixed-method descriptive study.
  
  
  METHODS
  Ontario, Canada Participants:  Community-dwelling adults with an SCI living in Ontario Interventions/methods:  The Arizona Social  Support Interview Survey was used to measure social networks. Participants were asked the following open-ended questions: (1) What have been your experiences with your health care in the community? (2) What have been your experiences with care related to prevention and/or management of SHCs?,  (3)What has been the role of your informal social networks (friends/family) related to SHCs?
  
  
  RESULTS
  Fourteen key informant interviews were conducted (6 men, 8 women). The overall median for available informal networks was 11.0 persons (range 3-19). The informal  network engaged in the following roles: (1) advice/validating concerns; (2) knowledge brokers; (3) advocacy; (4) preventing SHCs; (5) assisting with finances; and (6) managing SHCs. Participants described their informal networks as a "secondary team"; a critical and essential force  in dealing with SHCs.
  
  
  CONCLUSIONS
  While networks are smaller for persons with SCI compared with the general population, these ties seems to be strong, which is essential when the roles involve a level of trust, certainty, tacit knowledge, and flexibility. These informal  networks serve as essential key players in filling the gaps that exist within the formal health care system.
authors.affiliation: Institute of Health, Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada. sara.guilcher@utoronto.ca
authors.forename: Sara J T
authors.initials: SJ
authors.lastname: Guilcher
authors.forename: Tiziana
authors.initials: T
authors.lastname: Casciaro
authors.forename: Louise
authors.initials: L
authors.lastname: Lemieux-Charles
authors.forename: Catharine
authors.initials: C
authors.lastname: Craven
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: McColl
authors.forename: Susan B
authors.initials: SB
authors.lastname: Jaglal
mesh_terms: D000328:Adult; D000368:Aged; D003153:Community Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D019058:Community Networks / Q000458:organization & administration* / Q000706:statistics & numerical data; D003376:Counseling / Q000458:organization & administration / Q000592:standards; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration* / Q000592:standards; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012944:Social Support; D013119:Spinal Cord Injuries / Q000523:psychology* / Q000534:rehabilitation