title: The contribution of social networks to the health and self-management of patients with long-term conditions: a longitudinal study.
abstract: Evidence for the effectiveness of patient education programmes in changing individual self-management behaviour is equivocal. More distal elements of personal social relationships and the availability of social capital at the community level may be key to the mobilisation of resources needed for long-term condition self-management to be effective.
  
  
  OBJECTIVE
  To determine how the social networks of people with long-term conditions (diabetes and heart disease) are associated with health-related outcomes and changes in outcomes over time.
  
  
  METHODS
  Patients with chronic heart disease (CHD) or diabetes (n = 300) randomly selected from the disease registers of 19 GP practices in the North West of England. Data on personal social networks collected using a postal questionnaire, alongside face-to-face interviewing. Follow-up at 12 months via postal questionnaire using a self-report grid for network members identified at baseline.
  
  
  METHODS
  Multiple regression analysis of relationships between health status, self-management and health-economics outcomes, and characteristics of patients' social networks.
  
  
  RESULTS
  Findings indicated that: (1) social involvement with a wider variety of people and groups supports personal self-management and physical and mental well-being; (2) support work undertaken by personal networks expands in accordance with health needs helping people to cope with their condition; (3) network support substitutes for formal care and can produce substantial saving in traditional health service utilisation costs. Health service costs were significantly (p<0.01) reduced for patients receiving greater levels of illness work through their networks.
  
  
  CONCLUSIONS
  Support for self-management which achieves desirable policy outcomes should be construed less as an individualised set of actions and behaviour and more as a social network phenomenon. This study shows the need for a greater focus on harnessing and sustaining the capacity of networks and the importance of social involvement with community groups and resources for producing a more desirable and cost-effective way of supporting long term illness management.
authors.affiliation: National Institute for Health Research Collaboration for Leadership in Applied Health Research (NIHR CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Reeves
authors.affiliation: National Institute for Health Research Collaboration for Leadership in Applied Health Research (NIHR CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Christian
authors.initials: C
authors.lastname: Blickem
authors.affiliation: National Institute for Health Research Collaboration for Leadership in Applied Health Research (NIHR CLAHRC) Wessex, Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom.
authors.forename: Ivaylo
authors.initials: I
authors.lastname: Vassilev
authors.affiliation: School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Brooks
authors.affiliation: National Institute for Health Research Collaboration for Leadership in Applied Health Research (NIHR CLAHRC) Wessex, Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom.
authors.forename: Anne
authors.initials: A
authors.lastname: Kennedy
authors.affiliation: Centre for Health Economics and NIHR Research Design Service for Yorkshire and the Humber, University of York, York, United Kingdom.
authors.forename: Gerry
authors.initials: G
authors.lastname: Richardson
authors.affiliation: National Institute for Health Research Collaboration for Leadership in Applied Health Research (NIHR CLAHRC) Wessex, Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom.
authors.forename: Anne
authors.initials: A
authors.lastname: Rogers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004739:England; D005260:Female; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012648:Self Care; D012944:Social Support; D055815:Young Adult