title: Social capital in a lower socioeconomic palliative care population: a qualitative investigation of individual, community and civic networks and relations.
abstract: BACKGROUND
  Lower socioeconomic populations live and die in contexts that render them vulnerable to poorer health and wellbeing. Contexts of care at the end of life are overwhelmingly determined by the capacity and nature of formal and informal networks and relations to support care. To date, studies exploring the nature of networks and relations of support in lower socioeconomic populations at the end of life are absent. This qualitative study sought to identify the nature of individual, community and civic networks and relations that defined the contexts of care for this group.
  
  
  METHODS
  Semi-structured qualitative interviews were conducted with 16 patients and 6 informal carers who identified that they had social and economic needs and were from a lower socioeconomic area. A social capital questionnaire identifying individual, community and civic networks and relations formed the interview guide. Interviews were audio-taped, transcribed and analysed using framework analysis.
  
  
  RESULTS
  Participants identified that individual and community networks and relations of support were mainly inadequate to meet care needs. Specifically, data revealed: (1) individual (informal caregivers) networks and relations were small and fragile due to the nature of conflict and crisis; (2) community trust and engagement was limited and shifted by illness and caregiving; (3) and formal care services were inconsistent and provided limited practical support. Some transitions in community relations for support were noted. Levels of civic and government engagement and support were overall positive and enabled access to welfare resources.
  
  
  CONCLUSIONS
  Networks and relations of support are essential for ensuring quality end of life care is achieved. Lower socioeconomic groups are at a distinct disadvantage where these networks and relations are limited, as they lack the resources necessary to augment these gaps. Understanding of the nature of assets and limitations, in networks and relations of support, is necessary to inform interventions to improve end of life care for lower socioeconomic populations.
authors: Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia.
authors: Joanne M
authors: JM
authors: Lewis
authors: Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia.
authors: Michelle
authors: M
authors: DiGiacomo
authors: Discipline, Palliative and Supportive Services, Flinders University, 700 Goodwood Rd, Daw Park, South Australia 5041, Australia.
authors: David C
authors: DC
authors: Currow
authors: Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia ; School of Nursing, Johns Hopkins University, 525 North Wolfe Street, Baltimore, MD, USA.
authors: Patricia M
authors: PM
authors: Davidson
keywords: End of life care; Lower socioeconomic; Networks and relations; Palliative care; Social capital