Effects of social network changes on chronic illness management

Hyunsung Oh, ASU School of Social Work

"It is important to create a culture of health in the community if we want to amplify public health impacts for underserved patients managing chronic illnesses."

- Hyunsung Oh, KER Fellow 2019

Background

An aging national and global population is demanding skyrocketing medical costs to treat chronic illnesses, for which treatment outcomes are largely determined by how well patients manage their illness, through diet, exercise, medication adherence, and symptom monitoring. Disparities in chronic illness management disproportionately affect underserved groups, such as low-income seniors and people with disabilities. Scarce financial resources and inadequate infrastructure can make it difficult to adhere to recommended management strategies. Community norms, traditions, and beliefs may have the power to exacerbate or mitigate these disparities, but we don't yet know which norms are most important.

Research question

  • Is community a source of resilience for underserved groups when managing their chronic illnesses (e.g., diabetes, heart disease)?

Methods and findings

It is easy to say that community matters for managing chronic illness, but it is difficult to understand that interaction quantitatively. Oh used cutting-edge survey methodology, social network analysis, and agent-based modeling to examine the impacts of social networks on chronic illness management among low-income seniors and people with disabilities in publicly subsidized housing. He focused on two community attributes — trust toward health professionals and willingness to talk about health matters — and found that both are relevant to the quality of patients' illness management.

Trust in health professionals predicts the quality of adherence to health advice from doctors and nurses. According to Oh's model, when no community members trusted health professionals, average chronic illness management dropped to 1.10 on a scale of 1-6; when all community members trusted health professionals, it reached 5.84. Willingness to discuss health also had a strong effect, allowing patients to mobilize social support, learn new information, and explore different options for managing their illness.

Impact

By modeling the significance of community-level trust toward health professionals and willingness to discuss health with family, friends, and neighbors, Oh's project provides targets for community-wide public health interventions to improve residents' ability to manage chronic illness. He believes that these efforts are an essential part of creating a culture of health in the community, in which social connections are a source of resilience. His findings may inform network-based interventions that address disparities in chronic illness management and overall health.

Deliverables

  • Abstract submitted to the Arizona Health Equity Conference
  • Manuscript submitted to a public health or social work journal
  • Simulated model made available to service providers seeking to contextualize interventions to the community they serve