International Journal of Epidemiology 2002;31:698
© International Epidemiological Association 2002
Book Review |
Social Support Measurement and Intervention: A Guide for Health and Social Scientists.
Sheldon Cohen, Lynn Underwood, Benjamin Gottlieb (eds). New York: Oxford University Press, 2000, pp. 334 US$45.00. ISBN 0-19-512670-X.
This is a useful book orientated towards the selection and development of measures of social relations suitable for assessment and intervention in studies of physical and psychiatric illness. The editors use the same format as in their earlier volume Measuring Stress: A Guide for Health and Social Scientists sponsored by the Fetzer Institute with the laudable aim of improving the dissemination of methods for measuring psychosocial concepts, in this case social support.
After a first historical chapter there is an informative chapter on the different possible mechanisms, some competing, some complementary, by which social support may influence health, described within the context of the theoretical frameworks from which they were derived. This is interesting material, rarely brought together in the empirical literature, that is a helpful background to the chapters that follow on measuring social integration, social networks, and perceived and received support.
This is a comprehensive, well thought out, theoretically grounded book which recognises that social support occurs within the wider context of relationships that can be differentiated from social interactions. The authors suggest that there is a functional congruence between relationship processes such as interdependence, perceived partner responsiveness, sentiment, on one hand and types of support on the other. Beyond this people have a predisposition to behave toward others in particular ways. Some of this may be captured by measures of empathy, emotional expressiveness, perceived acceptance, social competence and patterns of attachment. Instruments are suggested to measure all of these concepts. However, practically, it may be difficult for respondents and researchers to distinguish these concepts and even more difficult to isolate those elements that predict good health. There is an appropriate plea for attention to discriminant validity of instruments, to define the limits of what an instrument measures and reduce the scope for response bias. At this stage of research on social support it is difficult to disprove the idea that it is a general positivity within social relations rather than specific aspects of relationships or support that drives the beneficial effects on health. Perhaps research stimulated by this book will help to unravel this conundrum. Observational measures of social interactions are also described, which may be less likely to have some of the problems found in self-report instruments. The use of self-report instruments is, nevertheless, essential to capture the subjective nature of social support.
If the measurement of social support is complex, social support interventions are even more so. There is an extremely helpful chapter encouraging would-be interventionists to design their interventions carefully taking account of the expressed needs of the population, the appropriate sources of support (from existing or new ties), whether to focus on dyadic relationships or support from groups, and the careful definition of health endpoints likely to be influenced by support and the mediating pathways through which support might act to achieve these health goals.
The evidence for the effectiveness and failures of peer support groups for coping with specific life events are described and ways of avoiding pitfalls in designing future groups are identified. Other types of interventions are discussed such as one-to-one support interventions: home visiting and mentoring programmes and the noted advantages of concentrating on enhancing support from the person's existing social network, where this is possible, rather than introducing external support which may not always match the person's cultural and personal needs. Karen Rook, in a thoughtful final commentary, emphasises the importance of the effects of companionship on health, and the necessity of attempting to separate the trait, personality-related aspects of social relations from the support received in social interactions. She also discusses social support as a form of social control and the relevance this has for curbing or encouraging unhealthy behaviours —an area that would benefit from further research.
There are a few criticisms of the book. Occasionally there is a lapse into deep jargon, which will not help the untutored reader in this field. Not surprisingly the book is very focused on the North American literature and ignores some of the recent European literature. This is a pity and limits some of the universal appeal of the book.
On the whole, however, this is an excellent book which is essential reading for anyone embarking on aetiological research or interventions in social support and health. In one bound it has become a classic text for social support researchers.
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