In a review of the literature from 1948 to 2001, 122 studies were found that correlated structural or functional social support with patient adherence to medical regimens. Meta-analyses establish significant average r-effect sizes between adherence and practical, emotional, and unidimensional social support; family cohesiveness and conflict; marital status; and living arrangement of adults. Substantive and methodological variables moderate these effects. Practical support bears the highest correlation with adherence. Adherence is 1.74 times higher in patients from cohesive families and 1.53 times lower in patients from families in conflict. Marital status and living with another person (for adults) increase adherence modestly. A research agenda is recommended to further examine mediators of the relationship between social support and health.

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Social support and patient adherence to medical treatment: a meta-analysis.

Respect for patients’ needs and wishes is central to a humane health care system. To better meet patients’ needs, providers have expressed increased interest in using patients’ evaluations and reports to complement other methods of quality assessment and assurance. Many hospitals routinely survey patients, but relatively little analysis of patients’ evaluations of hospital care has been published. Most of the literature on such evaluations is based on studies of outpatients. There have been some excellent descriptions of both the theoretical and practical issues involved in measuring patients’ assessments of inpatient care, but much more work in this area remains to be done. Project goals. The primary goals of the research on which this DataWatch is based were to determine which specific aspects of inpatient care are most important to patients and to document patients’ perceptions of those aspects of care in hospitals nationwide. Another goal was to assess the extent to which variations in reported quality of care might be related to characteristics of patients. In particular, we wanted to investigate whether patients with fewer resources, older patients, or patients in poorer health were more likely to report problems with their care. Here we report the results of a national telephone survey about selected aspects of care. We interviewed 6,455 adult patients recently discharged from the medical and surgical services of sixty-two hospitals selected to represent different hospital types and. all regions of the United States. The interview focused on events that indicate the quality of care in several clinically important areas of which patients are the best judges: patient education and communication with providers, respect for pa-

Patients evaluate their hospital care: a national survey.

To conduct a systematic review and meta-analysis on the relevance of low social support for the development and course of coronary heart disease (CHD).

Lack of social support in the etiology and the prognosis of coronary heart disease: a systematic review and meta-analysis.

Objective The present paper reviews theories of social support and evidence for the role of social support in the development and progression of coronary heart disease (CHD). Methods Articles for the primary review of social support as a risk factor were identified with MEDLINE (1966-2004) and PsychINFO (1872-2004). Reviews of bibliographies also were used to identify relevant articles. Results In general, evidence suggests that low social support confers a risk of 1.5 to 2.0 in both healthy populations and in patients with established CHD. However, there is substantial variability in the manner in which social support is conceptualized and measured. In addition, few studies have simultaneously compared differing types of support. Conclusions Although low levels of support are associated with increased risk for CHD events, it is not clear what types of support are most associated with clinical outcomes in healthy persons and CHD patients. The development of a consensus in the conceptualization and measurement of social support is needed to examine which types of support are most likely to be associated with adverse CHD outcomes. There also is little evidence that improving low social support reduces CHD events.

Social support and coronary heart disease: epidemiologic evidence and implications for treatment.

Nonadherence in the management of chronic illness is a pervasive clinical challenge. Although researchers have identified multiple correlates of adherence, the field remains relatively atheoretical. The authors propose a cognitive–affective model of medication adherence based on social support theory and research. Structural equation modeling of longitudinal survey data from 136 mainly African American and Puerto Rican men and women with HIV/AIDS provided preliminary support for a modified model. Specifically, baseline data indicated social support was associated with less negative affect and greater spirituality, which, in turn, were associated with self-efficacy to adhere. Self-efficacy to adhere at baseline predicted self-reported adherence at 3 months, which predicted chart-extracted viral load at 6 months. The findings have relevance for theory building, intervention development, and clinical practice.

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A Longitudinal Evaluation of a Social Support Model of Medication Adherence Among HIV-Positive Men and Women on Antiretroviral Therapy

This study addressed the issue of social support for patients' adherence to medical regimens. Social support of wives was assessed by structured interview of 150 male participants in the Coronary Primary Prevention Trial, their wives, and medical staff. In addition, wives were interviewed about their beliefs related to their husbands' health and participation in the trial. Unobtrusive packet counts were used as the measure of adherence. The participants were classified as having high spouse support if wife support scores were in the top one third of the distribution and as having low spouse support if scores were in the bottom one third as measured from inquiry of the participant, the spouse, and the staff. The adherence of men having low support averaged 70 percent, significantly lower than the high-support group, which averaged 96 percent. The correlations between spouses' health beliefs and their level of support were significant for three of four health belief variables. In particular, highly adhering men had wives who believed more strongly in the benefits of the Coronary Primary Prevention Trial.

Schrott Hg

Papers

Effect of spouse support and health beliefs on medication adherence.