Social support can be defined as the availability of close family, friends, and other significant people in the individual's life that is provided through the individual's social network (86). There is general agreement that there are several distinct types of social support (87,88):
■ Instrumental support (practical help).
■ Informational (provision of information).
■ Emotional (lending a good listening ear, showing understanding, helping talk over problems, or make difficult decisions).
■ Approval (giving verbal support).
Low perceived level of diabetes-related support has been related to a number of factors, including: lack of diabetes knowledge among individuals in the support network, resistance to making changes that would support improved patient self-care, the presence of serious interpersonal conflicts, and lack of specific requests for help from the individual with diabetes (32). There is strong empirical support for the value of good social support to health and longevity. For example, a large study of men tracked for 4 years (89) showed higher cardiovascular disease, accident, and suicide-related deaths among those classified as socially isolated (i.e., not married, fewer than six friends or relatives, no membership in community groups). In diabetes, reviews have shown moderate positive correlations between social support and markers of self-care such as glycosylated hemoglobin (HbA1c) (35). One study showed health-related quality-of-life is affected by the marital status of both type 1 and type 2 diabetic patients, with separated and divorced individuals generally experiencing lower levels of quality-of-life (34). Weissberg-Benchell and Pichert (90) have provided some simple questions for the diabetes clinician interested in exploring social support:
■ Who helps you care for your diabetes and how do they help?
■ Are there things they do or say that make it harder for you to care for your diabetes?
■ Who do you talk to for emotional support for having diabetes? Are they good listeners?
Social support is generally conceived of as a positive influence on health, although some support can be negative in type 2 diabetes if the patient fears being nagged or harassed about their self-care behaviors (91). The "diabetes police" is a term that has been coined to describe a pattern of behavior by family, friends, and others in the diabetes patient's social network where they monitor the patient's self-care behavior intrusively, and try to pressure the patient to improve self-care through persuasion, advice, criticism, and threats (32).
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