Social-ecological influences on interpersonal support in people with physical disability.

BACKGROUND: People with physical disability report lower amounts of emotional and informational social support compared with other populations but it is unclear how influences at the broader societal level impact support in this population. OBJECTIVE: To address this question, Berkman and Glass's social-ecological model was used to examine the influence of upstream factors on interpersonal support in people with physical disability. It was predicted that these factors would influence support even after controlling for the traditional measures linked to social support. METHODS: 331 adult participants with physical disability (43% female; mean age = 42.7; 88% White) completed an online cross-sectional survey measuring types and sources of social support, social integration, disability impact in social domains, environmental barriers, and relevant psychosocial variables such as depression. RESULTS: A hierarchical linear regression analysis showed that level of disability, perceived tangible support, social integration, depressive symptoms, environmental barriers, occupational independence, and having family or friends as primary support sources were significantly associated with perceived support at the final step (R(2) = .60, F(22, 255) = 17.68, p < .001). The social-ecological measures, environmental barriers and social integration, had the largest associations with interpersonal support. CONCLUSIONS: Results demonstrate the importance of measuring distinct support constructs and how the broader social environment may matter more in interpersonal support perceptions for people with disability than typical measures studied in the literature. Improving environmental factors will help improve social support.

Maintaining support in people with paralysis: what works?

Social support is a protective factor for well-being in the risk-and-resilience framework, yet people with paralysis report lower levels of support compared to people without paralysis. Rather than examine deficits, in this study, the authors conducted in-depth interviews with individuals who report high levels of social support to examine what sustains this protective factor. Because relationship equity affects social support, the authors also examined this. They selected participants who reported high levels of support from a survey sample of 299 U.S. adults experiencing some form of paralysis. Seventeen participants completed the in-depth interview. The importance of reciprocity, maintaining autonomy, and a positive outlook for sustaining support were themes identified in the content analysis. In their responses, people with high support emphasized that they do all they can to affect their environment positively, so that ideally, the only assistance that they cannot provide themselves is successfully obtained from others.