Research has ascertained the effect of informal support networks on health. Social support by healthcare providers has been investigated, but each study has made different choices concerning the measurement of this construct. Moreover, there is an overlap of concepts in the study of social support from the perspective of healthcare organizations. This overlap makes not possible to disentangle social support functions from interpersonal skills, communication ability, trust in the healthcare organizations, and so forth. To evaluate how healthcare support may impact health outcomes, reliable and valid instruments are needed to capture separate but related aspects of the construct. Inspired by psychosocial models of social support, the primary aim of this proposal is to develop the Health Provider Social Support scale (HPSS) to complement existing measures of quality of healthcare with an instrument aligned to psychological research. Second, we aim to examine how patients' personality and contextual factors moderate the relations of social support functions with the quality of healthcare and quality of life. To attain these goals we develop the HPSS on a sample of patients affected by chronic conditions. We will examine the relationships of the HPSS with variables that affect the perception of social support and its impact on the perceived quality of staff communication, the perceived technical competence of the healthcare provider, and with confidence and trust in the healthcare team. Because chronic diseases are a primary source of stress, we examine if healthcare social support might help to defuse patient anxiety and worries. We also examine the role of attachment in the relations of social support with the perceived health-care quality and health distress. The study will involve collecting information on the sense of belonging to a community of care, studying the difference in perceived social support from patients in religious and government-operated hospitals.
The role of support from healthcare providers is a challenging and little-explored area of research. There is a need to understand how and when the support provided by healthcare teams may influence the quality of care, and which function of social support has the greatest impact on the quality of life of cancer patients (patients with chronic, life-threatening conditions). To evaluate how healthcare support may impact on the perceived quality of care, and interact with patients' informal networks, scholars need reliable and valid instruments capable of measuring separate, but related aspects of the construct. It is worth noting that there is an overlap of concepts in the study of social support from the perspective of healthcare organizations. In fact, constructs similar but not identical to social support have been related to patient-reported outcomes. For example, these constructs include physician's interpersonal skills, or willingness to provide information to patients. Furthermore, scholars have considered clinician-patient communication and the degree to which a patient perceives him/herself to be part of a network of positive relationships with the healthcare provider.
Our approach differs from those mentioned above in that the HPSS do not confound social support with similar constructs like the quality of physician, treatment staff, and nurse communication, the perceived technical competence of the healthcare provider, and with confidence and trust in the healthcare team. By contrast, the HPSS aims to sharpen the distinction between emotional, information, appraisal, and instrumental support functions. Consequently, the HPSS would be useful to parse the health-related components of quality of care from the psychological variables that characterize the relations that patients have with the healthcare team. The four domains of the HPSS will be inspired by Cutrona & Russell's (1987) work on informal social networks, a characteristic that - we hope - may help fill the gap between the theory of social support in psychology and the quality of care literature in the health sciences. We believe disentangling the role of competing constructs might represent a definite advancement of knowledge regarding the state of the art of the healthcare research.
Our approach differs from the previous quality of care research in the following ways. First, we aim to develop items that not only describe social support functions and situations in general terms (e.g., "the doctor was listening to you"). Rather, we aim to provide the patients with illustrative examples for each item that makes the meaning more compelling to the patient and more observable to the healthcare team (e.g., "pausing to talk to you beyond the time strictly necessary to carry out his work; or leaving you time to talk to him about your fears"). Observable behaviors might be useful to produce accurate descriptions from the patients upon which one can give feedback for the healthcare team, with the goal of improving health practices and policies in the health care system. Second, we aim to develop items that, in principle, might apply to different health professions in the healthcare team (e.g., the doctor, the nurse, the physical therapist, and so forth). For each patient would then be possible to profile the support that he/she received from different role-functions in the healthcare staff. This information could help different healthcare professionals to make the patient-staff relationships better appropriate to patients' personal, relational modalities and more responsive to specific care needs.
Last, a novel aspect of this proposal is a multilevel approach to the study of the relations of social support functions with the perceived quality of care. As described in the methodological section of this proposal, we simultaneously assess individual variables (e.g., attachment), social level variables (the perceived social support by the healthcare provider), organization variables (the sense of community), and cultural variables (government-operated vs. religious hospitals). All these variables will be studied as correlated with the quality of healthcare and the quality of life of patients affected by chronic conditions.