A Social Network Analysis of Poverty and Health Care Utilization

本研究的目的是表征网络及其对医疗复杂个体健康相关决策和行为的影响，这些个体是医疗服务的高利用率个体，具有多重医疗、认知或社会挑战。社会学研究已经证明了社会网络对个人健康的重要性。社会关系对最弱势群体的健康可能更为重要。更好地了解社会网络在服务不足人群中的性质和影响，将有助于深入了解社会和健康差异，以及医疗保健和社会服务系统如何与网络成员更好地合作，以改善弱势群体的健康。该项目的总体目标是促进科学知识的发展，从而加强正式和非正式的安全网，改善社会中个人的福祉。该项目将使用以自我为中心的社会网络分析和对患者和提供者的定性访谈来研究弱势个体的网络是如何被他们的社会和健康状况所塑造的，以及什么样的正式和非正式的社会互动促进了与促进福祉的机构的生产性参与。具体而言，将从100名参与者中收集网络数据，并对50名参与者进行访谈，以(1)确定医疗安全网中个人的社会网络特征和复杂的、相互作用的社会和医疗脆弱性；(2)研究社会网络动态、健康行为、服务利用和慢性病管理之间的纵向关系，以确定促进或破坏患者对医疗机构参与的社会机制；(3)评估正式和非正式护理人员的优势、功能和结构地位，以了解机构和非专业人员在患者网络中的共同演变角色。本研究的潜在贡献包括：(a)改变我们对边缘人群的正式和非正式安全网以及社会关系提供的资源的概念理解，(b)增强我们确定和研究这些人群中的个人社会网络的研究方法，以及(c)增强我们补充社会网络并利用它们实现个人和社会利益的能力。该奖项反映了美国国家科学基金会的法定使命，并通过使用基金会的知识价值和更广泛的影响审查标准进行评估，被认为值得支持。

The objective of this study is to characterize the networks and their effects on health-related decisions and behaviors of medically complex individuals who are high utilizers of health services and who have multiple medical, cognitive, or social challenges. Sociological research has documented the importance of social networks for individual health. Social ties may be even more critical for the health of the most vulnerable. Developing a better understanding of the nature and influence of social networks among the underserved will provide insight into social and health disparities, and how the healthcare and social service systems can better partner with network members to improve the health of disadvantaged individuals. The overall goal of this project is to advance scientific knowledge that will strengthen the formal and informal safety net and improve the well-being of individuals in society.This project will use egocentric social network analysis and qualitative interviews with patients and providers to examine how disadvantaged individuals' networks are shaped by their social and health conditions, and what kinds of formal and informal social interactions facilitate productive engagement with institutions that promote wellbeing. Specifically, network data will be collected from 100 participants and interviews will be conducted with 50 participants to (1) identify the social network characteristics and complex, interacting social and medical vulnerabilities of individuals in the healthcare safety net; (2) examine longitudinal relationships among social network dynamics, health behaviors, services utilization, and chronic disease management to identify social mechanisms that foster or undermine patients' engagement with healthcare institutions; and (3) assess the strengths, functions, and structural positions of formal and informal caregivers to understand the co-evolving roles of institutions and lay persons in patients' networks. Potential contributions of this study include: (a) transforming our conceptual understanding of the formal and informal safety net among the marginalized and the resources provided by social ties, (b) enhancing our research methods for ascertaining and studying personal social networks in these populations, and (c) amplifying our ability to supplement social networks and leverage them to achieve individual and societal benefits.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.