A Social Network Analysis of Poverty and Health Care Utilization

本研究的目的是描述网络及其对医疗复杂个体的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者，并且具有多种医疗，认知或社会挑战。社会学研究证明了社交网络对个人健康的重要性。社会联系对于最脆弱群体的健康可能更为重要。更好地了解社交网络的性质和影响力，将有助于深入了解社会和健康差距，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推进科学知识，以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，以研究弱势个人的网络是如何由他们的社会和健康状况形成的，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富有成效的参与。具体而言，将从100名参与者中收集网络数据，并与50名参与者进行访谈，以（1）识别医疗安全网中个人的社交网络特征和复杂，相互作用的社交和医疗脆弱性;（2）研究社会网络动态、健康行为、服务利用之间的纵向关系，和慢性病管理，以确定促进或破坏患者与医疗机构接触的社会机制;（3）评估其优势、功能以及正式和非正式护理人员的结构地位，以了解机构和非专业人员在患者网络中的共同演变作用。本研究的潜在贡献包括：（a）改变我们对边缘化群体中的正式和非正式安全网以及社会联系提供的资源的概念性理解，（B）加强我们的研究方法，以确定和研究这些群体中的个人社交网络，以及（c）增强我们补充社交网络的能力，并利用它们来实现个人和社会利益。该奖项反映了NSF的法定使命，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.