Harnessing the social capital of rural communities for youth mental health: an asset-based community development framework

In Australia, we are facing a period of mental health reform with the establishment of federally funded community youth services in rural areas of the country. These new services have great potential to improve the mental health of rural adolescents. In the context of this new initiative, we have four main objectives with this article. First, we consider the notion of social capital in relation to mental health and reflect on the collective characteristics of rural communities. Second, we review lessons learned from two large community development projects targeting youth mental health. Third, we suggest ways in which the social capital of rural communities might be harnessed for the benefit of youth mental health by using asset-based community development strategies and fourth, we consider the role that rural clinicians might play in this process.     

Insiders and incomers: how lay public health workers' knowledge might improve public health practice

Since 2005, health trainers and other lay public health workers (LPHWs) have been increasingly active in the UK. Although elsewhere in the world LPHWs are expected to come from the communities within which they work and know that their knowledge is valued, neither is the case for LPHWs in the UK. This study sought to discover the lay knowledge of health trainers and other LPHWs, aiming to ascertain how this knowledge might more effectively be utilised within UK public health services. This paper describes a participatory and ethnographic case study research project undertaken on an anonymised urban estate in North East England. Findings were generated by a range of means including by participant observation and semi‐structured interviews. Seven LPHWs took part, as did 32 other community members. This study found that the lay health knowledge of an individual UK LPHW is determined primarily by his or her position within, or in relation to, the community within which he or she works. Insider LPHWs possess an embodied knowledge and incomer LPHWs possess an experiential knowledge which, although different from one another, are essentially interpersonal in nature. Lay health knowledge can take different forms, and different LPHWs can provide different forms of lay health knowledge. Public health structures and services in the UK should make better use of all forms of LPHW knowledge, and should seek from LPHWs training on how to engage the most ‘hard‐to‐reach’ or ‘difficult‐to‐engage’ groups. Services recruiting LPHWs should decide whether they are seeking embodied insider LPHW knowledge, experiential incomer LPHW knowledge or a mixture of both.     

Access to health care and community social capital

OBJECTIVE: To test the hypothesis that variation in reported access to health care is positively related to the level of social capital present in a community. DATA SOURCES: The 1996 Household Survey of the Community Tracking Study, drawn from 22 metropolitan statistical areas across the United States (n = 19,672). Additional data for the 22 communities are from a 1996 multicity broadcast media marketing database, including key social capital indicators, the 1997 National Profile of Local Health Departments survey, and Interstudy, American Hospital Association, and American Medical Association sources. STUDY DESIGN: The design is cross-sectional. Self-reported access to care problems is the dependent variable. Independent variables include individual sociodemographic variables, community-level health sector variables, and social capital variables. DATA COLLECTION/EXTRACTION METHODS: Data are merged from the various sources and weighted to be population representative and are analyzed using hierarchical categorical modeling. PRINCIPAL FINDINGS: Persons who live in metropolitan statistical areas featuring higher levels of social capital report fewer problems accessing health care. A higher HMO penetration rate in a metropolitan statistical area was also associated with fewer access problems. Other health sector variables were not related to health care access. CONCLUSIONS: The results observed for 22 major U.S. cities are consistent with the hypothesis that community social capital enables better access to care, perhaps through improving community accountability mechanisms.     

Social inequality and health: the role of social capital

The aim of the article is to examine whether and to what degree the unequal distribution of social capital in the population explains the relationship between socioeconomic position and health in Norway. Theoretical insight and empirical evidence seem to suggest that social capital mediates the effect of socioeconomic position on health outcomes. However, only a few studies have addressed this question and those that have done so have used few and simple indicators of social capital. This study is based on a nationwide cross-sectional survey (N = 3190) commissioned by Statistics Norway. The survey was designed to cover a comprehensive set of variables measuring different aspects of the theoretical construct of social capital. Two health outcomes, self-perceived health and longstanding illness, were analysed. The results showed that the mediating role of social capital between socioeconomic position and health was negligible for both health outcomes. After controlling for socio-demographic variables and socioeconomic position, only neighbourhood satisfaction and generalised trust showed a significant association with self-perceived health, whereas none of the social capital variables had any significant association with longstanding illness. Some theoretical and methodological implications of the results are discussed.     

Lay food and health worker involvement in community nutrition and dietetics in England: definitions from the field

Background  Community-based food initiatives have developed in recent years with the aim of engaging previously 'hard to reach' groups. Lay workers engaged in community nutrition activities are promoted as a cost-effective mechanism for reaching underserved groups. The primary objective of the study was to explore perceptions and definitions of lay helping within the context of National Health Service (NHS) community nutrition and dietetic services to identify existing terms and definitions and propose an overarching term.
Methods  Interpretive qualitative inquiry; semi-structured interviews with lay food and health worker (LFHW) and NHS professionals employed by community-based programmes, serving 'hard-to-reach' neighbourhoods, across England.
Results  In total, 29 professionals and 53 LFHWs were interviewed across 15 of the 18 projects identified. Across all the projects, there was a preference for the use of one of two terms, either Community Food Worker or Community Nutrition Assistant, in reference to lay workers. There was no consensus in terms of a unifying term or definition for this new role.
Conclusions  Current variation in the terms and definitions used for this role is problematic and is hindering development and effective utilization of lay helping within the broad remit of community food and health and dietetics. The umbrella term 'Lay Food and Health Worker' is proposed based upon definitions and interpretations from the field.     

社会资本在健康领域的应用现状

在解释收入不平等对健康差异的影响作用时，流行病学家引入了社会资本的概念，尽管社会资本理论自身还存在很多争议，但其与健康关系的研究引起了众多学者的兴趣。本文从各种社会资本的概念，社会资本在健康领域研究中的应用，社会资本影响健康的可能机制，各种测量方法和存在的不足以及在中国目前的应用现状等方面进行了浅析。     

Challenges facing community health workers in Brazil's Family Health Strategy: A qualitative study

Community health worker (CHW) programs are implemented in many low‐ and middle‐income countries such as Brazil to increase access to and quality of care for underserved populations; CHW programs have been found to improve certain indicators of health, but few studies have investigated the daily work of CHWs, their perspectives on what both helps and hinders them from fulfilling their roles, and ways that their effectiveness and job satisfaction could be increased. To examine these questions, we observed clinic visits, CHW home visits, and conducted semistructured interviews with CHWs in 7 primary care centers in Brazil—2 in Salvador, Bahia, and 5 in São Paulo, SP—in which CHWs are incorporated into the work of all primary care health teams. In addition to enhancing communication between the medical system and the community, CHWs consider their key roles to be helping persuade community members to seek medical care and increasing health professionals' awareness of the social conditions affecting their patients' health. Key obstacles that CHWs face include failure to be fully integrated into the primary care team, inability to follow‐up on identified health needs due to limited resources, as well as community members' lack of understanding of their work and undervaluing of preventative medicine. Increased training, better incorporation of CHWs into clinic flow and decision making, and establishing a clear community awareness of the roles and value of CHWs will help increase the motivation and effectiveness of CHWs in Brazil.     

Social capital and self-rated health: results from the US 2006 social capital survey of one community

Using data from the 2006 Social Capital Community Survey in Duluth, Minnesota, and Superior, Wisconsin, USA, we investigate associations between individual social capital measures (attitudes on trust, formal group involvement, informal socializing, organized group interaction, social support and volunteer activity) and self-rated health after controlling for individual and economic characteristics. In particular, we address issues of social capital as an endogenous determinant of self-reported health using instrumental variables probit estimation. After accounting for the endogeneity of these various measures of individual social capital, we find that individual social capital is a significant predictor of self-rated health.     

Maternal social capital and child health in Vietnam

STUDY OBJECTIVE: To explore the association between maternal social capital and child physical and mental health in Vietnam. DESIGN: Cross sectional survey. Measures of maternal structural social capital comprised group membership, citizenship, and social support. Measures of cognitive social capital comprised trust, social harmony, sense of fairness, and belonging. Child health was measured by anthropometrics and mothers' reports of acute and chronic physical health problems and child mental health. PARTICIPANTS: 2907 mothers and their 1 year old or 8 year old children from five provinces in Vietnam. MAIN RESULTS: The study found low levels of group membership and citizenship and high levels of cognitive social capital and support, and generally higher levels of social capital among the mothers of 8 year old compared with 1 year old children. All but one association was in the hypothesised direction (that is, higher levels of social capital associated with reduced risk of child health problems). There were more statistically significant relations between maternal social capital and the health of 1 year olds compared with 8 year old children, and between measures of social support and cognitive social capital and child health, than with group membership and involvement in citizenship activities. CONCLUSION: This study is the first to explore the association between multiple dimensions of social capital and a range of different child health outcomes in the developing world. These results now need to be tested using longitudinal data.     

社区卫生工作人员及居民行为对构建中医药社区体系影响的研究进展

通过查阅近年来社区卫生工作人员及居民行为的相关国内文献资料,对社区卫生工作人员及居民行为对构建中医药社区体系的影响进行综述。     

The measurement of bridging social capital in population health research

Social capital is defined as the resources available to individuals and groups through membership in social networks. The definition is consistent with either an individualistic approach or a collective approach. Social capital can be further classified according to bonding versus bridging social capital (e.g. relationships between individuals who are homogeneous or heterogeneous with respect to social class, race/ethnicity, or other attributes). We conducted a systematic review via Pubmed, the ISI web of knowledge and OVID of the studies that examined bridging social capital in public health settings. Our results indicate lack of consistency or uniformity in the operationalization of bridging social capital. We identify some promising approaches to measurement that should be further investigated in future studies.     

Epidemiology of participation: an Australian community study

STUDY OBJECTIVE: To determine the levels of participation in social and civic community life in a metropolitan region, and to assess differential levels of participation according to demographic, socioeconomic and health status. To contribute to policy debates on community participation, social capital and health using these empirical data. DESIGN: Cross sectional, postal, self completed survey on health and participation. SETTING: Random sample of the population from the western suburbs of Adelaide, the capital city of South Australia, a population of approximately 210 000. PARTICIPANTS: 2542 respondents from a sample of 4000 people aged 18 years and over who were registered on the electoral roll. MAIN RESULTS: The response rate to the survey was 63.6% (n=2542). Six indices of participation, on range of social and civic activities, with a number of items in each, were created. Levels of participation were highest in the informal social activities index (46.7-83.7% for individual items), and lowest in the index of civic activities of a collective nature (2.4-5.9% for individual items). Low levels of involvement in social and civic activities were reported more frequently by people of low income and low education levels. CONCLUSIONS: Levels of participation in social and civic community life in an urban setting are significantly influenced by individual socioeconomic status, health and other demographic characteristics. An understanding of the pattern of participation is important to inform social and health policy making. Increasing levels of participation will reduce social exclusion and is likely to improve the overall quality of community life.     

Value of life and behavior toward health risks: an interpretation of social capital

An individual assessing a risky job can be understood as a public good. He and each of his valued relationships place a demand for the preservation of his life and health for which he accepts a responsibility to preserve. Additional demands generally do not deplete his capacity for beneficial relationships, hence, they are nonrival. It follows that the more extensive are his relationships the greater is his social capital. Although a common metric to compare and aggregate such relationships is not practical, the paper demonstrates that the common social capital indicators can yield qualitative predictions on changes in risky behaviors in the context of conventional value of life models familiar within health economics. The individual will change his behavior toward risk upon experiencing an exogenous change in his social capital: when he marries, has children, acquires friends, or experiences a more socially active community. The empirical sections of the paper show this prediction to conform well to prior studies of micro data as well as to original empirical analysis of aggregate data.     

福州社区卫技人员工作满意度与稳定性调查

采用问卷调查和半结构式访谈相结合的方法,对福州市社区卫生服务中心卫技人员进行工作满意度和稳定性调查。结果显示目前福州社区卫技人员的工作总体满意度不高,最不满意的是工资、福利;高学历年轻医生流失严重。对此,提出提高薪酬水平、满足自我实现需要、关注高学历年轻医生的发展等建议。     

社会资本测量及其在健康领域应用

目的 社会资本是一个多维度多层面的概念,对其进行定量测量是一个非常复杂的程序。本文介绍了社会资本的相关概念及常用测量工具,并讨论了社会资本测量在健康领域的相关实证应用。建议在进行社会资本测量时,应根据调查所在地区的社会人口学特征、经济文化水平等因素,并结合研究目的选择需要测量的社会资本的维度,选用信度和效度量好的测量工具,或采用定性分析和定量测量结合的方法研究社会资本与健康的关联。     

Lost in translation: a genealogy of the "social capital" concept in public health

STUDY OBJECTIVE: To examine the genealogy of the social capital concept in public health, with attention to the epistemological concerns and academic practices that shaped the way in which this concept was translated into public health. DESIGN: A citation-network path analysis of the public health literature on social capital was used to generate a genealogy of the social capital concept in public health. The analysis identifies the intellectual sources, influential texts, and developments in the conceptualisation of social capital in public health. PARTICIPANTS: The population of 227 texts (articles, books, reports) was selected in two phases. Phase 1 texts were articles in the PubMed database with "social capital" in their title published before 2003 (n = 65). Phase 2 texts are those texts cited more than once by phase 1 articles (n = 165). MAIN RESULTS: The analysis shows how the scholarship of Robert Putnam has been absorbed into public health research, how three seminal texts appearing in 1996 and 1997 helped shape the communitarian form that the social capital concept has assumed in public health, and how both were influenced by the epistemological context of social epidemiology at the time. CONCLUSIONS: Originally viewed in public health research as an ecological level, psychosocial mechanism that might mediate the income inequality-health pathway, the dominance of the communitarian approach to social capital has given disproportionate attention to normative and associational properties of places. Network approaches to social capital were lost in this translation. Recovering them is key to a full translation and conceptualisation of social capital in public health.     

新型冠状病毒肺炎疫情下医护人员社会资本对创伤后应激障碍的影响

目的 了解新型冠状病毒肺炎（简称新冠肺炎）救治期间医护人员的创伤后应激反应水平和群组差异,提出疫情后有效恢复和改善医护人员心理状态的建议与意见。 方法 2020年6—7月通过方便抽样方式,收集我国19个省市自治区的公立医院信息,对新冠肺炎疫情下在岗的医护人员进行统计调查,调查问卷内容包括人口统计学资料、社会资本、控制感,以及创伤后应激障碍（PTSD）相关内容。采用描述性统计、独立样本t检验、相关分析、层级回归等方法进行数据分析。 结果 共收回有效问卷760份,其中315名医护人员参与了确诊或者疑似新冠肺炎患者的救治工作。受访的医护人员存在一定程度的PTSD,处于中等水平（2.2155~2.9385）。医生在经历过新冠肺炎疫情后表现出的规避、闯入和唤醒倾向均高于护士群体,差异均有统计学意义（均P < 0.05）。新冠肺炎定点救治医院的医护人员在规避反应上高于非定点医院,差异有统计学意义（P < 0.05）。直接参与新冠肺炎患者救治的医护人员规避、闯入和唤醒反应水平均高于未直接参与救治的医护人员,差异均有统计学意义（均P < 0.05）。结构资本（r=0.566）、人际资本（r=0.577）和认知资本（r=0.596）对医护人员的控制感具有显著正向影响。结构资本（r=-0.166）、人际资本（r=-0.177）和认知资本（r=-0.168）对医护人员的PTSD具有显著负向影响。控制感（r=-0.179）对医护人员的PTSD具有显著负向影响。 结论 医护人员感知的结构资本、人际资本和认知资本通过增强其控制感可以有效抑制创伤后应激障碍的形成与发展,医院应采取措施通过提高医护人员的社会资本感知和控制感降低创伤后应激障碍的影响。     

The importance of addressing social determinants of health at the local level: the case for social capital

Social determinants are gaining momentum in public health practice. Many proposed solutions for tackling social determinants are outside the scope of local public health professionals. This article reviews the literature to find possible moderating variables which may buffer the effects of the social determinants of health at the local level, and allow social determinants to be addressed within the purview of local health departments. The systematic approach employed for this article entailed searches of electronic academic databases (PubMed, EBSCO and Medline) and additional searches using Internet search engines and relevant websites for articles published between 1,975 and May 2010. The search revealed 2,554 articles, and 36 were determined appropriate for inclusion. The purpose of the search was to identify published articles relating to social determinants of health, social capital and effective approaches for addressing both at the level of the local health department. The search was then expanded to include unpublished material, to include the perspectives of local health departments. This process resulted in the inclusion of content from five sources. In this article, the case is made for focusing on social capital interventions to mitigate health problems associated with social determinants. Examples of successful interventions are provided to aid public health professionals in developing locale-specific solutions for addressing social determinants.