Places and health: a qualitative study to explore how older women living alone perceive the social and physical dimensions of their neighbourhoods

There is growing interest in the impact that neighbourhood environment might have on the health of older people. Although the number of older Australian women, particularly those living alone, is projected to increase in coming decades, their experiences of neighbourhood have not been exclusively examined. The aims of this paper are: (1) to explore, from the perspective of these women, the social and physical dimensions of neighbourhoods and (2) to investigate variation in these accounts according to whether women lived in areas of higher or lower socioeconomic status. Twenty women aged between 75 and 93 years, residing in metropolitan Adelaide, South Australia (SA), participated in a series of two in-depth interviews. Women's perceptions of their neighbourhood, and accounts of every-day activities in the community were analysed to determine how both social and physical aspects of neighbourhood might relate to health and wellbeing. Findings suggest that a reciprocal and trusting relationship with neighbours underpinned older women's sense of satisfaction with, and feeling of security within, the neighbourhood. Other factors such as living in close proximity to services and existing social networks were also seen as important. Women's stories demonstrated that they were able to draw on both existing social networks and neighbours to sustain their independence and social connection within the community. Women living in more disadvantaged areas were more conscious of social disconnection in their neighbourhoods, and to the way that traffic noise and pollution detracted from their neighbourhood environment. These findings indicate that, for older women living alone, trusting and reciprocal relationships with neighbours are likely to form an important part of their broader social support network and should be recognised in relation to the process of maintaining the health of older women living in the community.     

Actual or potential neighborhood resources and access to them: testing hypotheses of social capital for the health of female caregivers

This study considers three commonly overlooked aspects of neighborhood social capital: actual or potential network resources, access to such resources, and their potentially negative implications, as they bear on the health of adult female caregivers of children. Drawing upon Bourdieu's social capital theory and urban and community sociology research, two sets of related hypotheses are formulated and tested. The first set examines specific resources that inhere within neighborhood social relations by testing hypotheses concerning four forms of social capital (social support, social leverage, informal social control, and neighborhood organization participation) and their respective associations with daily smoking and perceived health. The second set assesses the importance of one's access to the neighborhood networks that possess such resources by testing hypotheses regarding how residents' neighborhood attachment moderates the association between social capital forms and these health outcomes in positive and negative ways. Analyses of the Los Angeles Family and Neighborhood Survey (L.A.FANS) linked with tract level census data indicate that specific social capital forms were directly associated with positive and negative health outcomes. Neighborhood attachment significantly moderated relationships between several social capital forms and health, indicating that a female caregiver's degree of network integration matters in both health promoting and health damaging ways. In addition to illustrating the utility of a Bourdieusian perspective for formulating explicit, testable hypotheses regarding how social capital may matter for health, these findings suggest that future public health studies of neighborhood social capital need to consider (1) the actual or potential resources that inhere within relationships, and (2) the role of access to such resources for promoting or compromising health.     

Do bonding and bridging social capital affect self-rated health,depressive mood and cognitive decline in older Japanese? A prospective cohort study

Little is known regarding the longitudinal effects of bonding and bridging social capital on health. This study examined the longitudinal associations of bonding and bridging social capital with self-rated health, depressive mood, and cognitive decline in community-dwelling older Japanese. Data analyzed in this study were from the 2010 (baseline) and 2012 (follow-up) Hatoyama Cohort Study. Bonding social capital was assessed by individual perception of homogeneity of the neighborhood (the level of homogeneity among neighbors) and of networks (the amount of homogeneous personal networks) in relation to age, gender, and socioeconomic status. Bridging social capital was assessed by individual perception of heterogeneity of networks (the amount of heterogeneous personal networks) in relation to age, gender, and socioeconomic status. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to evaluate the effects of baseline social capital on poor health outcome at follow-up by logistic regression analysis. In total, 681 people completed baseline and follow-up surveys. The mean age of participants was 71.8 ± 5.1 years, and 57.9% were male. After adjusting for sociodemographics, lifestyle factors, comorbidity, functional capacity, baseline score of each outcome, and other bonding/bridging social capital, stronger perceived neighborhood homogeneity was inversely associated with poor self-rated health (OR = 0.55, 95% CI = 0.30–1.00) and depressive mood assessed by the Geriatric Depression Scale (OR = 0.58, 95% CI = 0.34–0.99). When participants who reported a depressive mood at baseline were excluded, stronger perceived heterogeneous network was inversely associated with depressive mood (OR = 0.40, 95% CI = 0.19–0.87). Neither bonding nor bridging social capital was significantly associated with cognitive decline assessed by the Mini-Mental State Examination. In conclusion, bonding and bridging social capital affect health in different ways, but they both have beneficial effects on the health of older Japanese. Our findings suggest that intervention focusing on bonding and bridging social capital may improve various health outcomes in old age.     

'That's just the cesspool where they dump all the trash': exploring working class men's perceptions and experiences of social capital and health

This article explores issues relating to the concept of social capital which has been become an important explanation for inequalities in health. It is based on an analysis of in-depth interviews with working class men living in two contrasting socio-economic areas--one relatively disadvantaged and one advantaged. It highlights the role of different community contexts in the nature and extent of local social capital. In particular, it demonstrates how de-industrialization and economic change as well as material deprivation and a perceived dis-investment in local communities impacted on the men's levels of social capital. Analysis also shows the ways in which gender mediates the processes through which social capital is developed and accessed as a personal and social resource, and how the norms and values associated with working class masculinities appeared to preclude the men from building supportive health-enhancing relationships with others in their community. The prominence of social capital has focused attention on the subjective dimensions of community life as potential determinants of health. This article has, therefore, sought to contribute to this field by widening our understanding about the relationship between social capital, gender and health.     

Intergenerational understandings of personal,social and community assets for health

Connecting local citizens of different ages in productive social activity is considered a pathway towards greater health. This research explores how older adults and young people interpret and access assets from their geographical community in relation to their well-being and the extent to which a process of intergenerational bridging contributes to the creation of additional assets for health. Data is presented from a process of place-mapping, interviews, observations and arts-based approaches to: a) understand how personal, social and community assets supported perceived health and wellbeing for the young children and older adults who participated; and b) explore the impact of intergenerational connection on enhancing social capital. The research utilised bonding, bridging and linking forms of social capital, across several interactions amongst 41 individuals who reside in the same geographical community (Victoria, Australia). Assets for health, common across generations and located within the same geographical community were identified. Social connections were strengthened through conversations, reflections and an integration of ideas facilitated through an arts-based approach. Findings suggest that through intergenerational connection and sharing of resources to support health, including the sharing of community assets, progress can be made towards community strengthening with implications for health and wellbeing.     

The Personal Social Networks of Resettled Bhutanese Refugees During Pregnancy in the United States: A Social Network Analysis

Women comprise 50% of the refugee population, 25% of whom are of reproductive age. Female refugees are at risk for experiencing significant hardships associated with the refugee experience, including after resettlement. For refugee women, the strength of their personal social networks can play an important role in mitigating the stress of resettlement and can be an influential source of support during specific health events, such as pregnancy. A personal social network analysis was conducted among 45 resettled Bhutanese refugee women who had given birth within the past 2 years in the Akron Metropolitan Area of Northeast Ohio. Data were collected using in-depth interviews conducted in Nepali over a 6-month period in 2016. Size, demographic characteristics of ties, frequency of communication, length of relationship, and strength of connection were the social network measures used to describe the personal networks of participants. A qualitative analysis was also conducted to assess what matters were commonly discussed within networks and how supportive participants perceived their networks to be. Overall, participants reported an average of 3 close personal connections during their pregnancy. The networks were comprised primarily of female family members whom the participant knew prior to resettlement in the U.S. Participants reported their networks as “very close” and perceived their connections to be supportive of them during their pregnancies. These results may be used to guide future research, as well as public health programming, that seeks to improve the pregnancy experiences of resettled refugee women.     

‘A lot better than medicine’ - Self-organised ocean swimming groups as facilitators for healthy ageing

Exercise, spending time in nature and feeling part of a supportive community all contribute to better physical and mental health and to healthy ageing. This focused ethnography investigates how participation in self-organised ocean swimming groups contributes to healthy ageing amongst older men and women in the Australian coastal city of Perth. It explores the ways marine life, personal experiences and social connectedness mediate their group use of public blue space, and highlights that group membership promotes participants’ enhanced health and wellbeing, and supports development of self-efficacy and resilience. These findings suggest that more inclusive access to ocean swimming and other forms of active or adventure-based leisure activities should be advocated from a public health perspective.     

Aboriginal Australians' experience of social capital and its relevance to health and wellbeing in urban settings

Social capital has been linked to physical and mental health. While definitions of social capital vary, all include networks of social relationships and refer to the subsequent benefits and disadvantages accrued to members. Research on social capital for Aboriginal Australians has mainly focused on discrete rural and remote Aboriginal contexts with less known about the features and health and other benefits of social capital in urban settings. This paper presents findings from in-depth interviews with 153 Aboriginal people living in urban areas on their experiences of social capital. Of particular interest was how engagement in bonding and bridging networks influenced health and wellbeing. Employing Bourdieu's relational theory of capital where resources are unequally distributed and reproduced in society we found that patterns of social capital are strongly associated with economic, social and cultural position which in turn reflects the historical experiences of dispossession and disadvantage experienced by Aboriginal Australians. Social capital was also found to both reinforce and influence Aboriginal cultural identity, and had both positive and negative impacts on health and wellbeing.     

Why men experiencing deep poverty in Montréal avoid using health and social services in times of crisis

This article describes the experiences of men living in deep poverty regarding their decision not to seek out health and social services in moments of crisis, even when they recognized needing help. It presents results from a qualitative research project done in collaboration with a community center in a disadvantaged neighborhood of Montreal, Canada. It was designed to increase understanding of men's experiences of poverty and the role played by health and social services in their lives. Data were collected through 80 days of participant observation, 22 semi-directed interviews, and six group discussions with men living in poverty. The results show that these men are reluctant to use health and social services for three main reasons: 1) the nature of their problems; 2) their difficulty in seeking help; 3) the nature of services offered. The paper concludes with implications of the findings for future research and interventions.     

Why Do Some Women Know More? An Exploration of the Association of Community Socioeconomic Characteristics,Social Capital,and HIV/AIDS Knowledge

The objective of this study was to investigate the associations of community-level socio-economic status (SES) characteristics and social capital with women's knowledge of HIV/AIDS. We used a representative national sample of 6,771 women ages 15–49 years from the Bangladesh Demographic Health Survey of 2007. We extended the findings of prior studies by providing new evidence that both community and social capital were related to having knowledge of AIDS. The significant community characteristics associated with women's greater knowledge of AIDS were: women's higher mean age at first marriage, higher mean years of education, the higher percentage of women in the community who work, and higher mean household living standard in the community. Regardless of individual-level SES, living in a community with higher community-level SES and having greater social capital were associated with having a greater likelihood of hearing about AIDS. However, we found that once women knew about AIDS, not all of the community-SES and social capital indicators explained their advanced knowledge of AIDS prevention and transmission. Our findings underscore the importance of HIV/AIDS education campaigns in the disadvantaged communities, specifically targeting women who are not members in any non-governmental organizations, as well as greater use of media in educating women about AIDS.     

Food insecurity is associated with social capital, perceived personal disparity, and partnership status among older and senior adults in a largely rural area of central Texas

This study examined the association of compositional measures of collective social functioning, composed of community and familial social capital and perceived personal disparity, with food security among older (aged 50-59 y) and senior (aged ≥ 60 y) adult residents of the largely rural Brazos Valley in Central Texas using data from the 2006 Brazos Valley Community Health Assessment (analytic N = 1059, 74% response rate). Among older adults and seniors, 18.6% reported food insecurity (5.5% often and 13.1% sometimes), defined as running out of food and not having money to buy more. Low community social capital was reported by 22.4% of participants, and 30.8% indicated they were single, widowed, or divorced, an indicator of limited familial social capital. A robust multinomial regression model found the odds of reporting greater food insecurity increased for individuals who were women, African American, residents of a household with a low or poverty-level income, individuals who perceived themselves to be worse off than others within their community, and those who had low social capital. The odds of being food insecure decreased for older respondents, partnered respondents and persons with more education (pseudo r(2) = 0.27, p < 0.0000). Compositional level measures of collective social functioning are important associates of food insecurity among older adults and seniors, regardless of severity.     

"Sense of community belonging" in health surveys: what social capital is it measuring?

Canadian national health surveys regularly ask respondents to rate their sense of belonging to their local community. Health studies commonly use this question as a social capital indicator, but what social capital domains community belonging is measuring remains unclear. Analyzing Canadian General Social Survey data, we evaluate the validity of this measure with respect to network-based social capital and health. Results indicate that sense of community belonging is associated positively with several network-based social capital measures. Neighborhood network-based social capital most substantially reduced associations between sense of community belonging and health measures, but results differed by urban and rural settings. These findings indicate the need for public health surveys to include specific measures of respondents' networks.     

Using written vignettes in focus groups among older adults to discuss oral health as a sensitive topic

When the mouth yields pain and distress, it can impact psychosocially the lives of older adults and might constitute a sensitive topic for open disclosure. In this article, we describe our use of a written vignette in focus groups for discussion of oral health and disablement. Six focus groups were conducted with 42 older men and women with an average age of 75 years who were purposefully selected through advertisements posted in community centers and retirement homes. In discussions lasting for an average of 90 min, groups of up to 9 participants commented positively and negatively on the vignette's story and voluntarily discussed their personal experiences, family histories, and testimonies about the mouth and coping and adapting strategies to disabilities. The discussion about oral health can be sensitive, but the vignette shifted the focus away from the participants and allowed them to share personal experiences with oral health and disablement.     

Sexual health: the role of sexual health services among homeless young women living in Toronto, Canada

Recent statistics indicate limited condom use, high STI (sexually transmitted infection) rates, and a general lack of knowledge about reproductive and sexual health among homeless youth. This research focuses on the experiences of homeless female and transgendered youth, providing an insider's perspective on shaping sexual health interventions. This qualitative research is based on life history interviews and participant observation with eight homeless young women who reflect the diversity of the homeless population in Toronto, Ontario, Canada. Their particularized sexual experiences and health-seeking behaviors illustrate the range of issues faced by this community, speaking to the efficacy of current health promotion strategies. Too often faced with judgmental health and social service providers who they perceive to undermine their agency and empowerment, these women highlight the challenges they face when seeking sexual and reproductive health services and information. In addition to speaking to the struggles and frustrations they face in regard to their sexual health and the services with which they choose to interact, the women provide suggestions for improved care. From these, the authors include key recommendations for the provision of culturally competent, sex-positive, and nonjudgmental health services with the hope that health practitioners and promoters can learn from these experiences, both positive and negative, when caring for and supporting young women living in exceptional circumstances.     

Influence of income, income inequalities and social capital on the health of persons aged 65 and over in Spain in 2007

The aim of this study is to evaluate the influence of personal income [absolute income hypothesis (AIH)], income inequality and welfare [relative income hypothesis (RIH)], and social capital on the health of older people. Multi-level, cross-sectional logit models are calculated separately for women and men. The database employed was the Spanish Life Conditions Survey for 2007. The population consists of 6,259 persons aged over 65 years living in the 17 autonomous regions of Spain. The results confirm the AIH hypothesis: higher personal income is associated with better health. Education is also associated with better self-perceived health. The RIH hypothesis is partially confirmed due to the association between the Gini coefficient, regional per capita welfare and self-perceived health in older people, but only for women. Two different measures of social capital are used: the value of services of social capital and the percentage of people aged over 65 belonging to an association. Both factors are statistically associated with better self-perceived health in women. This study is the first to contrast the associations among income, income inequalities, social capital and the health of elders in Spain.     

An interpretative phenomenological analysis of African Caribbean women's experiences and management of emotional distress

African Caribbean women are under-represented within mental health services in the United Kingdom, despite sociocontextual vulnerabilities which may increase emotional distress. This qualitative study aimed to explore individual explanatory models of experiences of distress, coping and help-seeking choices, with a view to improving cultural relevance of services. Participants were recruited following their self-referral to self-help community wellbeing workshops. Interpretative phenomenological analysis was carried out following semi-structured interviews with seven African Caribbean women in central London, who reported previously experiencing emotional distress. The study was conducted during 2009. Five super-ordinate themes emerged from the data: explanations of distress, experiences of distress, managing distress, social and cultural influences and seeking help. Each super-ordinate theme consisted of several subthemes which described participants' experiences. Gender roles and a cultural legacy of being strong and hiding distress emerged as influential in participants' beliefs about managing personal difficulties. However, this was balanced with an acknowledgement that intergenerational differences highlighted an increasing acceptance amongst the community of talking about issues and seeking professional support. The findings offered support for the notion that understandings and responses to personal distress are subject to broad-ranging and interwoven influences. This complexity may be conceptualised as an 'exploratory map' where individuals make links between their current and newly encountered knowledge and experience to guide their personal route to coping and help-seeking. The study provides support for tailoring services to individual needs using a flexible approach which empowers individuals from black and minority ethnic groups by valuing explanatory models of distress alternative to the westernised medical model. Furthermore, findings emphasise the importance of readily available and accessible information about statutory and non-statutory community resources which use language relevant to the communities they are aimed at engaging.     

Are rural health professionals also social entrepreneurs?

Social entrepreneurs formally or informally generate community associations and networking that produces social outcomes. Social entrepreneurship is a relatively new and poorly understood concept. Policy promotes generating community activity, particularly in rural areas, for health and social benefits and ‘community resilience’. Rural health professionals might be well placed to generate community activity due to their status and networks. This exploratory study, conducted in rural Tasmania and the Highlands and Islands of Scotland considered whether rural health professionals act as social entrepreneurs. We investigated activities generated and processes of production. Thirty-eight interviews were conducted with general practitioners, community nurses, primary healthcare managers and allied health professionals living and working rurally. Interviewees were self-selecting responders to an invitation for rural health professionals who were ‘formally or informally generating community associations or networking that produced social outcomes’. We found that rural health professionals initiated many community activities with social outcomes, most related to health. Their identification of opportunities related to knowledge of health needs and examples of initiatives seen elsewhere. Health professionals described ready access to useful people and financial resources. In building activities, health professionals could simultaneously utilise skills and knowledge from professional, community member and personal dimensions. Outcomes included social and health benefits, personal ‘buzz’ and community capacity. Health professionals' actions could be described as social entrepreneurship: identifying opportunities, utilising resources and making ‘deals’. They also align with community development. Health professionals use contextual knowledge to envisage and grow activities, indicating that, as social entrepreneurs, they do not explicitly choose a social mission, rather they act within their known world-view. Policymakers could consider ways to engage rural health professionals as social entrepreneurs, in helping to produce resilient communities.     

Australian lesbian and bisexual women's health and social experiences of living with hepatitis C

We recruited women in two Australian locations to complete a questionnaire on their health and social experiences of living with the hepatitis C virus (HCV). Among 462 respondents 9% identified themselves as lesbian and 14% as bisexual. Bisexuals were more disadvantaged than lesbians or heterosexuals on income, work status, home ownership, and level of education. Lesbians and bisexuals were less likely to be referred for HCV treatment and were more likely to report being treated negatively by any health professional. Lesbians and bisexuals experience HCV differently from one another and from heterosexuals. Their needs are not being met by women's health and HCV-specific services.     

Support networks for Chinese older immigrants accessing English health and social care services: the concept of Bridge People

As Chinese immigrants in the United Kingdom age, they experience an increasing need to access health and care services. It has, however, been reported that older Chinese immigrants have difficulties in accessing these services. This study explored the experiences of this population in using health and care services and the strategies that they adopted to address their difficulties. A grounded theory method with a two‐staged research design was used. Stage 1 explored the participants’ experiences of ageing and use of health and social care services through focus group interviews. Stage 2 investigated the strategies individuals used to support access to and use of services through individual interviews. Forty‐four older Chinese people and 15 supporters participated in interviews during August 2011 and May 2013. These older Chinese immigrants were challenged in knowing about and in accessing services. Their difficulties were attributed to language barriers, lack of information and instrumental support, and emotional and cultural issues regarding use of health and care services. Their supporters facilitated access to services and acted as a bridge between the service and the user; therefore, they were given the title ‘Bridge People’. Bridge People have different backgrounds: family and friends, public sector workers and staff from community‐based Chinese organisations. The defining attributes of these supporters were: bilinguality, bicultural, multifunctionality and accessibility. There is no charge for this support; and the relationship between the Bridge Person and recipient involves trust and influence over decisions regarding use of health and care services. Bridge People should be recognised and identified by health, social care and housing services to promote engagement and use of services by older immigrant Chinese people.