Social capital and health care experiences among low-income individuals

Objectives. We examined relationships between social capital and health service measures among low-income individuals and assessed the psychometric properties of a theory-based measure of social capital.Methods. We conducted a statewide telephone survey of 1216 low-income New Mexico residents. Respondents reported on barriers to health care access, use of health care services, satisfaction with care, and quality of provider communication and answered questions focusing on social capital.Results. The social capital measure demonstrated strong psychometric properties. Regression analyses showed that some but not all components of social capital were related to measures of health services; for example, social support was inversely related to barriers to care (odds ratio=0.73; 95% confidence interval=0.59, 0.92).Conclusions. Social capital is a complex concept, with some elements appearing to be related to individuals’ experiences with health services. More research is needed to refine social capital theory and to clarify the contributions of social capital versus structural factors (e.g., insurance coverage and income) to health care experiences.The concept of social capital emerged from work in the social sciences by Putnam and others who defined social capital as what originates from social networks and the reciprocity, trustworthiness, and civic engagement created by these networks.1^–7 Epidemiologists have applied these concepts to public health and have worked to illuminate cause-and-effect relationships.3^,7^,8 At the same time, community interventions and community psychology researchers have used similar concepts of community capacity, sense of community, and community control to explore how to facilitate health status improvements.Researchers have found associations between high levels of community social capital and reduced all-cause mortality rates, better self-rated health, and lower levels of college binge drinking.3^,9^–11 These findings have led to the suggestion that social capital may play a role in mediating the relationship between income inequality and health.3^,4^,8^,12^,13One mechanism by which social capital may influence health, particularly in low-income communities, is its influence on people’s use of health care services. Residents of a community with high social capital may provide one another with greater instrumental and psychosocial support than do residents of a community with low social capital, or the community’s level of interconnectedness and trust may reduce barriers to care. To date, however, little research has examined the relationship of social capital to health service measures such as use of services, participation in care, or satisfaction with services.In one of the few studies to date, community social capital independently predicted the level at which patients trusted physicians.14 In another study, conducted among homeless individuals with mental illness in 18 different communities, associations emerged between community social capital and greater service integration, increased access to housing assistance, and a higher probability of individuals obtaining suitable housing, although an association with clinical outcomes did not appear.15 The few studies conducted, however, leave unanswered the broader question of whether and how social capital is associated with access to, use of, and satisfaction with health services. Also, these studies have not examined the relative contributions of social capital and structural factors such as geographic and financial conditions, which exert important effects on health care access.An additional, methodological difficulty in this field has been the lack of a consistent operationalization of the concept of social capital. Because unique measures of social capital have been applied in most published studies, between-study comparisons remain problematic. Also, the wide variation in measurement approaches makes interpretation of results difficult. Finally, because published studies rarely provide results from psychometric testing of their social capital measures, assessing the validity or reliability of these measures has remained difficult.In this study, we sought to address the need for standard measures of social capital by creating theory-based measures and testing their psychometric properties in a large, statewide sample of low-income individuals. We then used these measures to examine the association between social capital and individuals’ health care experiences.