Relationship between Social capital and Chronic illness self-management in Seoul, Korea

Abstract

Introduction: A growing burden and impact of hypertension and diabetes has led to a growing interest in its management. Chronic illness self-management supports patients with chronic conditions to have the best possible quality of life, improving health behaviors and decreasing the frequency of hospitalization (Bodenheimer et al., 2002). To implement effective self-management, more socialized understanding of the process is required (Gately et al., 2007). Several studies have indicated that socioeconomic status (SES) has a relationship with social capital (Glanz et al., 2002

Barlow, 2002) and influence the adherence ability to manage chronic illness (Goldman & Smith, 2002). Furthermore, "satisfaction" is the outcome of social capital (Harpham, 2002) as well as it decides treatment compliance and accessibility to health care (Hjortdahl & Laerum, 1992). The purpose of this study was to demonstrate the relationship between social capital and self-management of patients with hypertension and diabetes

furthermore investigate the differences in association by SES

and clarify the mediating effect of "satisfaction".

Methods: The data used in this study came from the Korean Community Health Survey (KCHS) of 2011, and the region was restricted to 8 districts of Seoul. The subject criteria was prevalence of hypertension and/or diabetes and adults aged 30 and above. Following Putnams notion, social capital was defined in terms of trust, reciprocity, networks, and participation, andTaking medication, following non-medication therapy, and attending to self-management education were set as management matters of chronic illness. Breslow-Day test and Mantel-Haenszel test were used in SES stratification analysis, and mediating effect of satisfaction was analyzed based on Baron & Kennys approach. Logistic regression was performed for analyzing adjusted association between variables. All analytic processes were performed using the statistical program SAS version 9.3.

Results: Hypertension patients were mostly dependent on medication for self-care, rather diabetes group attempted to manage their disease with more diverse manners including attending education. Generally, comorbidity group indicated better self-management aspects than those with single disease. Intimate and homogenous ties were predominant among participation (e.g. friendship activities: 56.97%) and network (e.g. family network: 79.26%). There are significant differences between social capital and self-management distribution by SES and several combinations indicate positive effect for high SES group only. And satisfaction came into mediator between trust and non-medication. After adjustment for confounding factors, network still had association with medication (OR 1.46, 95%CI 0.93-2.28, p<0.1), and participation with non-Medication (OR 1.38, 95%CI 1.03-1.84, p<0.05).

Conclusion: The structural social capital comprised of participation and network, tend to have positive effects on chronic illness self-management than cognitive social capital based on trust and reciprocity. The distribution and effectiveness of social capital and self-management manner depend on SES. In other words, high SES group manage chronic condition using their social resources (e.g. social capital and SES itself) properly, while low SES group have difficulty in achieving benefit of social capital due to a lack of their capacity. That is, low SES could be a barrier to take advantage of social capital on self-management, and it can broaden the health inequality between SES groups. We need to understand social context for chronic illness self-management and bring social capital strategies into self-management paradigm for enhancing patients' efficacy and management efficiency.