The benefit of neighbourhood social capital for health of people with chronic illness

Abstract

Connections between neighbours generate resources and support that can benefit health and well-being. These resources can be referred to as social capital. Neighbourhood social capital does not inhere in specific relationships between neighbours, but is a characteristic of the neighbourhood community. This means that neighbourhood social capital can also provide resources for people who are not personally connected to specific others in their neighbourhood. This thesis applied social capital theory to test hypotheses about the benefit of neighbourhood social capital for health of people with chronic illness. People with chronic illness may use resources provided through neighbourhood social capital to deal with the tasks and the limitations they are faced with due to their illness. The main question of this thesis is: Is neighbourhood social capital related to health of people with chronic illness? And if so, how can we explain the relationship between neighbourhood social capital and health of people with chronic illness? First of all, we assessed whether there is indeed a relationship between social capital and health of people with chronic illness. We then conducted a qualitative study to gain insight into the views of people with chronic illness on the contributions of neighbours, and other social network members, to health and self-management. A number of mechanisms have been proposed behind the relationship between neighbourhood social capital and health. This thesis examined four mechanisms that are relevant for people with chronic illness. Namely: 1.Increased access to health promoting services and amenities. Municipalities with more social capital might be more successful at undertaking collective action to ensure access to health promoting services and amenities. 2.The provision of affective and instrumental support by neighbours. 3.Improved chronic illness self-management through the resources provided by neighbourhood social capital. 4.Increased access to health information. Neighbourhood social capital may promote the diffusion of health-related information and therefore increase the likelihood that healthy behaviour is adopted. Increased access to health information in neighbourhoods can help people with chronic illness to make decisions about health and may compensate for a lack of health literacy skills needed to independently access and apply health information. Results show that neighbourhood social capital can benefit health of people with chronic illness, independent of individual social capital they possess. Neighbours make valuable contributions to self-management, but people with chronic illness indicate there are limits to the support they can and want to receive from their neighbours. Support by neighbours is not a resource provided through neighbourhood social capital but can only be accessed through individual connections to neighbours. This thesis did not find conclusive evidence for any of the hypothesized mechanisms behind the relationship between neighbourhood social capital and health. The results indicate that the effect of neighbourhood social capital on health of people with chronic illness is by no means homogenous across different subgroups. Evidence for the mechanisms behind the relationship between neighbourhood social capital and health varies between people with chronic illness based on health literacy skills, the physical disabilities people with chronic illness have and the urbanity of the neighbourhood.