Norbeck Social Support Questionnaire Research Articles

The social support systems of mothers with problematic substance use in their infant's first year

AbstractThe infants of women with histories of problematic alcohol and other drug use are among the most vulnerable children known to statutory child protection services, which they enter at a younger age, and in which they remain longer. The net results include overwhelmed child protection systems and the birth of subsequent children conceived to ease women's grief at the loss their infants. Without adequate and appropriate support to the mother and her family, the pattern repeats. Obstetric services have an important role to play in the assessment of risk and protective factors in the perinatal period and in determining pathways to service provision. A comprehensive assessment considers the availability and quality of informal support prior to activation of formal systems of support, both statutory, where engagement is mandated, and non‐statutory, where support is offered on a voluntary basis. This paper uses quantitative methods to explore the social networks of women with problematic substance use in the transition to motherhood and the relationship between formal and informal support systems and infant outcomes. Surveys were held with two counsellors from the Women's Alcohol and Drug Service (WADS), a specialist obstetric clinic in Melbourne, Australia, and with 18 child protection workers. In addition, the Norbeck Social Support Questionnaire (Norbeck, 1984; Norbeck et al., 1983) was administered with 20 participating mothers to measure levels of formal and informal support, as well as the type and quality of support available to mothers over a 12‐month period, and to consider the provision of social support against known outcomes for infants. The findings demonstrate that WADS counsellors made several referrals for most women but that there was little in the way of long‐term follow‐up by non‐statutory service providers, with most women experiencing a dramatic drop in support over the 12‐month period. Women whose main informal support was from a domestically violent partner, and those who had been in out‐of‐home care in their own childhood, were particularly vulnerable to losing the care of their infant. The role of child protection varied markedly across the 12‐month period, particularly in relation to the extent that a relationship between formal and informal systems of support for mothers and their infants could be established. Overall, the study findings demonstrate that mothers experienced diminishing formal and informal support over time and that the quality of social support available to the mother was more important in terms of outcomes for women and their infants than the quantity.

Mental Health Issues among Parents of Children with and without Intellectual Disability

The term Intellectual disability is a diagnostic term denoting the group of disconnected categories of mental functioning such as idiot, imbecile, and moron derived from early IQ tests, which acquired pejorative connotations in popular discourse. In the definition released by AAMR (Luckasson et al., 2002), mental retardation was described as a disability characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social and practical adaptive skills. The present study assessed the mental health issues among parents of children with and without intellectual disability. Parental Stress Index (PSI) (Abidin, 1995), was used to identify sources of stress in parent child sub systems. The Norbeck Social Support Questionnaire (NSSQ; Norbeck et al, 1995), was used to assess rates of the extent of perceived emotional support. Family Support Scale (Dunst et al, 1984) was used to assess the sources of family support available. Centre for Epidemiological Studies Depression Scale (CED-D; Radloff, 1977) was used to assess the current levels of depressive symptoms and mood. All these were administered on 120 mothers of Intellectual disabiled (ID) children aged 10 to 20 years and 120 mothers of healthy children with average intelligence (AI) as controls. The results revealed that, overall mothers of children with ID reported higher level of stress and are more depressed than mothers of children without ID. On the other hand, in terms of social and family support, mothers of ID children had significantly higher emotional support than mothers of children without ID. This may also be a reflection of the fact that even though in India the structure of the family has become nuclear; functionally families still operate within an extended social network.

Personal Predictors of Parents’ Educational Aspirations for their Children with Disabilities

In order to address the main research problem, the authors determined the correlation between personal predictors, i.e. the level of self-esteem measured by Fitts’ Tennessee Self-Concept Scale, the styles of coping with stress examined by Endler & Parkers’ Coping Inventory for Stressful Situations, the intensity of social support measured by Norbeck Social Support Questionnaire, and the level of educational aspirations of parents of children with disabilities, assessed by K. Parental Aspirations Questionnaire. The research involved 247 mothers and fathers of children with visual, auditory, motor and intellectual disabilities. Only full families were investigated. The research relied on multiple step-wise regression analysis, factor analysis, and path analysis for mothers and fathers separately. The high level of aspirations for the education of children with disabilities was dependent on the positive self-esteem of both mothers and fathers. The article presents a discussion of the results, study limitations, practical implications and future research areas.

Perceived stress and social support needs among primary family caregivers of ICU Patients in Taiwan

BackgroundFamily caregivers of intensive care unit (ICU) patients may experience distress due to their care recipients’ unexpected ICU hospitalization. Social support in coping with stress has been discussed from different cultural perspectives, but social support does not seem to buffer stress for Chinese people. ObjectivesThe purpose of this study was to explore stress perception and social support needs and their associations among Taiwanese primary family caregivers of patients admitted to the ICU for the first time. MethodsThis descriptive correlational study used the Perceived Stress Scale (PSS), the Impact of Events Scale-Revised (IES-R), the Norbeck Social Support Questionnaire (NSSQ), and structured interviews to explore stress perception and social support needs among Taiwanese primary family caregivers of patients admitted to the ICU. ResultsThe Taiwanese primary family caregivers (N = 71) perceived considerable social support, but they still experienced high stress, either daily life stress or ICU-related event stress. Most of them required extra support, such as discussion of medical conditions, disease treatment information and psychological support, even though they had social resources to assist them. ConclusionICU health professionals should actively inquire about family caregivers’ actual needs, even when family caregivers perceive considerable social support. Tailor-made interventions should be provided to assist family members in coping with stress. Further research should also explore the role of social support in stress and coping processes in Asian contexts due to cultural variance.

Tests of Revisions to the Norbeck Social Support Questionnaire.

Objectives:To compare the accuracy of averaged scores from the original Norbeck Social Support Questionnaire (NSSQ)and averaged scores from each of three new NSSQ versions (NSSQ-R.aid, NSSQ-R.n/a, and NSSQ-R.format). These three new versions of the widely used NSSQ were developed to address three previously identified concerns regarding score accuracy: the Aid subscale’s examples of aid, lack of an n/a response option, and the network nomination/rating procedure. Missing data rates were also assessed.Methods:A convenience sample (N = 223) completed one of the four NSSQ versions. Score accuracy (restriction) was assessed by size of correlation between averaged scores (averaged score/network size) and network size, with low correlations indicating less score restriction and higher score accuracy. Fisher’s r-to-z transformations assessed the significance of the difference between all correlations from the three versions. Missing data rates were assessed using chi-square tests of independence.Results:The cumulative effects of removing the aid examples and use of the n/a response option improved score accuracy; averaged Aid scores from the NSSQ-R.n/a were statistically significantly less restricted than corresponding scores on the original NSSQ. The final version (NSSQ-R.format) actually resulted in statistically significant decreased score accuracy for averaged Affect scores. There were no statistically significant differences in missing data rates among versions.Conclusion:Averaged scores from the NSSQ-R.n/a should be used. Future research should focus on the use of situation-specific Aid items.

Exploring Stress, Sleep Disturbances, and Fatigue Among Primary Family Caregivers in the ICU

Primary family caregivers (PFCs) in the intensive care unit (ICU) experienced stress and stress-related symptoms such as sleep disturbances and fatigue. These symptoms may cause physical and mental health problems and affect the quality of care that they provide to their care recipients. This study explored the levels of severity of stress, sleep disturbances, and fatigue experienced by PFCs in the ICU in order to understand the associations and to explore the predictors and influencing factors in the period following the first ICU admission of their care recipients. This descriptive correlational study was based on Lazarus and Folkman's Stress-Coping theory. Four questionnaires including the Impact of Events Scale - Revised, General Sleep Disturbance Scale, Lee's Fatigue Scale, and the Norbeck Social Support Questionnaire were used to measure the psychological stress symptoms and social support received by 72 PFCs. Descriptive statistics and multiple hierarchical regression analysis were utilized for data analysis. The participants suffered from high levels of event stress, poor sleep quality, and fatigue severity. However, they also received generally high levels of social support. Stress perception was found to positively associated with sleep disturbances and fatigue severity. The participants who experienced higher event stress sought additional assistance. The age and perceived event stress of PFCs were significant predictors of sleep disturbances, while perceived event stress was the only significant predictor of fatigue. This study provided healthcare professionals with important information to understand the psychological symptoms of PFCs. Future studies should identify the stressors of this caregiver group and explore their psychological symptoms during different hospitalization periods. Further interventions should be developed to help PFCs cope with stress and improve stress-related symptoms such as sleep quality and fatigue severity.

Factors Associated with the Presence of Strong Social Supports in Bhutanese Refugee Women During Pregnancy.

Social support may mitigate stress related to the refugee experience, including during resettlement. For refugee women, social support can play an important role during pregnancy. In-depth interviews were conducted within a sample of 45 Bhutanese refugee women. Perceived social support was measured using the Norbeck Social Support Questionnaire. Averaged social support scores are reported to account for personal network size. Participants were identified as "low support" and "high support" based on their reported score. The mean social support score reported was 18.9. Participants experiencing a secondary resettlement within the U.S. were 4.52 (95% CI 1.19-17.15) times as likely to report a "high support" network compared to participants who resettled directly from Nepal. Personal social networks are an important source of support for resettled refugee women during pregnancy in the U.S.. Refugee women who experience secondary resettlement may perceive stronger support from their personal connections.

Stress, stress-related symptoms and social support among Taiwanese primary family caregivers in intensive care units

ObjectivesTo explore the associations between stress, sleep disturbances, fatigue severity and social support among primary family caregivers in intensive care units during the early period of ICU hospitalisation. DesignCross-sectional, descriptive correlational study. SettingIntensive Care Units in a teaching hospital in Taiwan. Main outcome measuresPerceived stress (Impact of Events Scale-Revised), sleep disturbances (General Sleep Disturbance Scale), fatigue severity (Lee’s Fatigue Scale), social support (Norbeck Social Support Questionnaire) and one open-ended question. ResultsThe primary family caregivers (N = 87) were distressed and experienced poor sleep quality and fatigue during the early period of ICU hospitalisation. Primary family caregivers have various social support needs but being updated on the patients’ prognosis was at the top of the list. Perceived ICU hospitalisation stress was the only significant predictor for fatigue while age along with perceived event stress were the significant predictors for sleep disturbances. ConclusionStress-coping interventions are needed to reduce stress-related symptoms for the primary family caregivers. Social supports did not buffer stress in this study, which calls for further research to explore the culture variance and quality of social support.

Postnatal depression, maternal–infant bonding and social support: a cross-cultural comparison of Nigerian and British mothers

Objectives: The high prevalence of Post-Natal Depression (PND) in low and lower-middle income countries of Africa raises questions about the functionality of the abundant informal support accessed in the enmeshed family structure. This study examined the interaction between social support, parity and culture in the development of PND and maternal–infant bonding (MIB) among Nigerian, British and Nigerian Immigrant mothers in the UK.Methods: Participants (N = 124) were recruited from the UK and Nigeria via local support groups for mothers, websites offering motherhood-related content and social media. Questionnaires including the Edinburgh Postnatal Depression Scale (EPDS), Postpartum Bonding Questionnaire and Norbeck's Social Support Questionnaire were uploaded onto SurveyMonkey®.Results: Findings revealed significant cultural differences in PND and social support. Multiple regression analyses revealed that PND, social support and culture could predict MIB, with PND being the only significant independent predictor.Conclusions: Our findings highlight the importance that cultural factors play in the development of PND and the establishment of MIB in the context of culturally attuned healthcare services.

Partner Involvement During Pregnancy and Maternal Health Behaviors.

Objectives Healthcare provider focus often rests solely on a pregnant woman, while a woman's partner may prove to be an ally in a pregnant woman's health behaviors. The objective of this study is to assess the role of partner support and other demographic factors affecting alcohol and drug use in pregnancy. Methods This cross-sectional cohort study at Thomas Jefferson University Hospital evaluated pregnant women and their partners and obtained sociodemographic information, medical history, tobacco and alcohol use, and results from the Norbeck Social Support Questionnaire (NSSQ). Inclusion criteria were pregnant women 18-44years old, and English fluency. Subjects without support persons were excluded. Results 198 women were evaluated. Women who reported having a partner were less likely to smoke and drink, as 2.8% of partnered women smoked and 26% drank, compared with 12.2% non-partnered women smoked (p=0.01), and 42% drank alcohol (p=0.07). Significant factors positively influencing the NSSQ included being married, increased household income, and higher education (p<0.001). On multivariate regression, having a partner and higher income level were the most important predictors of the Social Support Score (p<0.05). Conclusions for Practice Having a partner during pregnancy is an important factor in alcohol and drug use. Patients with a reliable partner were less likely to smoke cigarettes and drink alcohol in pregnancy. Increased income and relationship status are other important factors for the support of pregnant women.

Caregiver Burden and Social Support in Mothers with β-Thalassemia Children

&lt;p&gt;&lt;strong&gt;BACKGROUND: &lt;/strong&gt;In our knowledge, there was no available information on social support and caregiver’s burden among parents of thalassemic children.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;AIM:&lt;/strong&gt; To examine caregiver’s burden and social support in mothers of thalassemic children, this study was conducted.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;METHODS: &lt;/strong&gt;This cross-sectional study was conducted from July to October 2013 in Jiroft Thalassemic Center (JTC) in southeast of Iran. To assess the caregiver’s burden and social support, caregiver burden scale and Norbeck social support questionnaire was used respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;RESULTS: &lt;/strong&gt;There was a response rate of 98% (160 out of 163 mothers were participated). Generally, 51.5% and 49.5% of mothers reported low and high level of social support, respectively. In term of caregiver’s burden, 20%, 29% and 51% of mothers reported high, moderate and low level of burden, respectively. There was no significant correlation between mean score of caregiver’s burden and mean score of social support.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;CONCLUSION:&lt;/strong&gt; Our study showed that social support of Iranian mothers with thalassemic children is low. In addition, caregiver’s burden among this group of mothers is high. Further research is recommended to prepare more evidence in this regard.&lt;/p&gt;

A Comparative Study of Self-Efficacy for Social Participation of People with Mental Illness in Japan and China

Self-efficacy for social participation (SESP) of people with mental illness was examined in urban areas of Japan and China. The subjects were 266 people (140 Japanese, 126 Chinese) with mental illness who were living in their local community. Our SESP scale (SESP27) and the Rosenberg Self-Esteem Scale, Norbeck Social Support Questionnaire (NSSQ), Sense of Coherence measure (SOC13), General Health Questionnaire (GHQ12), and a self-administered questionnaire related to living conditions were used for data collection. Data were analyzed descriptively, correlations between scales were examined, and multiple regression analysis was performed by country. The results showed that annual income was related to SESP in Japan and China. Therefore, improvement of welfare and employment support for economic independence is likely to improve SESP of people with mental illness in both countries. In addition, SESP in people with mental illness is affected by self-esteem in Japan, and coping skills such as improvement of life functions in China. Thus, SESP is affected differently by the social, cultural and institutional characteristics of each country.

Impact of Psychosocial Factors on Functional Improvement in Latino Older Adults After Tai Chi Exercise

Increasing evidence underscores the health benefits of Tai Chi (TC), although there is limited evidence of benefits among racial and ethnic minorities. This study investigated the impact of psychosocial status on balance among 23 Latino seniors after a twice-a-week, 12-week TC exercise program. Functional status was measured at baseline, immediately after, and three months following the TC exercise program, using the Timed Up and Go Test and Tinetti Falls Efficacy Scale. Psychosocial status was measured at baseline by the Center for Epidemiologic Studies Depression Scale and Norbeck Social Support Questionnaire. Both measures of functional status improved and were sustained after three months of TC. Greater improvement was significantly related to a higher level of baseline social support. More depressed seniors reported less fear of falling after TC. Depression and social support are important moderators of functional improvement after TC among Latino seniors.

Disclosure of HIV Status and Social Support Among People Living With HIV.

Background:Disclosure of HIV is important for improving self-care behaviors, psychological well-being, commitment to the treatment, and reducing risk of transmission. One of the major benefits of disclosure is social support, which is an essential resource for effective coping with HIV infection. However, receiving any social support requires disclosing of HIV status.Objectives:This study aimed to determine the disclosure of HIV status and its related factors such as social support in addition to demographic and disease characteristics among people living with HIV in Iran.Patients and Methods:This cross-sectional study, using simple random sampling, was carried out on 175 people with HIV/AIDS who referred to Behavioral Counseling Centers. The self-administrated, Norbeck Social Support Questionnaire was used to measure social support. Disclosure of HIV status was assessed with an investigator-designed questions. Multiple logistic regression analysis with backward Likelihood Ratio method was applied to identify the adjusted odds ratio between disclosure as dependent variable and demographic variables, social support as independent variables.Results:Participants were often disclosed their HIV status to family members. But there were differences about disclosure of HIV status within the context of the family. Family members were perceived as more supportive. Multiple logistic regression analysis demonstrates that the gender (adjusted OR = 0.181; 95% CI .068-0.479), CD4 cell count (adjusted OR = 0.997; 95% CI 0.994-0.999), route of transmission (injection-drug user [adjusted OR = 9.366; 95% CI 3.358-26.123] and other routes [tattooing, mother to child, dental services, etc.], [adjusted OR = 3.752; 95% CI 1.157-12.167]), and functional support variable (adjusted OR = 1.007; 95% CI 1.001-1.013) remained in the model as significant predictors for disclosure.Conclusions:The results of this study regarding disclosure of HIV status and its relations to social support and some demographic variables can provide an understanding based on the evidence for promotion of knowledge and coping interventions about people living with HIV/AIDS and their perceived social support status.

Social Support and Psychological Distress among Adolescents in Foster Care

There are 1.7 million orphans in Egypt, and the Egyptian foster care sector is largely a non-governmental relying on private support with minimal government supervision. The transition from living at home to living in foster care is difficult for anyone at this age. Psychological distress is one of the health problems faced by foster youth. Social agencies have no more power than the legal rights to offer support to these youths. Therefore, the aim of the study was to investigate the relationship between psychological distresses and social support provided to the adolescents in foster care. Subjects and methods: Three tools were utilized to measure the variables of the study: Socio- demographic data, Depression, Anxiety, Stress scale (DASS 42) and Norbeck Social Support Questionnaire (NSSQ). Results revealed that, 58% of subjects were males and more than half of the foster care adolescents came from rural area, poverty and divorce were the major reasons for entering foster care. Concerning level of psychological distress among the foster care adolescents, 77% of adolescents had mild to moderate stress, 60% had mild to moderate depression while more than half of them (54%) suffered from severe to extreme anxiety. As regard social support; more than half of foster care adolescents (52%) received support from their friends and males were more socially supported than females. Conclusion: Broken families (divorces) and poverty were the major reasons for placing children in foster care. Most of foster care adolescents had various levels of psychological distress especially depression and anxiety. Friends represented the main social support source for the foster care adolescents. Adolescents who had not anxiety had higher mean scores of social support than others. There is no a statistically significant differences between social support and psychological distress. Recommendations; Focusing on alternative families from relatives and neighbors, especially to orphans, those who came from broken families, or suffer from some circumstances of illness or economic hardship than foster care.

The Effect of Partner Support on Maternal Smoking and Alcohol Use During Pregnancy

INTRODUCTION: Paternal support is related to positive pregnancy outcomes. We explored the relationship between paternal involvement and maternal smoking and alcohol consumption during pregnancy. METHODS: This was an institutional review board-approved cross-sectional study. Pregnant women between the ages of 18 and 44 years old and their partners were surveyed in the outpatient obstetrics–gynecology offices of Thomas Jefferson University. Women who identified their partner as their main support were included. Demographic and health information was collected. A composite support score for each woman was generated from a modified version of the Norbeck Social Support Questionnaire on a scale from 5 to 35. Support scores were evaluated with women's current smoking and drinking status using analysis of variance and Student's t test. RESULTS: One hundred fifty-nine pregnant women and 60 partners were surveyed. Pregnant smokers had an average support score of 30.5 and pregnant nonsmokers had an average support score of 32.45 (P=.23). Of women who identified as relying on a partner, 5% reported smoking during pregnancy, whereas 18% of the women who did not rely on a partner reported smoking during pregnancy (P=.015). Pregnant alcohol users compared with nonusers had similar support scores. Of women who relied on a partner, 26% reported drinking alcohol during pregnancy, whereas 42% of women who did not rely on a partner reported drinking alcohol (P=.07). CONCLUSIONS: Pregnant women with a partner to rely on during pregnancy had decreased use of tobacco and alcohol. Support scores (Norbeck Social Support Questionnaire) were not related to smoking and drinking in pregnancy.

Social Determinants of Partner Support in Pregnancy

INTRODUCTION: Paternal support during pregnancy is associated with better birth outcomes. Little research has focused on what social determinants of health are associated with greater partner support during pregnancy. METHODS: In this cross-sectional study, 198 pregnant women between the ages of 18 and 44 years were surveyed in the outpatient obstetrics and gynecology offices of Thomas Jefferson University. Women who identified their partner as their main support were included in this analysis. Composite support score for each woman was generated from a modified version of the Norbeck Social Support Questionnaire on a scale from 5 to 35. Support scores were evaluated with women's demographic information using analysis of variance and Student's t test. RESULTS: Women who were married had an average support score of 33.07 compared with 30.78 for unmarried women (P<.001). Women with a household income of $0–20,000 had an average support score of 27.9, compared with 33.4 for those with an income of $100,000+, with feelings of support increasing by income bracket (P<.001). Women with a high school diploma or less had an average support score of 30.1, compared with 32.7 for those with a graduate degree (P=.01). Age, prior children, and health issues in pregnancy were not associated with a significant increase in support. CONCLUSIONS: Social determinants of health associated with increased partner support included relationship status, annual household income, and education level. Stability of relationship, financial status, and career all may allow a woman to feel secure as she moves forward in her pregnancy.

Identifying and Addressing Sources of Measurement Error in the Norbeck Social Support Questionnaire

Background and Purpose: The Norbeck Social Support Questionnaire (NSSQ) provides a rich portrait of one's perceived social support including network size/composition and quality of support. Analyses of quantitative research reports and critiques of the NSSQ revealed non-negligible measurement error. We document evidence of measurement error, report potential sources of this error, and present forthcoming psychometric testing. Methods: Quantitative evidence of measurement error from the NSSQ literature provided the basis for initial hypotheses concerning sources of error in network nomination and support ratings. We then conducted cognitive interviews to investigate these hypotheses. Results: Cognitive interviews revealed evidence of respondents' miscomprehension and response option bias. Conclusions: The current nomination process coupled with the lack of a “not applicable” response option and embedded examples in tangible Aid items reduces the accuracy of NSSQ subscores.

Identifying and Addressing Sources of Measurement Error in the Norbeck Social Support Questionnaire

The Norbeck Social Support Questionnaire (NSSQ) provides a rich portrait of one's perceived social support including network size/composition and quality of support. Analyses of quantitative research reports and critiques of the NSSQ revealed non-negligible measurement error. We document evidence of measurement error, report potential sources of this error, and present forthcoming psychometric testing. Quantitative evidence of measurement error from the NSSQ literature provided the basis for initial hypotheses concerning sources of error in network nomination and support ratings. We then conducted cognitive interviews to investigate these hypotheses. Cognitive interviews revealed evidence of respondents' miscomprehension and response option bias. The current nomination process coupled with the lack of a "not applicable" response option and embedded examples in tangible Aid items reduces the accuracy of NSSQ subscores.

Dissimilarities in Social Support as Described by Swedish- and Foreign-Born Persons Diagnosed with Type 2 Diabetes and Living in Sweden

Diabetes (DM) requires self-care that is demanding and may cause stress. Social support can buffer effects of stress. No previous study has been found comparing perceptions of foreign-born persons with DM, concerning the content of and need for social support with a population of origin. The aim was to compare the meaning of support and its impact on the life situation in Swedish- and foreign-born persons diagnosed with type 2 DM living in Sweden. A purposive sample of 74 persons; 34 foreign- and 40 Swedish-born, aged 32-80 years, diagnosed with type 2 DM, was included. The foreign-born persons were mostly Middle Eastern and Ex-Yugoslavian refugees. Mixed methods were used and data were collected by qualitative interviews and quantitative data collected by the Norbeck Social Support Questionnaire (NSSQ). Studying the figures measured by NSSQ, no significant differences were found according to gender but foreign-born men scored lower than Swedish, especially in emotional support and aid. The main findings showed that respondents, irrespective of origin, described the meaning of the concept of support mainly as information support in learning to manage DM. However, foreign-born persons also focused on medical support with regular follow-ups while Swedes emphasized the need for emotional support. Foreign- and Swedish-born persons are in general more similar than dissimilar in describing the meaning, need and impact of support. Irrespective of origin they want to learn to manage their disease and thus desire and need regular follow-up and information immediately from being diagnosed. Further studies are needed as the study is based on a limited sample.