Problematic Support Research Articles

Widening participation policy as practice: category work and local policy appropriations at student support units

ABSTRACT The massification of national systems of higher education in recent decades and the rapid increase in the number of students have raised widening participation for students from underrepresented groups as a central policy agenda. In this study I focus on an overlooked group in the research literature – student support practitioners, who provide advising and counseling services to students – and explore how these practitioners negotiate and shape widening participation policies as part of their ongoing work. The study is based on interviews with 43 support practitioners working in 17 Israeli higher education institutions. It draws on the policy-as-practice approach and the theoretical construct of category work to explore how these practitioners interpret, adapt, and modify widening participation policies. The analysis reveals three practices of category work: creation, transformation, and disruption of policy categories: Practitioners create a new category of flexible and part-time studies, transform the category of students eligible for support by expanding its boundaries to include low socioeconomic status, and disrupt a target group’s category by dissolving its boundaries, modifying its homogenous nature, and eliminating problematic support tools. This study contributes to our understanding of the gaps between WP policies and their appropriation, and of the processes in which local actors shape policy categories.

Проблемы тылового обеспечения войск Отдельного Кавказского корпуса в начале XIX в.

Проблемы тылового обеспечения войск Отдельного Кавказского корпуса в начале XIX в.

Health-related quality of life in systemic lupus erythematosus: a longitudinal study on the impact of problematic support and self-efficacy.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease which can affect any organ in the body, reducing patients' health-related quality of life (HR-QOL). Psychosocial research on SLE is quite recent and is mostly based on qualitative and cross-sectional evidence. Some studies suggest that a protective role is played by perceived self-efficacy in the management of the disease, while a detrimental role is played by problematic social interactions. In a longitudinal study, we tested the independent contribution of self-efficacy and problematic social support, in predicting patients' HR-QOL after 11 months. An online questionnaire was completed by 162 participants with SLE, the second questionnaire after 11 months. Controlling for corticosteroids and hydroxychloroquine use, self-efficacy in the management of the disease at Time 1 showed a significant and positive effect on HR-QOL at Time 2, while problematic social support (denying/uninformed) showed a negative effect. HR-QOL of SLE patients is influenced by self-efficacy in the management of the disease and problematic support. Specific attention should be paid to the quality of patients' social relationships and their perceived efficacy in the management of the disease in focused interventions as in daily clinical practice.

The Problematic Support Scale: A validation among patients with systemic lupus erythematosus.

The aim of the study was to develop and to assess the psychometric properties of the Problematic Support Scale, among patients with systemic lupus erythematosus. An online questionnaire was filled in by 344 systemic lupus erythematosus patients with a mean age of 39.66 years. Explorative factor analysis, later validated by confirmative factor analysis, showed the emergence of a two-factor structure in types of support provided: denying/uninformed support and oppressive support. Denying/uninformed support includes offers of support that neglect the disease manifestations and consequences. Oppressive support describes social support offers which are perceived as excessive and oppressive. Results confirm previous qualitative evidence and demonstrate good reliability and concurrent validity of the Problematic Support Scale. Theoretical and methodological implications for the study of social support are discussed.

Social Support and Psychosocial Well-being Among Low-Income, Adolescent, African American, First-Time Mothers.

The aims of this study are to describe for single, low-income, adolescent, African American new mothers how (1) primary sources of social support changed over time, (2) the level of social support (emotional, informational, tangible, and problematic) from these primary sources changed over time, and (3) social support from the primary supporter was associated with mothers' psychosocial well-being (self-esteem and loneliness) over time. A secondary analysis was conducted of data from a previous social support intervention study. The sample consisted of 35 single, low-income, adolescent (mean [SD] age, 18.3 [1.7] years), African American new mothers. Mothers completed social support, self-esteem, and loneliness instruments at 1 and 6 weeks and 3 and 6 months postpartum. Most mothers (64.7%) had changes in their primary social support provider during the first 6 months postpartum. The combination of the adolescent's mother and boyfriend provided the highest level of support, no matter the type, relative to any other source of support. At every time point, positive correlations were found between emotional support and self-esteem and between problematic support and loneliness. Single, low-income, African American, adolescent new mothers are at risk for not having a consistent source of support, which may lead to lower self-esteem and greater loneliness. Clinical nurse specialists could facilitate care guidelines for these new mothers to identify their sources of support at each home visit and advocate for the adolescent's mother and boyfriend to work together to provide support. Bolstering the mothers' natural sources of support can potentially improve self-esteem and reduce loneliness. Improvement in these sources of support could prevent a decline in the mothers' psychosocial well-being. Development and testing support interventions are advocated; findings could guide clinical nurse specialists in addressing these new mothers' needs.

Low-Income, African American, Adolescent Mothers' Depressive Symptoms, Perceived Stress, and Social Support.

The purpose of this descriptive repeated-measures study was to describe depressive symptom patterns and report changes over time in levels of perceived stress and social support depending on patterns of depressive symptoms in single, low-income, African American, adolescent mothers during the initial, 6-month postpartum period. Thirty-five adolescent subjects between the ages of 16 and 22 years old were recruited at health care clinics in two Midwestern cities. Data collections by advanced practice nurses were completed at 1 week, 6 weeks, 3 months, and 6 months postpartum at mothers' homes. Established instruments were used to measure depressive symptoms, perceived stress and social support. Results indicated 63% of adolescent mothers' experienced depressive symptoms sometime during this transition period and 11.4% of these subjects had depressive symptoms at all 4 time points. Depressive symptoms were associated with perceived stress at each time point. Emotional support was inversely associated with depressive symptoms at 2 of the 4 time points. Depressive symptoms and problematic support were significantly related at 3 months and 6 months. Although single, low-income, African American, adolescent mothers are considered a high risk group, some are at even greater risk. This extremely high risk group have depressive symptoms throughout the first 6 months postpartum with the highest level of perceived stress and the most variability in social support relative to groups that were never depressed or were in and out of depression. More studies are needed to understand how to best help these high risk adolescents successfully transition to motherhood.

Positive and problematic support, stress and quality of life in patients with systemic lupus erythematosus

ABSTRACTBackground and Objectives: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease. Previous studies showed that perceived social support has an important role in enhancing patient's quality of life (QOL). However, the precise mechanisms through which social support exerts such an effect are not completely understood. The aim of this paper is to test two alternative models explaining the relationship between social support (positive and problematic) and two dimensions of QOL: Health-Related (HR-QOL) and Non-Health-Related (NHR-QOL). Design: Model A (mediation) hypothesized that positive support would reduce stress while problematic support would increase stress), and that this in turn would reduce QOL. Model B (moderation) hypothesized that the effect of support on QOL would be moderated by the experience of stress in that more stressed individuals would show stronger effects. Methods: Three hundred and forty-four Italian patients with SLE completed an online questionnaire. Results: Stress partially mediated the relationship between support and QOL dimensions (either HR-QOL and NHR-QOL) thus supporting Model B. As hypothesized, positive support reduced stress, while problematic support increased stress. Conclusions: These findings help to explain the complex relationship between social support, stress and QOL in patients with SLE.

Problematic Social Support From Patients’ Perspective: The Case of Systemic Lupus Erythematosus

Several studies demonstrated the importance of psychosocial factors, like social support, for understanding the experience of people with Systemic Lupus Erythematosus (SLE). Less information is available on “problematic support”; that is, instances of support that are perceived as non-supportive, even though the provider’s actions may be well intended. Aim of this qualitative study was to explore the experiences of problematic support from SLE patients’ perspective. Nine women with SLE were interviewed and transcripts were analyzed through qualitative content analysis. Three main types of problematic social support were indentified. Oppressive support describes social support offers characterized by excessive worries and unwanted advices. Support denying the illness is characterized by a neglect of the disease or of its consequences. Support based on divergent illness representations is perceived as not punctual and not in line with patients’ actual clinical condition. This study confirms the complexity of providing useful support to SLE patients and suggest that also people living close to patients should represent a target of interventions.

"I managed it pretty good": birth narratives of adolescent mothers.

The aim of this study was to understand adolescent mothers' childbirth experiences. Semistructured interviews were conducted with participants recruited from a community-based program for adolescent mothers. Fourteen mothers described their birth experiences. Using a narrative analytic approach, responses were reconstructed into birth stories. Stories, condensed into poetic form, were compared and contrasted. Four unique categories emerged: connected births, surreal births, disconnected births, and disempowered births. Categories differed by agency, support, and emotional tone. Positive support was found in stories that portrayed high agency and positive affect, whereas problematic support was apparent in stories that conveyed passivity, frustration, and disappointment. This study has implications for tailoring childbirth education for adolescent mothers and can inform health-care professionals working with this population.

Social support and recovery among Mexican female sex workers who inject drugs

This qualitative study describes social support that female sex workers who inject drugs (FSW-IDUs) receive and recovery efforts in the context of relationships with family and intimate partners. We conducted thematic analysis of in-depth interviews with 47 FSW-IDUs enrolled in an intervention study to reduce injection/sexual risk behaviors in Tijuana, Mexico. FSW-IDUs received instrumental and emotional social support, which positively and negatively influenced recovery efforts. Participants reported how some intimate partners provided conflicting positive and negative support during recovery attempts. Problematic support (i.e., well-intended support with unintended consequences) occurred in strained family relationships, limiting the positive effects of support. Mexican drug treatment programs should consider addressing social support in recovery curricula through evidence-based interventions that engage intimate partners, children and family to better reflect socio-cultural and contextual determinants of substance abuse.

Do spouses know how much fatigue, pain, and physical limitation their partners with rheumatoid arthritis experience? Implications for social support

To determine whether perceptions of clinical manifestations (fatigue, pain, and physical limitation) of rheumatoid arthritis (RA) differ between spouses and their partners with RA, and to determine whether the differences are associated with the perception of beneficial and problematic spousal social support. English-speaking adults with RA of ≥ 6 months' duration and their spouses (n = 222 couples) completed standardized questionnaires for fatigue, pain, physical limitation, beneficial spousal support, and problematic spousal support. Spouses completed questionnaires based on their perception of their partner with RA. Agreement scores for fatigue, pain, and physical limitation were calculated by subtracting spouse scores from the scores of the partner with RA. Agreement levels were defined a priori: agreement (within ± one-half of a minimum clinically important difference [MCID] unit), overestimator (< one-half an MCID), and underestimator (> one-half an MCID). Separate hierarchical linear regression models were used to measure the association between beneficial support and problematic support after adjusting for RA duration, physical health, sex, educational level, relationship duration, and satisfaction. Response rate for couples was 82%. Relative to participants with RA, spouses overestimated fatigue (26%), pain (29%), and physical limitation (39%), and underestimated fatigue (11%), pain (17%), and physical limitation (34%). After statistically controlling for demographic, disease, and psychosocial variables, participants with RA whose spouses underestimated fatigue received more problematic support (R(2) = 3.7%, P = 0.002), as did those whose spouses underestimated or overestimated physical limitation (R(2) = 3.4%, P = 0.017). Persons with RA perceived more problematic spousal support when their spouse underestimated fatigue, or underestimated or overestimated physical limitation levels.

Towards sustainable fisheries subsidies: Entering a new round of reform under the Common Fisheries Policy

On 22 April 2009 the European Commission published its ‘Green Paper on the Reform of the Common Fisheries Policy’. The Green Paper points out a contradiction in policy, noting on one hand that public financial support to the Community's fisheries sector is substantial, but on the other hand such support is often incompatible with other Common Fisheries Policy (CFP) objectives, particularly the need to reduce overcapacities. Providing an analytical framework to better understand the effects of subsidies as well as an overview of existing funding schemes under the CFP, this article aims at answering some of the questions posed by the European Commission within its Green Paper. Answers are based on two ideas: the exploitation of marine capture resources ultimately depends on the level of available fish stocks and that a large share of subsidies fuels the race to fish by inducing investment incentives for the fisheries sector. Policies that have ignored this tend to encourage inefficient and unsustainable fishing as well as the misallocation of public funds. Although support schemes under the CFP have changed in recent years, some problematic support schemes persist. A future reform will have to continue the course taken towards sustainable and efficient approaches to supporting the fisheries industry.

Problematic Social Support, Family Functioning, and Subjective Well-Being in Women with Rheumatoid Arthritis

The purpose of this study was to examine the relationship of problematic social support and family functioning to measures of subjective well-being in a sample of women with rheumatoid arthritis. Seventy-three women with rheumatoid arthritis completed questionnaires that assessed problematic support (i.e., negative support, unavailability of emotional support), family functioning, and subjective well-being (i.e., life satisfaction and the absence of negative affect or depressive symptoms). Pearson product moment correlation coefficients and hierarchical multivariable regression analyses were conducted. The latter analyses controlled for age, length of time since diagnosis, education, income, pain and fatigue-two prominent symptoms of rheumatoid arthritis. The two measures of problematic support were significantly inversely related to family functioning (p < 0.01 and p < 0.001) and life satisfaction (p = 0.02 and p < 0.001), but were not significantly related to each other. Family functioning was positively related to life satisfaction (p < 0.001) and inversely related to negative affect (p < 0.001) and depressive symptoms (p < 0.001). In multiple regression analyses higher symptom severity, greater problematic support, and lower family functioning were associated with depressive symptoms (p < 0.001) and negative affect (p < 0.001), while higher family functioning and a decrease in symptom severity were associated with life satisfaction (p < 0.001), above and beyond demographic variables and length of time since diagnosis. Subjective well-being in women with rheumatoid arthritis is related to perceptions of family functioning and the amount and type of support received from others, above and beyond the pain and fatigue that characterizes rheumatoid arthritis and is negatively associated with well-being.

Spousal support following knee surgery: Roles of self-efficacy and perceived emotional responsiveness.

The objective was to investigate self-efficacy to manage recovery from surgery and perceptions of the spouse's emotional responsiveness of adults recovering from knee surgery as mediators of the association between the quality of support from the spouse following surgery and recovery outcomes. In-person interviews of married older adults (N = 134) with osteoarthritis of the knee who underwent total knee replacement surgery were conducted at 1 month before surgery, 1 month after surgery, and at 3 months after surgery. Outcomes were knee limitations and depressive symptoms. Self-efficacy mediated the associations between emotional support and problematic support and improvement in knee limitations as well as between emotional support and improvement in depressive symptoms. Perceptions of the spouse's emotional responsiveness did not mediate associations between support and recovery outcomes. Findings suggest that emotional support from the spouse can improve recovery outcomes in part by strengthening efficacy beliefs to manage recovery, and problematic support can hinder optimal recovery in part by weakening efficacy beliefs.

Couples' support provision during illness: The role of perceived emotional responsiveness.

DThe authors investigated emotional (empa-thy) and problematic (minimizing) supportexchanges between 243 women experiencinga lupus sare-up and their husbands. Hus-bands and wives reported the amount ofsupport they provided to each other and theextent to which they felt the support theyreceived from partners was emotionally re-sponsive (validating). The authors expectedindividualsO perceptions of spousesO emo-tional responsiveness to mediate the rela-tionship between support and psychosocialwell-being. As predicted, more spousal emo-tional support was interpreted as beingmore emotionally responsive, which in turnwas associated with better well-being. Incontrast, more problematic support was in-terpreted as being less emotionally respon-sive, which in turn was associated withpoorer well-being. Couples who are able tomeet each othersO emotional needs may ex-perience better adjustment when copingwith chronic illness.Keywords: emotional support, emotionalresponsiveness, depression, marital satis-faction, chronic illness

Social support and quality of life of patients prior to stem cell or bone marrow transplantation

To determine the positive and detrimental aspects of social support prior to allogeneic or autologous bone marrow transplantation/stem cell transplantation. Cross-sectional. Patients completed the German version of the Illness-specific Social Support Scale (ISSS) and the Quality of Life (QoL) Questionnaire Core 30 (EORTC QLQ-C30). Participants were 282 patients (62% autologous SCT, 39% women, 97% haematological malignancies, 72% with partner). We found satisfactory reliability values for both ISSS scales: positive support (Cronbach's alpha=.91) and problematic support (=.73). Patients living with a partner displayed higher scores in positive interaction than patients living alone (p<.001). Analysis showed a significant main effect of partnership, p<.001; F(1)=8.345, and better scores for women, p<1; F(1)=2.758. Furthermore, we determined a negative correlation between problematic interaction and emotional/social function (p<.001) and a positive correlation with insomnia, but no correlation between positive interaction, QLQ-C30, and Karnofsky's index. We could distinguish between helpful and harmful support, and determine clinically important associations of problematic support. Partnership seems to be a major source of positive interaction.

Health-related quality of life in breast cancer: A cross-cultural survey of German, Japanese, and South Korean patients

The aim of this study was to evaluate health-related quality of life (HRQOL) in breast cancer patients across countries, and to cross-culturally examine the impact of psychosocial factors on HRQOL. A total of 413 women with breast cancer from Germany (n = 195), Japan (n = 112), and Korea (n = 106) completed a survey assessing HRQOL and HRQOL-related factors. HRQOL was measured using the Short-Form Health Survey (SF-8). Measures of psychological distress (Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised), coping (Dealing with Illness Inventory-German Revised), and social support (Illness-Specific Social Support Scale-German Revised) were included. The effect of the factor country on physical QOL was seen to be significant, but small (P = 0.049, ES = 0.018). The scales of General Health (P = 0.023), Vitality (P = 0.004), and Role Emotional (P = 0.003) differed across countries, with the South Korean patients having lower scores compared to the German and Japanese patients. The nature of the impact of psychosocial factors on HRQOL did not differ greatly across countries except with regard to avoidance, however, the degree to which these factors influence HRQOL did differ greatly. Overall, depression, depressive coping, and problematic support showed a strong detrimental effect on the HRQOL of breast cancer patients. Results from this study suggest that strategies which target an improvement of HRQOL in cancer patients should also consider the patients' cultural and healthcare system contexts. Interventions are needed to improve detrimental psychosocial factors.

Effects of spousal control and support on older adults' recovery from knee surgery.

The authors investigated associations between spousal control (influence) and support on the recovery outcomes for 70 men and women (mean age = 70) undergoing an increasingly common surgical treatment for osteoarthritis (OA) of the knee. Spouses' positive (motivating) and negative (pressuring) control and spouses' emotional (understanding) and problematic (dismissing) support were examined as predictors of patients' adherence and improvement in well-being. Positive control was associated with better adherence, but only among patients whose spouses provided little problematic support. In contrast, negative control strategies tended to elicit increases in negative affect. Overall, our findings revealed that the effectiveness of spousal control depended largely on the quality of support provided by the spouse.

Barriers to Caregiver Compliance with Eating and Drinking Recommendations for Adults with Intellectual Disabilities and Dysphagia

Background There is scant research on the subject of dysphagia and people with intellectual disabilities. This study explores the barriers which caregivers believe make following Speech and Language Therapists’ (SLTs) dysphagia management strategies more difficult.Method Semi‐structured open‐ended interviews were conducted with 46 caregivers who supported 40 intellectually disabled adults with dysphagia.Results Caregivers perceived particular difficulties in modifying food and drinks to safe consistencies, achieving the agreed positioning during mealtimes, and in using support and prompting strategies. Problematic support and prompting strategies included difficulties with pacing correctly; facilitating people to adequately relax and concentrate; observing and prompting people to pace suitably and take safe amounts of food and drink in each mouthful. Additional barriers identified included time pressures, staff turnover and insufficient reviewing of SLT management strategies by caregivers.Conclusions Findings suggest that additional training and monitoring is required to ensure caregivers are aware of their role and responsibility in promoting safe oral intake for adults with dysphagia and intellectual disabilities. Ongoing support is suggested for people with intellectual disabilities and dysphagia to help them understand the reasoning behind management strategies.

Women's experiences with HIV/AIDS: mending fractured selves

* Acknowledgments * Chapter 1. Introduction * Disruption and Legitimation: Hillary * Problematic Repair Strategies: Denise * Disruption and Nonrepair: Stephanie * HIV/AIDS As a Gender Issue * Analytic Framework: Biographical Disruption and HIV/AIDS * Sample and Methodology * Overview of This Book * Chapter 2. Feeling Like Nothing: Receiving an Diagnosis and Initial Disruption * Biographical Disruption Among Women with HIV/AIDS * Hopelessness * Disbelief * Social Withdrawal * Placing Blame * Putting Oneself Last * Assigning Meaning and Sense of Self * Women and Disruption * Chapter 3. Living with Infection: The Impact of Illness on Everyday Life * Gender and the Psychosocial Impact of Infection * Adaptive Tasks for Women with HIV/AIDS * The Perceived Significance of Gender * Women's Unique Experiences and Needs * Chapter 4. Towards Legitimation: Coping with HIV/AIDS * Coping with HIV/AIDS: A Brief Review of the Literature * Women's Ways of Coping: Repairing Disrupted Biographies * Going Public and Becoming an Activist * Support Groups * Spirituality * Establishing Positive Lifestyles * Avoidance * Legitimation and Sense of Self * Chapter 5. Social Support: The Role of Informal Networks in Women's Lives * Social Support and HIV/AIDS * Familial Support Networks * Problematic Support * Keeping the Secret: Untapped Support Networks and Self-Protection * Social Support and Illness Progression: Speculating on the Likelihood of Future Support * Chapter 6. Women As Carers: The Dual Challenge of Caregiving and Living with Infection * Mothering * Planning for the Future: Child Care and Guardianship * Caring for Adults with HIV/AIDS * The Consequences of Caring * Chapter 7. Multiple Assaults on Self: The Relative Impact of HIV/AIDS on Women's Lives * I'm Used to Being Ate Up Anyway * Nothing Compares to HIV * The Relative Impact of Assaults * Chapter 8. Disruption and Repair: Lessons from Women's Illness Experiences * The Strengths and Weaknesses of Women's Coping * Formal Care and Women with Infection * Empowerment and Social Change * Experiencing Illness: Extending HIV-Positive Women's Experiences to Other Populations * Appendix: Sample Demographic Summary * References * Index