Social Support Structures Research Articles

Perinatal Loneliness and Isolation Early in the COVID-19 Pandemic in New York City: A Qualitative Study.

During the COVID-19 pandemic, birthing parents were identified as a high-risk group with greater vulnerability to the harms associated with SARS-CoV-2. This led to necessary changes in perinatal health policies but also to experiences of maternal isolation and loneliness, both in hospital settings, due to infection mitigation procedures, and once home, due to social distancing. In this study, we qualitatively explored birthing and postpartum experiences in New York City during the early days of the pandemic when lockdowns were in effect and policies and practices were rapidly changing. Using thematic analysis, our focus was on experiences of isolation, navigating these experiences, and the potential impacts of isolation and loneliness on maternal health for 55 birthing people. Participants described numerous stressors related to isolation during the birthing process, including reconciling their hopes for their birth with the realities of the unknown and separation from partners, family, and friends in the hospital. During the postpartum period, loneliness manifested as having limited or no contact with family and friends, which led to feelings of a need for strengthened social support systems. The impact of these negative experiences shaped mental health. Overall, we found that solitary experiences during birthing and postpartum isolation were major sources of stress for participants in this study. To support impacted families and prepare for future crisis events, clinicians and researchers must prioritize the development of strong clinical and social support structures for perinatal people to ensure both maternal and child health.

Hiding in plain sight: Cooperative Extension as an underutilized approach to improving cancer survivorship outcomes in underserved populations.

Explore the potential utility of a Cooperative Extension-specific program to support post-active treatment cancer survivors. A user-centered study was conducted to identify barriers to and facilitators of the implementation of a program for adult cancer survivors living post primary cancer treatment ("cancer survivors") via Cooperative Extension("Extension"), including interviews analyzed using the Consolidated Framework for Implementation Research. Participants included Cooperative Extension Educators and adult cancer survivors in Oklahoma who completed data collection from July 2023 to September 2023. N = 20 participants were enrolled. Cancer survivors indicated poor familiarity with Extension, or a primary association with agriculture. Some voiced surprise Extension was not already providing cancer-related programming. Many expressed poor support in their communities due to issues secondary to rurality, often relying on non-cancer programs. Educators voiced a strong capability to deliver cancer-related programming if intentionally designed, with many already providing education on relevant topics (e.g., finances, nutrition, physical activity). A salient barrier was poor connectivity with the healthcare system. There is an immense need for improved survivorship care in underserved communities due to poor social connectedness, support structures, and poor mental health. Cooperative Extension is well-poised to deliver cancer survivorship-specific programming. Cooperative Extension provides an extensive network of professionals who can provide support to cancer survivors, particularly those post-active treatment.

Navigating Challenges Resilience of Women Entrepreneurs in Khyber Pakhtunkhwa’s Entrepreneurial Ecosystem

This research paper examines how women entrepreneurs in Khyber Pakhtunkhwa navigate the entrepreneurial ecosystem and social support structures. Grounded in an interpretivist research philosophy, the study delves into the subjective experiences of women entrepreneurs, highlighting their roles in fostering economic stability within their communities. A hybrid inductive and deductive research approach, combined with a multiple case study method, was employed to gain a comprehensive understanding of the challenges faced by women entrepreneurs. Data were collected through in-depth semi-structured interviews with 18 purposively sampled women entrepreneurs. The analysis, using a hybrid thematic approach, identified key themes related to the resilience of women entrepreneurs in the face of social and financial challenges, social advocacy, and economic independence. The findings illustrate how these women overcome socio-cultural barriers and limited institutional support, leveraging their entrepreneurial ventures to create inclusive spaces and advocate for gender equality.

Scarce perinatal social support for women with OUD: Opportunities for doula services

ProblemPersons with opioid use disorder (OUD) often lack social support, which is associated with improved recovery outcomes. BackgroundIn the last two decades, the rate of opioid use disorder (OUD) among pregnant people has quadrupled. QuestionThis study aimed to describe the prenatal and postpartum social support networks and needs of persons with OUD and assess perceived acceptability of community-based social supports such as doulas. MethodsThis mixed methods study utilized quantitative and qualitative data to understand social support structures and needs. Data was collected through surveys –demographics and social mapping; Adverse Childhood Experiences (ACE) tool; Connor Davidson Resilience 25-item (CDRS-25) scale– and a semi-structured interview. A total of 34 participants from a single urban opioid treatment program consented to participate. FindingsParticipants were on average 34.9 years old, White (64.7%), and unemployed (91.2%). Participants described small perinatal social support networks, which decreased in size from the prenatal to postpartum period. Only half (52.9%) reported adequate prenatal and postpartum social support. Doulas and peer recovery support specialists were perceived as valuable in perinatal health, social support, and recovery domains, with interest in doulas seen particularly amongst those with fewer reported supports. Discussion: The scarcity of prenatal and postpartum social support among persons with OUD is critical to address, given the increased risk of relapse during the postpartum period which has implications for the maternal child dyad. Conclusion: Due to multiple disparities in prenatal and postpartum social support (small networks, inadequate support), doulas represent a trusted community-based support to be integrated into healthcare teams to address maternal morbidity/mortality associated with opioid use.

Double pandemic for Sub-Saharan African women during COVID-19: A Critical Patriarchal Exposé with Intervention Strategies

The Covid-19 pandemic presented a lot of macro and micro challenges throughout the entire world. While some of these impacts were immediately felt, others have long term consequences. Some of the major impacts were the macroeconomic challenge which left many governments, organisations and individuals in a state of disarray - causing a lot of physical and mental health issues among both men and women. However, research suggests that women were disproportionately affected by mental health issues. This is because women especially in Sub-Saharan Africa are considered to be ‘vulnerable’ to several of the major challenges facing the continent and the burdens they carry make them susceptible to mental health problems. Against this background, this study explores three key areas: the relationship between patriarchy and gender-based violence during COVID-19 in Africa, how the pandemic exacerbated existing gender inequalities, and the impact of COVID-19 on women's mental health. This study is a literature review that draws on academic journals, books, reports, media sources and electronic databases. The study concludes that the COVID-19 pandemic disproportionately impacted African women, leading to a rise in gender-based violence, a widening of existing gender inequalities, and a negative impact on women’s mental health. The study recommends strengthening existing traditional social support structures, such as families and women's groups, to better equip them to assist women during crises.

"They Just Love Me"-An Examination of Social Support Experiences and Values Among People With TBI.

Social support is important for health and functional outcomes after traumatic brain injury (TBI), but many adults with TBI report inadequate social support. Little research has examined the social support priorities of adults with TBI or what an optimal social support network should include. The objective of this study was to describe the social support structures and experiences of adults with TBI. Community-based rehabilitation program. Community-dwelling adults with TBI, predominantly from racial and ethnic minority groups. Cross-sectional collection of quantitative and qualitative data. Number of close social contacts and total social contacts, along with a report of the frequency of social support using the Medical Outcomes Study Social Support Survey. Qualitative interviews were used to examine the quality of social support and participant values and priorities. Participants had an average of 4.3 close contacts (median 3.5, range 1-10), an average of 8.5 total social contacts (median 7, range 2-28), and a low frequency of social support (mean 28.4, SD=24.7). Interview themes fell under 2 grand themes: structure of social networks (social networks are made up of families; proximity influences the type of support) and quality of social support (commitment vs indifference; doing things with and for others adds meaning; and "they just love me"). Participants in this study had small social networks and a low frequency of social support. Findings suggest that people with TBI value committed support partners, social inclusion, bidirectional relationships, and emotional connection, yet experience lower support in these areas compared to tangible support. Future research should examine how to adapt existing models of social support to more closely align with participant values. Rehabilitation services may need to focus more heavily on individual and family training, addressing strategies to develop and maintain relationships, emotional connection, and communication to enhance relationship and social support quality.

Psychological distress and associated factors among medical students in Addis Ababa, Ethiopia: A cross-sectional study (May 2018)

BackgroundPsychological distress, posing a substantial threat to the well-being of medical students, is linked to heightened risks of academic struggles and suicidal tendencies. Despite its profound impact, comprehensive studies on the prevalence and determinants of psychological distress among medical students remain scarce, particularly in developing nations like Ethiopia. This study sought to robustly assess the prevalence of psychological distress and its determinants among medical students in Addis Ababa, Ethiopia. MethodsA rigorous institution-based cross-sectional study involving 423 medical students utilized a stratified random sampling technique. The Kessler Psychological Distress Scale (K10) served as the assessment for psychological distress. The scale has been validated for use in Ethiopia and demonstrates a sensitivity of 84.2 % and specificity of 77.8 %. Scores above 20 on the K10 were considered as indicative of psychological distress, while scores falling within the ranges of 10–19 were likely to indicate wellness. Logistic regression was used to investigate the association between dependent and independent variables. Odds ratios (OR) with corresponding 95 % confidence intervals (95 % CI) were meticulously calculated to discern the strength of associations. ResultsOut of the 423 participants, 390 were included in the current study, resulting in a response rate of 92.2 %. A formidable prevalence of psychological distress was exposed, registering at 42.82 % (95 % CI 37.97, 47.82 %). Strikingly, female students exhibited a disproportionately higher prevalence (62.03 %) compared to their male counterparts (37.93 %). Factors such as test anxiety, suicidal attempts, and suboptimal time management were pivotal contributors to escalated rates of psychological distress. Multivariable analysis underscored the significance of certain determinants, revealing that high GPA scores were protective [AOR 0.25, 95 % CI 0.13, 0.49], while inadequate social support [AOR 5.7, 95 % CI 2.96, 11.24], a history of suicidal attempts [AOR 5.62, 95 % CI 1.34, 23.4], and problematic test anxiety [AOR 5.02, 95 % CI 2.67, 9.42] were associated with heightened vulnerability. ConclusionThis study unveils a pervasive and concerning landscape of psychological distress among medical students in Addis Ababa, with a stark gender disparity. Interventions targeting test anxiety, fortifying social support structures, and providing accessible mental health resources are essential to mitigate these challenges and enhance the resilience and well-being of medical students, thereby reducing or preventing psychological distress.

The Impact of Population Ageing on the Economy

In the face of the escalating global phenomenon of population aging, this comprehensive study seeks to explore the intricate and far-reaching consequences of aging on the global economy. The research background accentuates the profound reshaping of familial, societal, and national structures induced by this pervasive trend, giving rise to extensive economic apprehensions. Delving into critical domains such as the labor market, consumption patterns, and the social security system, the present paper systematically unravels the manifold opportunities and challenges arising from the aging population, drawing insights from an exhaustive review of both domestic and international literature and empirical cases. Employing a methodology encompassing literature reviews and in-depth case analyses, the study capitalizes on diverse global experiences to formulate adaptable and responsive strategies. The conclusive findings underscore the pressing need for the expeditious implementation of flexible policies and the fortification of social support structures. This study serves as a fount of profound insights for policymakers, offering a roadmap towards fostering sustainable societal development amidst the prevailing wave of population aging.

The Power of Peers: Understanding the Link Between Social Support and Grit Among Working Students

In the modern academic sphere, students often juggle work and studies, leading to challenges in maintaining academic progress. A key trait associated with managing these challenges is grit, defined as long-term perseverance and passion for goals. This research investigated the correlation between peer social support and grit among part-time working students in Salatiga, Central Java. Utilizing Multi-stage Snowball Sampling for participant selection, the study collected data from 120 undergraduate students, employing the Social Support Scale and the Grit Scale. Statistical analysis confirmed a significant positive relationship between peer social support and grit. Given the importance of grit in academic and professional outcomes, and the pivotal role of peer social support in cultivating it, this study underscores the need for educational interventions that enhance social support structures for part-time working students. The findings offer vital insights for educators and policymakers, advocating for the integration of peer-driven support systems in academic settings.

Bypassing digital literacy: Marginalized citizens’ tactics for participation and inclusion in digital societies

This article asks what digital literacy tactics low-literate Dutch adults employ to bypass their low-literacy to be able to participate in digital society, and what the consequences are for their socio-digital exclusion and inclusion. It contributes to a better understanding of the impact of digitalization for low-literate citizens, and the linguistic and digital barriers encountered in everyday life. Drawing upon participant observations and semi-structured interviews with low-literate adult citizens in four libraries, a community center, and a school for adult education ( N = 73), this article develops a taxonomy of five tactics which enables low-literate citizens to digitally participate despite their linguistic and digital barriers: (1) informal support structures, (2) formal support structures, (3) non-written communication, (4) translation software, and (5) optimal character recognition. We show how these tactics of appropriating the affordances of information and communications technologies (ICTs), and making use of social networks enable low-literate Dutch citizens to participate in socially situated manners, making use of social support structures and digital literacies developed in relation to “foreign” languages. Consequently, this study counters the stigma on such marginalized groups, who are often assumed to be unable or unwilling to participate, and presents them as not adhering to the dominant discourse of participatory culture. Hence, the added value of this study is threefold: (1) it centers the capabilities of low-literate citizens stemming from social capital and obfuscated linguistic potential, (2) it gives visibility toward more hidden everyday (digital) practices of marginalized subgroups with a larger distance toward the digital society, and (3) it foregrounds the lived experiences of the user and their (limited) use of ICTs, and how tactics are developed and practiced to bypass linguistic and/or digital barriers showing situated agency and problem-solving capacities. We argue that digital literacies should not be considered as a prerequisite for digital participation and inclusion, as our findings show that low-literate Dutch citizens are a highly diverse group that are capable of participating, despite their low (digital)-literacy. However, they do so in socially situated and non-written manners, in line with their digital and linguistic capabilities and barriers.

INTERCONNECTIONS AMONG SOCIAL CONNECTEDNESS, PSYCHOLOGICAL INFLEXIBILITY, AND MEANING IN LIFE AMONG CAREGIVERS OF CANCER PATIENTS

The present study explores the interconnections among social connectedness, psychological inflexibility, and meaning in life among caregivers of cancer patients these psychological variables interact with demographic and caregiving factors, such as gender, age, cancer stage, daily caregiving hours, total caregiving duration, and the caregiver's relationship to the patient. Understanding these interconnections is essential for developing psychological support tailored to caregivers' unique challenges in oncology settings. The sample consisted of 141 caregivers (76 females and 65 males) aged 18 to 45, who provide daily support to cancer patients in varying stages of the disease. Participants were assessed using three validated scales: the Social Connectedness Scale-Revised (Lee & Robbins, 2001) to measure their sense of belonging and interpersonal relationships, the Meaning in Life Questionnaire (Steger, 2006) to assess their sense of purpose, and the Acceptance and Action Questionnaire-II (Bond et al., 2011) to evaluate their level of psychological inflexibility, or rigidity in handling stress. Pearson’s Product-Moment Correlation analysis was conducted to examine the relationships among SC, PIF, and MIL, revealing significant positive correlations across all variables, indicating that caregivers who felt a strong sense of social connectedness and purpose in life tended to experience lower psychological inflexibility. Additionally, multiple linear regression analyses highlighted how demographic and caregiving factors influenced these core psychological dimensions, shedding light on complex, multifaceted interactions.The findings underscore the importance of social and psychological support structures for caregivers. Caregiving characteristics, such as the time spent in caregiving per day and total caregiving duration, were found to have significant impacts on the sense of connection, adaptability, and meaning that caregivers derive from their roles, while variables like gender and caregiver-patient relationship did not show significant effects. The study emphasizes the need for targeted interventions that address these dynamics to bolster caregivers' mental well-being and resilience.

Colleagues’ Support and Techno-Complexity: The Importance of a Positive Aging Climate

Aim/Purpose: With a focus on promoting sustainable career paths, this article investigates the intricate relationship between age diversity management and techno-complexity, emphasizing the pivotal role of a supportive work environment. Background: In the modern workplace, the dynamics of age diversity emerge as a crucial element influencing the well-being and productivity of employees, particularly amidst the swiftly evolving digital landscape. This becomes especially pertinent when considering workers’ unique challenges adapting to technological advancements. Methodology: Utilizing a cross-sectional design, data were collected from 160 employees in an Italian multinational company within the metalworking sector. Contribution: This study provides valuable insights into the complex dynamics between the aging climate, colleagues’ support, and techno-complexity. It emphasized the importance of considering the direct effects of organizational factors and their in-direct influences through social dynamics and support structures within the workplace. Findings: The results revealed the mediating role of colleagues’ support in the relationship between the aging climate and techno-complexity. These findings highlight the importance of a supportive work environment in the context of sustainable career development, contributing to a comprehensive understanding of diversity management within the modern digital era. Recommendation for Researchers: Our results open to a series of implications and future directions. First, the unexpected finding regarding the direct relationship between the aging climate and technostress calls for a deeper exploration of the intricacies involved. Future studies could delve into specific organizational contexts, technological demands, and individual differences that may modulate this relationship. Future Research: Future studies could delve into specific organizational contexts, technological demands, and individual differences that may modulate this relationship.

Parent psychological distress and parent-child relationships two years into the COVID-19 pandemic: Results from a Canadian cross-sectional study.

Mental health impacts of the COVID-19 pandemic have not been felt equally within populations. Parents with children living at home were early on identified as a population at heightened mental health risk, with concerns about the potential long-term impacts of the pandemic on parents' mental health, family functioning, and children's well-being. This study investigates impacts of the pandemic on parents' psychological distress, contextual sources of distress, and associations with family functioning nearly two years into the pandemic. Data were drawn from a national cross-sectional survey of adults living in Canada in November and December 2021 that was representative by age, gender, household income, and region. Parents with children < 18 years old living at home (N = 553) reported their experiences of psychological distress, pandemic-related stressors, coping mechanisms, and family functioning (changes in parent-child interactions, children's anxiety). Chi-square tests, logistic regression, and linear regression analyses examined sociodemographic inequities in parents' levels of psychological distress, sources and mitigating mechanisms of distress, and associations between psychological distress and family functioning. Nearly two years into the pandemic, parents with children at home reported nearly double pre-pandemic population estimates of moderate to severe psychological distress. Psychological distress was more frequently reported among parents with pre-existing mental health conditions, disabilities, and financial stressors. Parents with greater psychological distress reported increases in negative parent-child interactions due to the pandemic and higher anxiety among their children. This study identifies sustained negative impacts of the pandemic on parents' mental health and family functioning in Canada nearly two years into the pandemic, despite high vaccine uptake and declining infection rates. Disparities in financial stress, social support structures, and pre-existing mental health were identified as underlying sources of psychological distress. These results highlight that meaningful responses to promote mental health among parents and families must address social and structural inequities.

Mediating immediacy in the era of ‘treat all’: The (chrono)logics of HIV treatment initiation in Shinyanga, Tanzania

PurposeImmediate initiation of antiretroviral treatment following HIV infection is a cornerstone of the current HIV ‘universal test and treat’ approach. Delayed progress along the HIV care continuum is thus framed as a major stumbling block in effective HIV epidemic control. Through examining the HIV care trajectories of people diagnosed with HIV in Shinyanga Region, Tanzania, we offer a critical interrogation of the HIV care continuum. MethodsData are drawn from a social science study on the uptake of a ‘treat all’ model of HIV prevention and care conducted from 2018 to 2019. Methods included interviews with participants who tested positive (n = 30) and interviews (n = 25) with health staff involved in the testing campaigns. FindingsExploring individuals’ care trajectories, we found that most participants followed pathways to care that do not easily align with the current emphasis on rapid, linear progress from testing to treatment initiation. Instead, participants' trajectories from diagnosis to treatment happened on a different, non-linear time scale mediated through social relations and diverse communities of care. We thus conceptualize five pathways of linkage to care - virtuous/immediate, delayed testing, repeat testing, negotiated, and ‘failed'. ConclusionBased on our findings we propose a community-centered HIV care continuum that exposes moments of potential connection with or rupture from the health system and centers the importance of social support structures and forms of relational labor involving broader communities of care.

Aging with spinal cord injury: A narrative review of consequences and challenges.

Given the increase in life expectancy, aging with a pre-existing spinal cord injury (SCI) is becoming more common. This condition is challenging as compromised health status and functional independence can worsen. We aimed to provide an updated overview of the consequences of aging with SCI, highlighting the main challenges facing this population in a narrative review of the current literature we retrieved from the PubMed database from 2000 to 2022 on any aspect related to aging in persons with SCI. Here we address adverse circumstances that increase disability and hinder an active lifestyle, such as progressive physical deterioration, secondary health conditions, limitations in personal activity, changes in family and social support structures, aging of caregivers, and depletion of economic resources. Favorable changes are also observed, including psychosocial adjustments that improve quality of life. Additionally, various interventions are discussed to promote well-being, health, and social participation. Due to the relevance of this issue, people with SCI and all those who take care of them must have up-to-date information to carry out the necessary measures to promote healthy aging in a more inclusive social environment.

Ubuntu as a mediator in coping with multimorbidity treatment burden in a disadvantaged rural and urban setting in South Africa

BackgroundPeople living with multimorbidity in economically precarious circumstances in low- and middle-income countries (LMICs) experience a high workload trying to meet self-management demands. However, in countries such as South Africa, the availability of social networks and support structures may improve patient capacity, especially when networks are governed by cultural patterns linked to the Pan-African philosophy of Ubuntu, which promotes solidarity through humanness and human dignity. We explore the mediating role Ubuntu plays in people's ability to self-manage HIV/NCD multimorbidity in underprivileged settings in urban and rural South Africa. MethodsWe conducted semi-structured interviews with 30 patients living with HIV/NCD multimorbidity between February–April 2022. Patients attended public health clinics in Gugulethu, Cape Town and Bulungula, Eastern Cape. We analysed interviews using framework analysis, using the Cumulative Complexity Model (CuCoM) and Burden of Treatment Theory (BoTT) as frameworks through which to conceptualise the data. ResultsDespite facing economic hardship, people with multimorbidity in South Africa were able to cope with their workload. They actively used and mobilized family relations and external networks that supported them financially, practically, and emotionally, allowing them to better self-manage their chronic conditions. Embedded in their everyday life, patients, often unconsciously, embraced Ubuntu and its core values, including togetherness, solidarity, and receiving Imbeko (respect) from health workers. This enabled participants to share their treatment workload and increase self-management capacity. ConclusionUbuntu is an important mediator for people living with multimorbidity in South Africa, as it allows them to navigate their treatment workload and increase their social capital and structural resilience, which is key to self-management capacity. Incorporating Ubuntu and linked African support theories into current treatment burden models will enable better understandings of patients’ collective support and can inform the development of context-specific social health interventions that fit the needs of people living with chronic conditions in African settings.

A Progressive Reading of Customary and Religious Norms Associated with Heteronormativity in South Africa

Customs that enforce heteronormativity, generally also safeguard the interests of society’s vulnerable, for instance orphans and widows, to name two examples. The recognition that non-heterosexual people is a minority group with legitimate concerns is important, as they could contribute to family support while maintaining their identity and mental well-being. Non-heterosexual individuals’ interests are protected in the current Constitution; however, their protection must transform social support structures beyond written laws. Social structures tend to accept change at a slower pace than progressive laws. In South Africa the gender-normative and heteronormative are generally being overridden by a ‘don’t ask, don’t tell’ code, where sexual minorities are gradually gaining acceptance in a dominantly heteronormative society. In this article, the authors argue against the customs of spousal inheritance and ukuthwala, which, among others, are being imposed on non-heterosexual people, because they suggest a person’s sexuality belongs to a clan. These cultural practices may serve a purpose in society but could be interpreted to support constitutional values. For instance, traditional healers as custodians of culture have documented instances of being gender-fluid, when a female could be possessed by a male spirit, thus requiring a female sexual partner. Indigenous culture as it is known, has been tainted by capitalism, patriarchy, foreign religion, and the absolute opinions of a few elders. Which begs the question whether heteronormativity truly is a South African construct.

Tactical strangers: Mobility, trade, and gendered strangerhood in West Africa

AbstractMande women in West Africa unable or unwilling to conform to patriarchal gender expectations risk being evicted from social and kinship support structures. Some nonconformist women from Mali respond to this predicament by engaging in tactical strangerhood: they choose to remain on the social margins, capitalizing on their situation as strangers by working as foreign traders in Dakar (Senegal). Tactical strangerhood entails only partial inclusion into patriarchal family and social structures and constitutes one of the nonconformist ways in which women in West Africa enact gender roles. Long‐distance trade and travel by Mande women have led to new forms of gendered strangerhood, challenging—and potentially transforming—dominant ideologies of gender differentiation in this part of West Africa. By engaging in tactical strangerhood, women develop new forms of gendered subjectivity. Tactical strangerhood can therefore be considered an implicitly feminist and emancipatory exercise.

Exploring caregivers' experiences of Kangaroo Mother Care in Bangladesh: A descriptive qualitative study.

Kangaroo Mother Care (KMC) is an evidence-based intervention recommended by the World Health Organization (WHO) to reduce preterm mortality and morbidity. The aim of this study was to explore caregivers' experiences of providing KMC in hospital settings and after continuation at home in Bangladesh in order to assess enablers and barriers to optimal implementation. Interviews with fifteen caregivers were conducted using an interview guide with semi-structured questions in August 2019 and March 2020. Convenience sampling was used to select hospitals and participants for the study. The inclusion criteria were being a caregiver currently performing KMC in the hospital or having been discharged one week earlier from the KMC ward. The interviews were audio recorded, transcribed verbatim, and translated. The data were analyzed using thematic analysis with an inductive approach. Three themes were identified as regards the caregivers' experiences of providing KMC: conducive conditions, an empowering process, and suboptimal implementation. The results showed that there are supporting circumstances for caregivers performing KMC in Bangladesh, including social support structures and positive attitudes to the method of care. It also appeared that the caregivers felt strengthened in their roles as caregivers by learning and performing KMC. However, the implementation of KMC was suboptimal due to late initiation of KMC, difficulties with keeping the baby skin-to-skin, and pain after cesarean section hampering skin-to-skin practice. The social and cultural conditions for the caregivers to perform KMC as well as the empowerment the parents felt in their roles as caregivers when performing KMC are facilitating factors for this method of care. Initial separation and late initiation of KMC, as well as disregard for the mothers' needs for care and support, were barriers to optimal practice leading to missed opportunities. These facilitators and barriers need to be addressed in order to succeed in scaling up the national KMC program.

Misguided social support? How Danish veteran families affected by PTSD experience formal and informal social support

Existing literature highlights that posttraumatic stress disorder (PTSD) after military deployment not only affects the formerly deployed veteran, but when the veteran has a family, has detrimental effects on the entire family. While research suggests that social support can have a positive mediating effect on the impact of PTSD, we know little about how veteran families experience the impact of PTSD, and how this relates to their experiences of formal and informal social support. Drawing on a hermeneutic phenomenological framework, we addressed this gap by exploring perceptions and experiences of formal and informal social support in six Danish veteran families. We found veteran families to be closely involved with formal and informal social support structures. However, the social support available did not always match their needs or understandings of helpful social support. Some families experienced an overload of social support or perceived the provided social support as inappropriate or prescribed. We construe these three types of social support as misguided social support—support that did little to meet their actual needs—on the contrary. We discuss how families come to experience and understand social support as an overload, or as inappropriate or prescribed; and what it takes for social support not to be experienced as misguided. We suggest that in order to meet families’ social support needs, tailored social support and improved collaboration between (in)formal social support structures and veteran families may promote more meaningful social support of veteran families affected by PTSD.