ObjectiveThe purpose of this study is to examine the contribution of health behaviors (self-management and coping), quality of care, and individual characteristics (depressive symptoms, self-efficacy, illness representations) as mediators in the relationship between socioeconomic status (SES) and glycemic control.MethodsA sample of 295 adult patients with type 2 diabetes was recruited at the end of a diabetes education course. Glycemic control was evaluated through glycosylated hemoglobin (HbA1c). Living in poverty and education level were used as indicators of SES.ResultsBootstrapping analysis showed that the significant effects of poverty and education level on HbA1c were mediated by avoidance coping and depressive symptoms. The representation that diabetes is unpredictable significantly mediated the relationship between living in poverty and HbA1c, while healthy diet mediated the relationship between education level and HbA1c.ConclusionsTo improve glycemic control among patients with low SES, professionals should regularly screen for depression, offering treatment when needed, and pay attention to patients' illness representations and coping strategies for handling stress related to their chronic disease. They should also support patients in improving their self-management skills for a healthy diet.
Background: People in recovery from anxiety, depressive or bipolar disorders can receive both formal (from practitioners) and informal help (from family and friends). These two types of helping relationships have often been studied separately as either therapeutic relationships or social support. Yet, the mechanisms of these two forms of help have not been empirically compared in the context of mental health recovery. Aims: The purpose of this study is to compare the mechanisms of informal help and formal help in recovery by combining the perspectives of individuals in recovery, their informal helper and their practitioner. Method: Individual interviews were conducted with 15 triads ( N = 45 participants) comprising a person in recovery, their most significant informal helper and their most significant practitioner to compare the two forms of help through a mixed method approach. Based on the paradigm of critical realism, the research puts the emphasis on the triangulation of data sources and types. Results: The informal and formal helping relationships serve multiple functions some can be found in both, often in different ways (communication, presence and availability). Informal helpers tend to serve a broader array of functions than practitioners do. Regarding differences, formal help is characterised by scheduling, time limitations and professional competencies. Informal help is characterised by emotional closeness, companionship and reciprocity. Also, people in recovery are active when it comes to determining the role that their helpers play (agency). Conclusions: Social support from family members and friends, as well as help from professionals can contribute to recovery in different ways. Attesting to the agency of people in recovery, the two forms of help are not only perceived as complementary, they are deliberately kept so.
Support from caregivers is an important element of mental health recovery. However, the mechanisms by which social support influences the recovery of persons with depressive, anxiety, or bipolar disorders are less understood. In this study, we describe the social support mechanisms that influence mental health recovery. A cross-sectional qualitative study was undertaken in Québec (Canada) with 15 persons in recovery and 15 caregivers—those having played the most significant role in their recovery. A deductive thematic analysis allowed for the identification and description of different mechanisms through a triangulation of perspectives from different actors. Regarding classic social support functions, several of the support mechanisms for mental health recovery were identified (emotional support, companionship, instrumental support, and validation). However, informational support was not mentioned. New mechanisms were also identified: presence, communication, and influence. Social support mechanisms evoke a model containing a hierarchy as well as links among them.
This article explores some of the possible links between community psychology and critical realism, a relatively new approach to the philosophy of science that has received little attention from community psychologists. Critical realism is presented in relation to seven key insights that can be linked to fundamental tenets of the ecological approach in community psychology. These insights are: (1) A complex reality exists independently of our ideas about it, and this reality is knowable, although imperfectly. (2) Reality is composed of a complex and stratified hierarchy of open systems. (3) Causality is best understood in terms of causal processes that may or may not be directly observable or generalizable; these processes involve complex interactions among generative mechanisms and contextual conditions. (4) Theory and theorizing about causal processes are central to both scientific explanation and practical action. (5) Theory exists at multiple levels of abstraction, ranging from models to metatheory. (6) A diversity of methods can provide evidence in the search for causal processes operating in context. (7) As social scientists, we have an obligation to use social science knowledge to promote human flourishing. Although these insights may be familiar to many community psychologists who adopt an ecological approach to their work, we suggest that clearly articulating these principles can provide more solid foundations for inquiry in the field. We conclude the article by highlighting how critical realism may help to bridge the research‐practice gap in community psychology and similar social sciences.
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