Synthetic social support: Theorizing lay health worker interventions

Abstract

Levels of social support are strongly associated with health outcomes and inequalities. The use of lay health workers (LHWs) has been suggested by policy makers across the world as an intervention to identify risks to health and to promote health, particularly in disadvantaged communities. However, there have been few attempts to theorize the work undertaken by LHWs to understand how interventions work. In this article, the authors present the concept of 'synthetic socialsupport' and distinguish it from the work of health professionals or the spontaneous social support received from friends and family. The authors provide new empirical data to illustrate the concept based on qualitative, observational research, using a novel shadowing method involving clinical and non-clinical researchers, on the everyday work of 'pregnancy outreach workers' (POWs) in Birmingham, UK. The service was being evaluated as part of a randomized controlled trial. These LHWs provided instrumental, informational, emotional and appraisal support to the women they worked with, which are all key components of social support. The social support was 'synthetic' because it was distinct from the support embedded in spontaneous social networks: it was non-reciprocal; it was offered on a strictly time-limited basis; the LHWs were accountable for the relationship, and the social networks produced were targeted rather than spontaneous. The latter two qualities of this synthetic form of social support may have benefits over spontaneous networks by improving the opportunities for the cultivation of new relationships (both strong and weak ties) outside the women's existing spontaneous networks that can have a positive impact on them and by offering a reliable source of health information and support in a chaotic environment. The concept of SSS can help inform policy makers about how deploying lay workers may enable them to achieve desired outcomes, specify their programme theories and evaluate accordingly.

Special Issue: Complexity, Routines, and Reflexivity in Professional Work

“…We then introduce a model of three key features of risk work and the tensions which emerge as they are combined in practice (see Figure 1), alongside an understanding of processes by which these tensions may become more explicit or remain latent within everyday working experiences and practices. Our arguments are grounded in an extensive review of related literatures (Gale, Thomas, Thwaites, Greenfield, & Brown, 2016), our own recent empirical studies (see, for example, chapter 5 of Brown & Calnan, 2012;Gale, Dowswell, Greenfield, & Marshall, 2017;Gale, Kenyon, MacArthur, Jolly, & Hope, 2018, Veltkamp & Brown, 2017 and pilot work to test our emerging theory, and are presented alongside a reworking of key features of post-phenomenological social theory. The final section points to some further possibilities for extending this model and lines of research in relation to two fundamental questions: first, how is risk work practically and pragmatically accomplished amid the residual uncertainties, which emerge when handling risk?…”

Strengthening Social Interactions and Constructing New Oral Health and Health Knowledge: The Co-design, Implementation and Evaluation of A Pedagogical Workshop Program with and for Homeless Young People

“…This meal was shared between the participants and the workshop facilitators and started a process of mutual trust and interaction, as proposed by Freire [19,20]. …”

“…Despite these policy recommendations and CFRA interventions to prevent and/or solve health and oral health problems, young people experiencing homelessness continued to experience limited access and engagement with health and social care services [16,17]. Within a lexicon of mistrust, negativity, perceived stigmatization, and acknowledged awkwardness, [18,19], significant communication barriers exist between those utilizing and those providing oral health, health, and social services. In their exploration of community health workers, Gale et al [19] posed that the communication between health workers and clients was unusual, as their interactions were content and time-limited with none of the spontaneity of social interacting.…”

“…Within a lexicon of mistrust, negativity, perceived stigmatization, and acknowledged awkwardness, [18,19], significant communication barriers exist between those utilizing and those providing oral health, health, and social services. In their exploration of community health workers, Gale et al [19] posed that the communication between health workers and clients was unusual, as their interactions were content and time-limited with none of the spontaneity of social interacting. They conceptualized this type of interaction as a ‘synthetic social interaction’, and while appropriate for health workers to communicate oral health and health service information, it inadvertently promoted a more paternalistic communication style, with a top-down approach that resulted in feelings of mistrust, stigma, and/or negativity in client groups.…”

“…They conceptualized this type of interaction as a ‘synthetic social interaction’, and while appropriate for health workers to communicate oral health and health service information, it inadvertently promoted a more paternalistic communication style, with a top-down approach that resulted in feelings of mistrust, stigma, and/or negativity in client groups. This work [19] questioned the approaches used and called for new creative and participative methods to engage with young people experiencing homelessness. There was a need to promote a more spontaneous and social interaction style that would permit the promotion of joint working and engagement between client and practitioner, ultimately to improve health, oral health, and psychosocial wellbeing.…”