Background on Supportive Relationships
What are supportive relationships strategies?
- Intervention strategies used to increase social support in order improve prevention, management and rehabilitation behaviors for heart disease and stroke (e.g., lifestyle changes to reduce weight or increase healthy behaviors, monitoring and taking medications to regulate blood pressure and cholesterol).
- These strategies may focus on increasing the information individuals have about heart disease and stroke [informational support], offering a venue for sharing experiences and feelings and reinforcing and encouraging behavioral changes [emotional and appraisal support] and giving assistance to help access necessary information or resources [tangible support]. These various types of support may be provided through involvement with individuals (e.g., family members, friends, co-workers, neighbors), organizations (e.g., schools, worksites, health care facilities, faith-based organizations, Area Agencies on Aging. or communities (e.g., elected officials), and create opportunities to identify and address challenges collectively rather than individually (e.g., collective problem-solving or advocacy). At the community level, collective action is accomplished through the establishment of community health coalitions such as the Kansas City Chronic Disease Coalition.
- Building strength in numbers, supportive relationships can:
- increase support for detecting signs and symptoms of heart disease, heart attack, and stroke;
- promote behavior change through social engagement with others related to opportunities to prevent heart disease and stroke (e.g., walking groups to increase physical activity, sharing recipes to enhance healthy eating, role modeling smoking cessation techniques to eliminate tobacco use);
- minimize the impact of heart disease and stroke by creating opportunities to collectively improve knowledge, skills, and behaviors related to management and rehabilitation (e.g., monitor and take medications to regulate blood pressure or cholesterol);
- encourage support for programs, environmental changes or resources, and policies and practices influencing heart disease and stroke; and
- change community norms related to preventing or managing heart disease and stroke.
How can I use supportive relationships strategies in heart disease and stroke interventions?
- Supportive relationships interventions may help to change behaviors in order to prevent heart disease and stroke from occurring (primary prevention), or work with those who have already developed heart disease or stroke to decrease the negative effects of that condition through changing behaviors or rehabilitation (secondary prevention). Social support may have formal (e.g., structured support group meetings) or informal (e.g., getting a ride to the doctor’s office from a neighbor) influences on an individual’s ability to prevent and manage heart disease and stroke.
- Supportive relationship interventions may be designed to discuss challenges and advice for heart disease and stroke prevention and management. Supportive relationships may be provided in the form of face-to-face interactions, telephone calls, email or through interactive web-based systems. These interventions may include specific information as part of each call or face-to-face session, or may be more open ended and responsive to the specific needs of the individual. These interventions may target the individual at risk for or diagnosed with heart disease and stroke or the individual’s support system (e.g., family, friends, co-workers).
- Supportive relationships interventions are successful for many reasons, such as: individuals can ask questions or clarify what they have been told, those providing support can also provide referrals and resources to assist the individual and longer-term relationships can help to sustain behavior change over time.
What are the different types of heart disease and stroke supportive relationships strategies?
- Increase health care provider support for heart disease and stroke prevention and management. For example, a health care provider may provide support to an adult with heart disease to increase his or her compliance with medications or lifestyle behavior modifications. Health care provider support may be offered through face-to-face interactions, letters, email or telephone calls. These support efforts may be initiated by the health care provider or the patient or client (e.g., counseling during an office visit, telephone numbers the individual can call for support when needed, websites the individual can access to ask questions or share concerns).
- Increase school-based support for heart disease and stroke prevention and management For example, peer educators can be trained to provide support through school-based activities such as athletic programs; teachers, school nurses, and coaches can be trained to provide formal structured support (e.g., individual tutoring sessions covering heart disease and stroke related topics) or less formal support (e.g., advice or encouragement); and family members can be encouraged to provide support through joint educational and skill building sessions, letters, newsletters, or videos sent home with the students. These cues to action (see Health Belief Model) can describe or illustrate the challenges of heart disease and stroke prevention (e.g., showing peer models making decisions not to eat certain foods at school functions) and instigate discussion between school representatives, family members, and students about these struggles. School-based programs may also use student peer led support groups to encourage certain lifestyle behaviors that may decrease the likelihood of developing heart disease or stroke (e.g., not smoking, healthy choices regarding nutrition and physical activity).
- Increase worksite support for heart disease and stroke prevention and management. Worksites can be considered a mini-community with interventions that provide tangible support (e.g., ensuring healthy foods and drinks are available in the cafeteria and vending machines), informational support (e.g., contact information for individuals responsible for maintaining organizational resources and information regarding heart disease and stroke) and emotional and appraisal support (e.g., buddy systems, lay health advisors, or team contests). Some worksite supportive relationships interventions have been initiated by management while others have been developed jointly through labor and management negotiations e.g., health care coaching through insurance provider and personal health assessments offered by employer).
- Increase support from faith-based organizations for heart disease and stroke prevention and management. Faith-based organizations may, for example, help people recognize that health is part of the divine message through connections between spiritual and physical health. Specific activities or messages can help individuals to prevent or manage their heart disease (e.g., nutritious foods served at social gatherings, walking clubs organized through faith-based organizations). Through health ministry and membership in the faith community, these organizations can also increase knowledge and skills about the health risks or benefits of preventing and managing heart disease and stroke through health messages as part of sermons or testimonials from congregation members. Ministers, faith community nurses (e.g., parish nurses) and members have prayed with fellow members, found resources for them, comforted them, and helped to nurture them. Faith-based organizations are an ideal setting because people look to them for social support and interaction. Faith-based organizations can incorporate heart disease and stroke prevention and management as part of their mission and serve as centers of daily life, social structure and community life.
- Increase community support for heart disease and stroke prevention and management. For example, informational, emotional and appraisal support can be provided through websites, phone calls or automated messages (e.g., program initiated calls to individuals, predetermined messages on certain topics being made available when people call a certain number). Individuals staffing these lines may be medical personnel, health educators or trained lay health advisors. Other examples of community support include the use of community role models who can speak to community members about the risks of heart disease and stroke (e.g., Olympic champions, sports players, and other local celebrities who have experience with heart disease and stroke).
- Increase family support for heart disease and stroke prevention and management, and provide support to these caregivers. Heart disease and stroke prevention and management affects all members of a family. In terms of prevention and management, there may be lifestyle behavior modifications that influence not only an individual but also an entire family system (e.g., changes in dietary habits). Alternately, once an individual has had a heart attack or stroke, the caregivers of the individual may need social support to enhance their ability to act as caregivers to these individuals and to reduce the burden of care giving.
What should I consider when developing campaign and promotion messages for my heart disease and stroke intervention?
- Supportive relationships interventions can be very successful when the support is tailored to the individual’s needs. For example, a non-smoker who is very conscientious about the nutritious value of the foods she eats may need support to help her increase her physical activity rather than general messages that incorporate tobacco use, nutrition, and physical activity. In order to provide tailored advice to the individual, the person providing the support has to determine the specific characteristics of the individual and the challenges faced. Supportive relationships interventions may include an assessment at the beginning to uncover some of these characteristics and challenges. An assessment of the individual’s health behaviors, heart disease and stroke symptoms and readiness to change may be necessary.
- Supportive relationship interventions work best when the advice also takes into account the person’s gender, age, language, race or ethnicity and other cultural factors.
- The concept of readiness to change (drawn from the Transtheoretical Model or Stages of Change) suggests that individuals may need different kinds of interventions to help them prevent or recover from heart disease and stroke depending on how ready they are to change their behaviors. Supportive relationships may be particularly important when people are ready to change their self-management behaviors (i.e., supportive relationships can help to reinforce these decisions). Because heart disease and stroke are chronic diseases, many individuals may initiate behavior changes (e.g., minimize consumption of foods with sodium and fat, get regular physical activity), and then relapse or go back to less healthy lifestyle choices. Support often includes information to help individuals to recognize that this is not unusual and to work with individuals to develop strategies to help prevent relapse in the future (see Relapse Prevention Theory).
- It can be helpful to recognize that changes in behaviors may happen in small steps. For example, adding fruit and vegetables may be the first step, followed by reducing the fat in commonly used recipes (e.g., skim milk instead of whole milk, canola oil rather than vegetable oil), reducing sodium in snacking habits (e.g., carrot sticks instead of potato chips), or decreasing portion sizes. Every individual will have preferences for what steps may be the easiest to take first, and these preferences may depend largely on the support of others for these changes (e.g., family, roommate, friends, co-workers).
With whom should I work to create supportive relationships strategies for heart disease and stroke interventions?
- To develop your supportive relationships strategies or to determine the most appropriate ways to provide support, it is often helpful to work with different community partners. Examples of potential partners include:
- civic organizations/ community organizations (e.g., Head Start, Boy/ Girl Scouts, YMCA, 4H Club)
- Missouri Department of Health and Senior Services
- Local health departments
- health care services (e.g., clinics, hospitals, community health centers and federally qualified health centers)
- government agencies (e.g., transportation, planning, WIC, food stamps, social services, parks and recreation, community development, economic development, Area Agencies on Aging AAA))
- researchers and evaluators
- senior/ independent living facilities
- faith-based organizations
- neighborhood organizations and community members
- metropolitan centers
- media (e.g., newspaper, billboards, television, radio)
- communications or advertising agencies
- celebrities and professional athletes
- elected officials/ policy-makers/ decision-makers/ community leaders
- advocacy organizations (e.g., American Heart and Stroke Association and American Association of Retired Persons (AARP) clean air, green space preservation)
- consumer organizations (e.g., supermarkets, restaurants, gyms)
- producers, distributors, and manufacturers (e.g., food, tobacco, active/sedentary recreation)