BACKGROUND

Whilst there has been a focus on the importance of social support for managing long-term conditions, there has been little specific focus on the characteristics of social networks that shape self-management. Policy emphasis is placed on individual responsibility for self-care, and this influences commissioning of health-care services. Assumptions are often made by policymakers about accessibility and preference for support and the influence of the social context on chronic illness management.

OBJECTIVE

To examine the social networks of individuals with long-term conditions and identify how the characteristics of their composition influences support needs.

DESIGN, SETTING AND PARTICIPANTS: Thirty participants completed initial face-to-face in-depth interviews, telephone follow-ups and final face-to-face interviews in the north-west of England. A longitudinal qualitative design was used to elicit the subtle changes in relationships over a year.

FINDINGS

The findings suggest that the relationships which constitute a social network influence perceived support needs and attitudes to self-management. The amalgamation of relationships was characterized into three network typologies (family focused, friend focused or health-care professional focused) according to which types of relationships were dominant. In the absence of support, accounts highlighted a small number of substitutes who could provide support at times of critical need.

DISCUSSION

This study challenges the notion of 'self'-management as an individual construct as many of the practices of illness management involved the support and/or negotiation of roles with others. By examining the nuances of relationships, this study has highlighted the tacit boundaries of practical and emotional support provision.