How social relationships influence medication compliance This week’s focus is on social support – an area that has received extensive attention in health research.  Social support is what arises from our social relationships; it is the care and assistance we receive from others, especially as it relates to physical and mental health.  With such a broad definition, social support has been shown to affect nearly every health outcome studied.  There are differences in the extent of that impact, however, depending on the specific health issue or behavior, how social support is defined and measured, and factors related to the individuals involved.  As an introduction to this topic, we’ll focus on the different types of social support and the factors that most commonly determine how helpful it is in managing health and its effect on patient adherence. Social support encompasses a range of behaviors and these are often categorized as:  i) emotional support, ii) instrumental (or practical) support, iii) informational support, and iv) appraisal.  Emotional support includes care, empathy, companionship, and trust whileinstrumental support includes tangible or practical aid (such as providing money or transportation to a doctor’s appointment for example).  Informational support includes advice, suggestions and other forms of education/knowledge about health while appraisal provides feedback and affirmation that can be used for self-evaluation of health behaviors and/or beliefs.  A single source of social support may provide multiple kinds of social support (e.g., a friend who listens to your struggles with healthy eating and recommends a good cookbook) or only one kind of social support (e.g., a pharmacist who tells you how to properly take your medications). In health research social support is often measured as perceived social support (how much support an individual thinks or feels s/he is getting), actual/received social support (how many times an individual actually received some form of assistance, for example on a weekly basis), and/orsocial integration (the number of persons available to provide support). The most important factors related to the individuals involved are: i) nature of the relationship(spouse, friend, clinician), ii) proximity and/or accessibility, iii) knowledge/experience with respect to the health problem or health behavior. Of course there are also broader aspects to how social relationships influence health including social influence, social undermining, and social comparison.  This highlights an important point about social support, namely that it can also exert negative influences (aside from positive ones).  For example, long-term caregiving can be stressful and, eventually, taxing on the caregiver’s own health.  Similarly, a miss-match between the type of support desired/needed and the type received can be discouraging (or even damaging) to the person seeking support. Strong levels of social support are linked with lower levels of stress, greater levels of happiness, and a longer life.  It is worthwhile to take a few moments to think about your current social network – in what ways is it is helpful (or harmful) to your health?  Next week we will provide a specific exercise you can do to increase the level of social support you receive from your own social network.