Study On Social Capital And Chronic Diseases Prevention And Control At The Individual Level

BackgroundNowadays, chronic diseases has become a significant social problem and main burden of healthcare which threatens human health along with its rapid progress of morbidity and mortality. Effective strategies for chronic diseases prevention and control should embody the soul of leading force of the government, multi-sectoral cooperation and the participation of the whole society. But how to establish an effective, government-led,multi-department coordination mechanism, how to better integrate existing resources of chronic disease prevention and control, and how to develop potential, intangible resources to compensate for physical resources which is insufficient.The social capital theory provides a new idea to solve these problems. By effectively integrating and resonable allocating physical resource, human resource, and information resource in the field of chronic diseases prevention and control, social capital combinates the various resources and exhisibits more effective and ecomonic. This research is to explore the association between dimensions of social capital and chronic diseases at the individual level by cross sectional study on healthy people, high risk population and chronic diseases patients.Objectives To analyze the impacts of social capital on chronic disease prevention and control at the individual level, to discuss the effect of social capital on the health related behavior and quality of life, to explore the strategies for developing and utilizing social capital in the field of chronic disease prevention and control.Methods By the methods of literature study, expert consultation, preliminary test questionnaire,We constructed the self-designed questionnaire of social capital and chronic diseases prevention and control at the individual level. We collected data by the random and convenient sampling method and face-to-face questionnaire survey in 6 counties(districts) in Anhui province. Quantitative data were input using Epi Data 3.1 software and carried out the descriptive statistics analysis, reliability analysis to test the internal consistent reliability, factor analysis to test the construct validity, single factor and the multi-factor logistic regression analysis to explore the relationship between social capital and chronic diseases prevention and control using SPSS 16.0 software.Results(1) Social capital Scale contains six dimensions and thirty five items. Cronbach’s alpha of the self-designed social capital scale is 0.86, six dimensions of social capital Cronbach’s alpha are between 0.61~0.93, the questionnaire and six dimensions have high reliability. Six dimensions accounted for 6.163% ~ 14.718%, accumulated variance was 59.103%, and the construct validity was in line with the theory of idea and framework.(2) 2723 residents participated the research and finished questionnaire, and 2500 questionnaires were valid, the response rate was 91.81%. There were 517 cases in healthy group, 586 cases in high risk groups, and 1397 cases in chronic diseases group(318 cases of cancer, 358 cases of COPD, 436 cases of type 2 diabetes,and 417 cases of stroke, 132 cases of patients with two or more chronic diseases). In healthy group, the proportion of women was higher(74.9%). the proportion of 25~44 age group was higher in healthy group(42.6%), and 60~ age group was higher in both high risk and chronic diseases group(69.3%, 85.0%). The proportion of college degree and above was higher in healthy group(24.6%), while the proportion of illiterate/less literacy was high in both high risk and chronic diseases group(35.0%, 45.0%). Surveyed people with the career of stable job and farmer(33.1% and 52.6%, 44.9% and 46.1%, 55.6%and 37.8%), and with less than 1000 yuan were dominated(54.2%、59.0%、67.7%).(3) Healthy group had higher scores of social participant and reciprocity, and chronic diseases group had lower scores of the two dimensions. Scores of social network, social support, and cohension were higher in health and high risk groups than in chronic diseases. There were statistically significant differences of social capital dimensions in three gourps(P < 0.001) except trust(P = 0.172). People in this survey had low level of social participation(2.0 ± 3.3, 1.3 ± 2.4 and 0.9 ± 1.8), average level of social support(13.8±3.4, 13.7±3.2 and 13.2±3.3), and high level of social network(16.0±3.0, 16.2±3.1 and 15.4±3.1), trust(29.0±4.2, 28.6±4.6 and 28.6±4.3), reciprocity(19.2±2.6, 18.7±2.9 and 17.9±3.3) and cohension(15.8±2.9, 15.6±2.91 and 15.0±2.9).(4) The awareness of knowledge about chronic diseases in healthy group, high risk group, and chronic diseases group were 44.5%, 36.1%, and 28.1% respectively. Social support was positively associated with the awareness of knowledge about chronic diseases in healthy group(adjust-OR = 1.08, 95%CI: 1.02~1.15) and social participation in high risk group(adjust-OR = 1.30, 95%CI: 1.15~1.46). Social participation(adjust-OR = 1.16, 95%CI: 1.07~1.25), social support(adjust-OR =1.06,95%CI: 1.02~1.10), trust(adjust-OR = 1.04,95%CI: 1.01~1.07) and reciprocity(adjust-OR = 1.06, 95%CI: 1.02~1.11) were positively associated with the awareness of knowledge about chronic diseases in chronic diseases group.(5) Trust(adjust-OR = 1.08, 95%CI : 1.02~1.15, adjust-OR = 1.06, adjust-OR =1.06, 95%CI: 1.02~1.1195%CI: 1.02~1.11) and reciprocity(adjust-OR = 1.11,95%CI:1.00~1.23, adjust-OR = 1.12,95%CI: 1.05~1.20) were positively associated with 150 min moderate-intensity physical activity per week in healthy group and high risk group, while in chronic diseases group social participation(adjust-OR = 1.14,95%CI: 1.05~1.22), trust(adjust-OR = 1.04, 95%CI: 1.02~1.07) and reciprocity(adjust-OR = 1.12, 95%CI: 1.08~1.16) were positively associated with 150 min moderate-intensity physical activity per week. Social participation(adjust-OR = 1.11,95%CI: 1.02~1.21) and social support(adjust-OR = 1.11, 95%CI: 1.04~1.18) were positively associated with physical activity in healthy group, and social participation(adjust-OR = 1.22,95%CI: 1.08~1.38) in high risk group, and all six dimensions were no statistically significant association with physical activity in chronic diseases group(P> 0.05).Social participation was positively associated with healthy diet in healthy group(adjust-OR = 1.33, 95%CI: 1.15~1.54), social participation(adjust-OR = 1.33,95%CI: 1.14~1.57) and reciprocity(adjust-OR = 1.08,95%CI: 1.01~1.16) in high risk group, social participation(adjust-OR = 1.44, 95%CI: 1.28~1.61), social network(adjust-OR = 1.06, 95%CI: 1.03~1.10), trust(adjust-OR = 1.04, 95%CI: 1.01~1.06)and cohension(adjust-OR = 1.06, 95%CI: 1.02~1.10) in chronic diseases group.Social participation was positively associated with controlling weight in healthy group(adjust-OR = 1.15, 95%CI: 1.04~1.27), social participation(adjust-OR = 1.25,95%CI: 1.11~1.41) and trust(adjust-OR = 1.07,95%CI: 1.03~1.11) in high risk group,social participation(adjust-OR = 1.26,95%CI: 1.15~1.38), trust(adjust-OR = 1.04,95%CI: 1.02~1.07) and cohension(adjust-OR = 1.05, 95%CI: 1.01~1.09) in chronic diseases group.Social participation(adjust-OR = 1.43, 95%CI: 1.24~1.66) and reciprocity(adjust-OR = 1.15, 95%CI: 1.05~1.26) were positively associated with learning healthcare knowledge in healthy group social participation(adjust-OR = 1.26,95%CI:1.11~1.44) in high risk group, social participation(adjust-OR = 1.48, 95%CI:1.33~1.65), social network(adjust-OR = 1.05,95%CI: 1.01~1.09) and trust(adjust-OR= 1.10,95%CI: 1.06~1.14) in chronic diseases group.Social participation(adjust-OR = 1.67, 95%CI: 1.39~2.01, adjust-OR = 1.22,95%CI: 1.06~1.39, adjust-OR = 1.31, 95%CI: 1.18~1.46) was positively associated with early treatment and regular physical examination in three groups, but social network(adjust-OR = 0.91, 95%CI: 0.86~0.97) and cohension(adjust-OR = 0.90,95%CI: 0.85~0.96) were negatively associated with early treatment and regular physical examination in high risk group.The proportion of smoking in chronic diseases group was 17.5%. All six dimensions were no statistically significant association with smoking in chronic diseases group(P > 0.05), as participating in hobby association(adjust-OR = 1.45,95%CI: 1.04~2.02), and care about community by yourself(adjust-OR = 1.22,95%CI:1.04~1.43) and neighbors(adjust-OR = 1.26, 95%CI: 1.06~1.49) were postively associated with smoking, and trust in relatives or family was negatively associated with smoking(adjust-OR = 0.78,95%CI: 0.63~0.96).(6) Physical health and mental health were evaluated by SF-36 to reflecte the quality of life in high risk and chronic diseases group. In high risk group, social network(adjustOR = 1.09,95%CI: 1.03~1.16), social support(adjust-OR = 1.11,95%CI: 1.04~1.18)and reciprocity(adjust-OR = 1.12,95%CI: 1.04~1.20) were positively associated with physical health, social network(adjust-OR = 1.08, 95%CI: 1.02~1.15), reciprocity(adjust-OR = 1.14, 95%CI: 1.07~1.21) and cohension(adjust-OR = 1.13, 95%CI:1.06~1.20) were positively associated with mental health. Social network(adjust-OR =1.14, 95%CI: 1.10~1.19, adjust-OR = 1.15, 95%CI: 1.10~1.19), social support(adjust-OR = 1.09, 95%CI: 1.06~1.13, adjust-OR = 1.05, 95%CI: 1.01~1.08),reciprocity(adjust-OR = 1.10, 95%CI: 1.06~1.14, adjust-OR = 1.16, 95%CI:1.11~1.20) and cohension(adjust-OR = 1.13,95%CI: 1.08~1.17, adjust-OR = 1.17,95%CI: 1.12~1.22) were positively associated with both physical and mental health in chronic diseases group.Conclusions At the individual level, the questionnaire has high reliability and ideal construct validity.People in this survey had low level of social participation, average level of social support, and high level of social network, trust, reciprocity and cohension. Healthy group had higher social capital and chronic diseases group had lower social capital.There were statistically significant differences of social capital dimensions in three gourps except trust. Social capital can improve the awareness of knowledge about chronic diseases. Social capital is beneficial to promote people’s physical activity,dietary behavior, and learning healthcare knowledge. Social capital is beneficial to promote early treatment and regular physical examination in healthy group and chronic diseases group. Social capital is beneficial to improve quality of life of high risk and chronic diseases group.Although exist some limitations, according to the result of our research, this study enriched the theory of social capital and chronic diseases prevention and control by empirical research in China, explored the relationship between social capital and chronic diseases prevention and control in three kinds of group at the individual level,rised to the height of the social capital theory in the field of chronic diseases prevention and control, and provided a new train of thought in the current resource scarcity problem urgently to be solved for chronic diseases prevention and control. Either from the theoretical perspective of social capital, or from the practical significance of the scientific prevention and control of chronic diseases, this kind of research is very necessary. Literature study shows that the study was the first time in our country.