Title

Social connectedness and engagement in preventive health services: an analysis of data from a prospective cohort study

Authors

·       Stafford M.^a, b,

·       von Wagner C.^c,

·       Perman S.^e,

·       Taylor J.^f,

·       Kuh D.^b,

·       Sheringham J.^d

Author Affiliations

·       ^a The Health Foundation, London, United Kingdom

·       ^b MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom

·       ^c Department of Behavioural Science and Health, University College London, London, United Kingdom

·       ^d National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care North Thames, Department of Applied Health Research, University College London, London, United Kingdom

Publisher

Elsevier Ltd

Date of Publication

September 2018

Series/Report no.

The Lancet Public Health, Volume 3, Issue 9, Pages e438 - e446

Abstract

Background

Evidence of the possible health benefits of social connectedness is increasing. We aimed to examine poor social connectedness as a possible barrier to participation in preventive health services among older people (aged 53–69 years).

Methods

We analysed data from a prospective cohort study of 5362 socially stratified births from the Medical Research Council National Survey of Health and Development enrolled in England, Scotland, and Wales in March 1946. At ages 68–69 years, participants reported participation in blood pressure and cholesterol measurement, eyesight and dental check-ups, influenza immunisation, and bowel and breast cancer screening. Our primary outcome measure summed participation across all these tests and services at ages 68–69 years. We tested associations between structural and functional social connectedness from ages 53 years to 69 years and total count of participation in these preventive services in Poisson models controlling for sex, education, occupational class, employment, chronic illnesses, and general practitioner consultations for health problems.

Findings

940 (44%) of 2132 participants attended all preventive services within the recommended timeframes. At ages 68–69 years, being unmarried or not cohabiting (incident rate ratio [IRR] 1·33, 95% CI 1·20–1·47) and small personal social networks (IRR 1·51, 1·32–1·71) were independently associated with non-participation in more services, with associations consistent across most services. High social relationship quality at ages 68–69 years (IRR 0·91, 95% CI 0·87–0·95) and increasing social relationship quality from ages 53 years to 69 years (IRR 0·93, 0·89–0·97) were associated with low risk of non-participation.

Interpretation

Individuals with poor social connectedness appear to be at greater risk of not engaging in the full range of preventive services than individuals with good social connectedness. Improvement of access to social contacts and networks in older ages is already recommended for the maintenance of good mental health. This study suggests that social connectedness could also improve participation in a wide range of preventive health services, and hence could improve use of the health-care system and population health.

주요 내용

최근 사회적 연결이 건강에 미치는 이점에 대한 증거가 증가하고 있다. 본 연구는 노인(53-69세)의 예방적 보건 서비스 참여에 대한 장벽으로서 열악한 사회적 연결성을 조사하는 것을 목표로 했다.  영국, 스코틀랜드, 웨일즈에 등록된 Medical Research Council National Survey of Health and Development에서(1946년 3월)  5362명의 사회적 계층 출생에 대한 전향적 코호트 연구의 데이터를 분석하였다. 분석 결과, 사회적 연결이 낮은 개인은 사회적 연결이 양호한 개인보다 전체 범위의 예방적 보건 서비스에 참여하지 않을 위험이 더 큰 것으로 나타났다. 이 연구는 사회적 연결성이 광범위한 예방 의료 서비스에 대한 참여를 향상시킬 수 있다는 것을 나타낸다.  본 연구의 결과는 사회적 연결을 통해 의료 시스템 및 개인의 건강을 개선할 수 있음을 시사한다.

ISSN

2468-2667

DOI

https://doi.org/10.1016/S2468-2667(18)30141-5