Toward a contextually-valid measure of social support among middle-aged and older African Americans in a southern urban community

A gap in the literature on social support among middle-aged and older African Americans and limitations in scales measuring social support among this group indicate a need for a new measure of social support that is sensitive to the cultural context in which this population lives. The literature indicates that social support is a multidimensional, fluid phenomenon, i.e., it has many dimensions and each dimension may have significance for individuals and communities at different periods in time and in different geographical locations. The specific goals of this research were to (1) identify the domains and dimensions of support among middle-aged and older African Americans, ages 38 to 65, that potentially moderate the effects of psychosocial factors on health outcomes; (2) use the research findings to construct a new, contextually valid scale that measures social support among this population in a southern urban community; and (3) document the methodological process by which the first two goals were achieved. The iterative research process consisted of thirty-one methodological steps in nine phases over a four-year period. Six sets of data obtained from a content analysis of popular magazines, five types of interviews, a semi-structured questionnaire, a visual assessment of the community, and participant observation were analyzed for recurrent themes associated with social support. The findings were used to construct scale items that reflect culturally-relevant domains and dimensions of social support that are not typically assessed in traditional scales. Introduction There are a number of excellent scales that measure social support in the general population; however, few, if any, have tapped into the unique experiences of older African Americans. Furthermore, these scales are not comprehensive enough to elicit contextually-based responses from middle-aged and older African Americans, ages 3865, who live in a southern urban community. This may result in investigators missing (or worse yet, misunderstanding) important information regarding social support among men and women in this age category and geographical location. A gap in the literature and limitations in current scales measuring social support indicate a need for a new measure of social support that is sensitive to the cultural context in which middle-aged and older African Americans live. This study had three goals: (1) to identify, using qualitative and quantitative research methods, the domains and dimensions of support among African Americans, ages 38-65, that potentially moderate the effects of psychosocial factors on health outcomes; (2) to use the findings of this research to construct a new contextually valid scale that measures social support among this population in a southern urban community; and (3) to document the methodological process by which the first two goals were achieved. Methodology With NIA (National Institute on Aging) grant funding (5P02AG12058-02), The Duke University Exploratory Center (EC) for Research on Health Promotion in Older Minority Populations was established to conduct multidisciplinary pilot research and interventions and to initiate programs of health education and community outreach aimed at improving the health status of older African Americans. The scientific emphasis was on the interaction of psychosocial, behavioral, and physiological factors as they affect health and illness in older African American males and females. Duke investigators selected hypertension as their research theme. Researchers also were interested in filling a major gap in the scientific literature on health and aging in middle-aged and older African Americans. Duke EC investigators argued that social factors have received little attention in studies of hypertension among this older population. In the proposal stage of the Duke EC grant, the NIA Study Section questioned whether the scales previously used by Duke (including Dressler’s Scale of Chronic Role Stressors and the Duke Social Support Index) were “comprehensive enough to indicate the real life levels of support and environmental stress in this population, and were thus leading to an underestimation of the association of the ‘environment’ with hypertension. ” In response, the Duke EC decided to conduct a sub-study to develop new scales to measure stress and social support among older African Americans. This research focused on the development of one of the new scales: the African American Social Support