Social Norms and Self-Management Ability Among Uninsured Primary Care Patients

Akiko Kamimura, PhD, MSW; Rebecca Higham, BS; Samin Panahi, BS, MS; Edward Lee, BS; Jeanie Ashby, MPH

Disclosures

South Med J. 2020;113(8):407-412. 

In This Article

Abstract and Introduction

Abstract

Objectives: The purpose of this study was to examine the association between social norms and self-management ability among uninsured low-income primary care patients.

Methods: Data were collected from adult patients at a free clinic using a self-administered survey from August to December 2018.

Results: Higher levels of social norms to exercise were associated with higher levels of all aspects of self-management ability. Lower levels of social norms to use substances were associated with higher levels of all aspects of self-management ability, except for variety in self-management. Better health was associated with higher levels of investment behavior of self-management ability.

Conclusions: The findings of this study suggest the association between social norms and self-management ability and its impact on health among low-income, uninsured primary care patients. Self-management ability is important for maintaining health. Providing intervention programs on self-management skills should focus on not only individual behaviors but also social norms that affect their health behaviors.

Introduction

Good self-management of chronic conditions refers to being responsible for one's health, being knowledgeable about one's health, using the knowledge to manage health-related risks, and actively using health information to make decisions on one's health.[1] Self-management of chronic conditions is essential for improving health outcomes.[2] The factors influencing chronic disease self-management include individual characteristics (e.g., knowledge about their disease), health status, resources (e.g., insurance), environmental factors (e.g., living arrangement), and the healthcare system (e.g., access to care).[3] Low-income patients often experience challenges in self-management for chronic conditions.[4] Mental health and social support from family and friends affect self-management behaviors among medically underserved populations.[4]

According to the social-ecological model, multilevel social factors affect individual health-related behaviors.[5] The context and culture of a community or neighborhood are crucial components of assessing chronic disease self-management in the social-ecological model.[6] Previous studies examined community-based chronic disease self-management intervention programs for low-income individuals;[7,8] however, little is known about the association between community norms and self-management ability among low-income individuals. It is vital to examine the association because low-income individuals tend to live in an impoverished community, which may have negative community norms.[9,10]

The purpose of this study was to examine the association between social norms and self-management ability among low-income individuals. Exercise and substance abuse were included among social norms because these factors are closely related to social norms.[11,12] The research question of this study is: How are social norms related to self-management ability among uninsured low-income individuals? The tested hypothesis was: Higher levels of positive social norms are associated with higher levels of self-management ability. This study is important to increase the knowledge about self-management ability among underserved populations that would help individuals develop effective intervention programs.

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