The goal of this study is to present a broad overview of social support research. It presents both traditional and feminist perspectives, the pros and cons of research on gender differences, and an introduction to social support research on a number of specific issues pertaining to women. The following is a brief summary of each section of the literature review.

PART 1: SOCIAL SUPPORT DEFINITIONS AND LINKS TO RESEARCH

The term "social support" covers a broad range of meanings. It is defined in functional, structural, and/or conceptual terms. Researchers agree that social support needs to be defined carefully when developing a research study.

Social Support and Research Social support is studied objectively through quantitative methods such as network analysis, and through subjective evaluations, such as the perception of the helpfulness of support received.

Problems in Social Support Research Certain aspects of support are easy to study, such as how many people are in a support network. Other aspects are more difficult. True experimental designs are difficult, and therefore, causality cannot be determined. Self-reporting can be a problem area, therefore using multiple methods of assessment is recommended. Support now is being seen by some researchers as a process that can change over time, rather than as a stable entity. These researchers recommend assessing support on several occasions over the life of the stressful event.

Links to Health and Well Being Health can be defined using a biomedical model or by using a holistic one that includes the interaction of mind and body and the surrounding environment. Research has linked social support to health through physiological studies as well as theoretical models such as the "buffering hypothesis" and "main effect."

Women and Health Why focus on women's health? There are many issues that affect only women, or affect women disproportionately. As well, most studies have included only white males, with results generalized to women. Women also are not a homogenous group—results may vary due to factors such as developmental stages or ethnicity. Gender roles also are thought to influence women's health.

Stress, Coping and Social Support Stress is an element in the environment that poses a threat, and coping is an individual response to stress. There are many kinds of coping responses. Researchers are not sure if an individual brings a set of coping skills to a stressful event or whether coping changes depending on the situation. Studies have found, however, that some types of coping may be more effective for certain situations or at different stages of a stressor. One unique model of coping is presented in the context of "place," where environmental upheaval causes individuals to reassess and manage change. This is best done through interpersonal collaboration. Empowered collaboration refers to groups who share common values coming together to change their surrounding environment for the better.

Negative Coping. The current trend in health is toward individual responsibility. This includes education and prevention and the development of a healthy lifestyle. This trend does not take into account health determinants that are beyond an individual's control or the context of a behaviour. Social support research needs to look more deeply at the issues surrounding a woman's health choices to understand the reasons why these choices are made.

Women and Coping. Traditional models that describe the way women cope have indicated that women rely more on emotion-focused coping and relationship-coping than methods linked to higher psychological distress. When assessment tools were evaluated, researchers found that positive aspects of emotion-focused coping had not been assessed. Once this adjustment was made, women were found to have lower levels of depression and hostility. When assessing relationship-focused research, this method of coping was found to be a valued behaviour when placed in context of a woman's life. This indicates not only the need for assessments to consider the context of women's lives, but also the need to be cautious of assessment results.

Negative Aspects of Support Not all support has positive aspects. The support itself may be ineffective or inappropriate, or the supportive person can create stress or conflict. Some researchers have found that negative interactions are more harmful than positive interactions are helpful. Also, the meaning of support to the individual receiving help is important, as support can imply dependence.

Factors That Influence Support
Environmental Distress and Support. The external environment can play a role in social support by providing opportunities for support interactions to take place, or by discouraging supportive behaviours. Household crowding is one example of a variable that can decrease supportive behaviour.

Major Life Events and Minor Stressors. Two important external determinants are daily hassles and major life events. Individuals dealing with major life events—such as death of a spouse—appear to receive more support than those dealing with daily hassles, such as child care, although if an event lasts for a long period of time, support can wane. One researcher suggests looking at the relationship between major life events and daily hassles, claiming there is often a ripple effect between the two, and they can be additive in nature. Interpersonal conflicts have been identified as the most upsetting type of daily hassle.

Perceived and Received Support, and Reciprocity. Perceived support, or what a person expects to receive and what is actually received, may be different. Received support needs to be seen by the recipient as helpful. The persons giving support may think they are being helpful, when in fact, the recipient does not feel it is so. Reciprocity, or the exchange of support, varies among individuals and the relationships in which they are involved. Long-term relationships do not require immediate return on support as balance can be achieved over the length of the relationship.

Reciprocity and Social Obligation. It appears that the exchange of support needs to be balanced, otherwise feelings of obligation can result. The type of exchange and the relationship involved can influence the exchange (for example, a work supervisor is allowed to give more informational support than a co-worker). Relationships with family members, where support may be based on duty, may lead to greater feelings of obligation than relationships with friends, where the relationship is voluntary.

Individual Differences. Social support may be linked to an individual's health through their self-esteem, perhaps through feelings of worthiness of support. There also are many individual characteristics that have been linked to social support such as social skills, coping abilities, locus of control, meaning of life and personality traits.

Social Connections
Social Ties and Subgroups. Social support systems that are normally stable can be undermined by chronic stressors. Some studies have shown that during some stressful events, certain subgroups in a community may receive less help. These are usually groups whose resources have been strained before the event. In addition, secondary stressors resulting from the initial event can also affect the support network.

Support Enhancement: Support Groups. Mutual aid/self help (mash) groups can provide valuable support to individuals who are undergoing stress from chronic illness or personal problems. There is a danger that the focus stays on the individual, rather than looking at outside influences.

Companionship and Intimacy. There are links between social support and intimacy. Friends are important, especially for women. One researcher suggests re-conceiving the marriage relationship as a context, rather than a descriptor of who people are.

PART 2: GENDER DIFFERENCES

Gender Research There are many problem areas with traditional gender research, including criticism that the focus is not on underlying power structures but on biological differences. Some researchers, however, believe gender research can still be helpful to point out the differing needs and wants of women. If undertaking gender research, there are several guidelines to follow and researchers and policy-makers need to be aware that interpretation of data can result in potentially harmful outcomes for women.

Gender Differences and Social Support There is limited research on gender differences and social support. Research problems in this area include a lack of adequate conceptualization and measurement. Women and men have different social networks. It also appears that both women and men choose women as their preferred helper. Women are not only informal supporters, but in professional capacities such as nurses and social workers, they are formal supporters as well. Women also are expected to be family caretakers not only for their own families but for in-laws.

Women, Work and Social Support It was assumed initially that working outside the home was detrimental to women's health. However, it now appears that work provides access to new support networks for women. There are many variables that can affect work satisfaction. Overall, work appears to have health benefits for women. For homemakers, there are assumptions that work roles of wife, mother and housewife are compatible, and that the home is seen as a sanctuary, or stress-free place. Some researchers now refute these assumptions.

PART 3: SPECIFIC GROUPS OF WOMEN

Aboriginal Women Aboriginal women have health care needs that are different from those of Aboriginal men and non-Aboriginal women. There is little comprehensive research data on Aboriginal women, especially Métis women. Social support can be a source of strength or a liability for Aboriginal women. Relocation to urban centres forces overcrowding in substandard housing. Aboriginal women represent the highest percentage of single-parent families in the country.

Minority Women Research seldom addresses issues of race and class differences, yet there are different concerns for women of varying ethnic backgrounds. Inequity is a major problem. Women from some cultures are reliant on family males for financial decisions, which can impact decisions about women's medical treatment and compliance. Social networks and links between members can be different for some ethnic groups. There is a need for health care providers to be culturally-sensitive.

Pregnant Women Social support during pregnancy has been shown to be beneficial. Women who are socially disadvantaged, such as pregnant teenagers, can benefit especially from support.

Lesbians There is little research on health and lesbian women. Lesbians often face discrimination when attempting to receive health care. Health care professionals need to be educated about lesbians and health to create health care services that are welcoming to lesbians. One group on the Internet provides world-wide support for lesbians with informational support and chat groups that provide access to other lesbians. While this technology can offer support, one drawback is the availability of computer access.

Older Women Older women have different health needs than older men, yet there is little research on this group of women. Women generally live longer then men, but they do not enjoy good health. Older women received more drugs and suffer from more stress from poverty, loneliness and family caregiving. Employed older women, and women who volunteer, appear to have greater life satisfaction. This is possibly due to the increased access to companionship and support. Reciprocity in support is important for older women, particularly with adult children than with friends.

Rural Women Living with Violence There is little research on the support networks of women who live with violence despite the acknowledgement of the isolation that these women face. This is of particular importance to rural woman, who not only are isolated socially, but geographically as well. For rural women the type of help that is available is different from that available to women who live in the city. Women who help this group by volunteering on crisis lines and educate the community are often isolated as well, and they face public harassment for their work. There have been a few initiatives by community groups to address the issue of violence. However there is still little funding from governments for shelters. The Saskatchewan Farm Stress Line is a unique way to support rural people. Problems are discussed with trained counsellors who have a farming background.

Divorced Women Divorce can be a stressful time for women, due in part to the disruption of their support networks. Social support can relieve distress, but the type of support is important. Friends and children have been reported to be the most helpful. Outside agencies are seldom used for support by divorced women.

Alcoholic Women It appears that women alcoholics are more isolated socially than male alcoholics. Women alcoholics report less satisfaction with their support network, especially for emotional support. One study has shown that as children, women alcoholics report having had less supportive families than the control group.

Women Living with AIDS aids is increasing rapidly among minority, low-income women. Unlike gay men, women with aids often do not have strong support systems. Women also are faced with different issues than men, such as pregnancy. Women are often the caregivers of people with aids. It is often difficult for individuals with aids who are not well to maintain support systems. Disclosure of aids is a factor in developing or maintaining a support system. Sometimes disclosure means rejection. The development of professional, community support is required.

Women Living with Cancer Cancer causes long-term stress which can affect interpersonal relationships. Social support has been shown to be effective in the psychosocial adjustment and coping processes associated with the diagnosis and treatment of cancer. Support groups have shown to be an effective intervention. Young adults with cancer also benefit from support groups with peers as they have different needs than older cancer patients. Cancer research needs to address psychosocial issues for women, given that the quality of life for women is as important as disease treatment. There is little research on cervical cancer that integrates social and psychological issues with prevention and treatment of cancer. One researcher has found links between early family ties and women who are at high risk for cancer. The level of support in current relationships prior to cancer also can determine the level of support a person with cancer will receive. Caregivers often have a difficult time dealing with support needs of patients. One study has found family and caregivers have different definitions of support. Communication of support needs is important. Interventions also need to consider women's ethnic backgrounds.

Women Living with Chronic Illness Chronic illness can mean significant life changes. Marital quality has been reported to influence support for the chronically ill. The expectations of family and health care professionals also can influence the well-being of the patient. Most of the caretakers of the chronically ill are women.

Women Living with Disabilities For people with disabilities, social integration has been found to improve social support. "Natural supporters" (not disability service providers) are individuals who provide support to disabled people. Such services have been criticized for being male-oriented. Several researchers suggest that the issues important to disabled women have been ignored by feminist researchers. Researchers need to redefine definitions such as "independent," to mean having control over one's life, rather than the ability to do certain tasks.

PART 4: FEMINIST RESEARCH METHODS

While there is no one type of feminist methodology, there is some common ground. This includes the idea that research is not value-free, and that values can impact all stages of the research process. Also, it includes a focus on the diversity of women's experiences and the effects of the social context within which a woman lives. For those who wish to use traditional methods, one group of researchers has several recommendations. Others recommend moving away from the biomedical model to include psychosocial and physical environments, developmental stages, and respecting and listening to women's different ways of "knowing." Changing the research process to include more involvement by participants is also recommended. Research should not be limited to white, middle class women, and research tools need to screened for bias, language barriers, reading levels and/or content congruence.

CONCLUSION

Research needs to have a broader scope not only of what areas are researched but how research is done. Context, socio-economic status and culture are some of the variables that need to be included if researchers are to develop a better picture of the lives women lead. As well, methods such as feminist participatory research, which reduces the power inherent in other research methods, are a vital way to gain an understanding of women and the process of support. Other research methods can be used if they incorporate feminist philosophy that acknowledges the bias that can influence research outcomes.

There are many groups of women who currently have not participated in research on social support. These include older women, Aboriginal women, immigrant women, women who live in poverty, disabled women, lesbians and adolescents. More research is needed with these groups, as often they are the women in our society who have less social support.

There is a great deal of research on individual characteristics of the persons receiving support, as well as their coping styles. There is little research on characteristics of caregivers or the benefits of care giving. The emphasis on the individual can be a dangerous area, as it may lead to blaming individuals for their own lack of support. More research on external factors that contribute to support, and a focus on research as a process rather than a one-time event would be useful.

Research has shown that people prefer informal support (family, friends) over formal agency services. Studies also indicate that women are preferred as support givers. Women traditionally are involved in care giving jobs at work. In attempting to increase women's support networks, what kind of implications are there for women as the primary support givers? what are the ways the community can encourage women to use formal agencies? how can these agencies become more welcoming to women, especially those women who are marginalized by society?

Technology has presented new possibilities for support, including emotional support through chat lines and e-mail, as well as up-to-date informational support. How can this technology be used to enhance support, and what are the detriments, such as who has access?

In order to provide support for those women who are not receiving it, or not receiving enough, we need to understand better how the support process works and what it is that women in specific situations really need. We need to understand the burden of being a caregiver, as well as the potential benefits. We need to explore how the various roles combine, such as care giver and support receiver, and learn what it is that women are coping with on a daily basis. By including women in the research process, by listening to their voices, and by hearing their stories, perhaps one day no woman will ever have to stand alone.