Examining the Utilization of Social Capital by Ghanaians When Seeking Care for Chronic Diseases: A Personal Network Survey

Objectives: With limited social security and health protection in Ghana, intergenerational support is needed by those living with NCDs, who incur recurrent costs when seeking NCD care. We measured the level of informal support received by NCD patients and identified factors that influence support provision. Methods: We surveyed 339 NCD patients from three hospitals in Ghana, who listed their social ties and answered questions about their relationship and support frequency. We analyzed the relationship between social support, demographic and health information, characteristics of social ties, and network characteristics. Results: Participants described 1,371 social ties. Nearly 60% of respondents reported difficulties in their usual work or household duties due to chronic illness, which was also the strongest predictor of support. Patients with higher wellbeing reported less social support, while older age and having co-habitant supporters were negatively associated with support, indicating caregiver burnout. Conclusion: Ghanaian NCD patients receive support from various caregivers who may not be able to handle the increasing healthcare and social needs of an aging population. Policies should therefore enhance resource pooling and inclusiveness for old age security.

1. Sociodemographics, 2. Social health protection, 3. Chronic disease history and engagement in care, 4. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS) (Tennant et al. 2007), a. Abridged version of WEMWBS, featuring seven positively-phrased 5-point Likert scale questions, such as "I've been feeling relaxed," and I've been feeling interested in new things."The scale is scored out of 35, with scores above 27.5 being indicative of "high wellbeing."While the scale has not be specifically validated in a Ghanaian population, however its construct and cross-cultural validity has been validated in various other sub-Saharan African contexts, including Niger, Kenya and Tanzania.5.The multidimensional scale of perceived social support (MSPSS) {Wilson, 2017 #762;Zimet, 1988 #559}.a. 12, 7-point Likert scale questions such as "I get the emotional help and support I need from my family," and "I can count on my friends when things go wrong."The MSPSS is scored out of 84, with scores between 12 and 35 indicating low perceived support, scores between 36 and 60 indicating medium perceived support, and scores between 61 and 84 indicating high perceived support.The MSPSS has been validated in a wide range of cultural contexts, including Ghana.6. 'Name generator' (Bidart & Charbonneau 2011;Fernández-Peña, Molina, and Valero 2018;McCarty et al. 2019b), 7. 'Name interpreter' Sections one through five collected information on the participants themselves (the egos) while sections six and seven collected information on the characteristics and support behaviour of members of their social network (the alters).
The "name generator" asked participants to (Bidart & Charbonneau 2011;Fernández-Peña, Molina, and Valero 2018;McCarty et al. 2019b): '[…] list up to 6 people in your social environment.List people that you have talked to either in person or by phone or internet, at least one time in the past 6 months.List the people who are the most important to you for any reason, and indicate the type of relationship that you have with this person.This list can include people such as your family members, friends, neighbours, or elders.' The 'name interpreter' stage of the questionnaire asked participants a loop of questions for each alter that was elicited by the name generator.These questions asked about the attributes of each alter, such as their age, gender and residential proximity to the ego.
We then specifically asked egos about the frequency of contact with the alter and the support that they may receive from the alter.We began by generically asking participants, 'has (alter) supported you in coping with your chronic disease in the past 6 months?'Support' may include emotional support, prayer, food, time, labour, money or sharing helpful knowledge and information'.Subsequent questions then gathered more information on the following three sub-types of support: -Emotional support, such as providing comfort to the ego, making them feel respected or loved, or praying with/for them -Informational support, such as sharing advice and knowledge, or helping to understand doctor's instructions -Material support, such as giving money for healthcare or bus fare, providing transport to the health facility, or cooking and helping with other tasks at home For the purposes of analysis, emotional support and informational support were pooled together as non-material support.
For alters who provided material support, we asked more detailed information about the type of material support and the amount of support given in the case that an alter gave money to an ego.

Table S1 :
Categorical variable used to quantify the provision of social support (left), and the categories' corresponding conversion to a count variable (right).

Table S2 :
Mean differences in number of social support events between levels of ego-level and alterlevel predictor variables.Significance testing used unequal variances t-tests for predictor variables at the ego level, and linear regressions adjusted for ego-level clustering for predictor variables at the alter level.

Table S3 :
Multilevel negative binomial regression models for predicting the count of person-days of emotional and informational support provided by alters to egos over the past month (N2=339, N1=1371)

Table S4 :
Negative binomial regression models for predicting the total count of person-days of informal social support received by egos from all of their alters over the past month (N=339)