CHAPTER 5: RESULTS
5.4 SOCIAL CAPITAL
5.4.2 Network dynamics
with only five respondents, four of them older old persons, making contact between daily to once a week with their doctors.
Volume of contact had a significant association with loneliness, with 145 days less contact with people who were rated as socially lonely compared to those who were not socially lonely (U=2.8, p=.005).
Closeness: The closest relationship reported was with a spouse (2.8, 95% CI 2.2- 3.4), with all five respondents feeling “very” or “extremely close” to them, followed by their children (2.1, 95% CI 1.9-2.5) with 44 (77.2%) respondents reporting that they felt “very close” to “extremely close” to their children (Table 16: Network density and dynamics). The lowest level of closeness was by the 36 respondents who had a nurse in their network, only six (16.7%) felt close towards the nurses.
An important indicator of closeness is the ability to confide in a network member. All five respondents indicated that they would confide in their spouse and 57 (76%) reported that they were likely to confide in their children (see Table 16: Network density and dynamics). The community group was a network group amongst the most frequently contacted, where 48 (64.0%) were involved in activities outside of the residential facility. However the levels of closeness (18, 51.4%) and willingness to confide (19, 57.6%) in them were much lower. Despite only 21 (37.5%) feeling close to their religious leader 30 (60%) were likely to confide in him/her. The willingness to confide in nurses (15, 38.5%) was higher than level of closeness, but was the lowest out of all network groups and is linked to the low trust scores.
Trust: The ability to confide in a network member which is linked to the value of trust, a significant social capital asset. The average score for trust, was relatively high, with respondents scoring an average score 18.3 (sd 3.6) out of a possible 25, (range 9 to 25). The highest trust was reported towards doctors (55, 74.7%) with a slight increase in their likelihood to confide in doctors (36, 60%). The lowest trust was reported for nurses (31, 41.3%), with lower levels in the likelihood to confide in nurses (31, 41.3%) (See Table 17: Trust levels). There was no significant difference noted in the expressions of trust and any of the demographic variables (younger old and older old, gender, race, home language, marital status, education level).
There were significant difference in trust scores for those who were not lonely (19.3, sd 2.8), lonely (17.6, sd 3.9) and intensely lonely (13.3, sd 3.8), (K=7.1, p=.029). This may indicate that when trust decreases, levels of social loneliness may increase.
Similarly, there were significant differences in mental wellbeing between respondents
who trusted people (19.7 sd 4.7) and those who did not (15.6 sd 6.2) (U=3.1, p=.002).
Table 17: Trust levels
Trust Item Frequency
(Trusted a lot / mostly trusted)
n (%)
Frequency (Trusted sometimes)
n (%)
Frequency (Mostly cannot be trusted/
Can’t trust at all) n (%)
Towards my doctor I feel 56(74.7%) 31(41.3%) 6(8.0%)
Towards security in my surrounds I feel 53(70.7%) 19(25.3%) 3(4.0 %)
Towards hospitals I feel 43(57.3%) 14(18.7%) 18(24.0%)
Generally people 34(45.3%) 31(41.3%) 10(13.3%)
Towards nurses I feel 31(41.3%) 29(38.7%) 15(20.0%)
Social Support: Social support was measured using the Oslo-3 Social Scale with three questions that measured for primary support, concern shown to the respondent as well as the ease to access practical help. The average score for Social Support was 10.8 (sd 2.2, range 3-14) out of 14. There were no significant differences in social support across the categories of age groups, gender, race, home language, marital status and educational status. When social support was categorised as per Boem (2012), 10 (13.3%) respondents experienced poor support, 33 (44.0%) respondents’ experienced moderate support and 32 (42, 7%) experienced strong support.
In examining the individual items, primary support of a count of six or more was by 12 (16.0%), three to five members available for 24 (32.0%), and one to two members for the majority (39, 49.3%), while two felt they had no-one to rely on.
These small support networks had no association with their level of mental wellbeing. Despite the small support networks the experience of concern by others was high with the majority (37, 49.3%) reporting “lot of concern”, six (8.0%) “little to no concern and interest”. The ability to access practical help was seen as “easy to very easy” by 52 (69%) and difficult by 8 (10.7%) and associated with mental wellbeing. There was a significant difference between those presenting as mentally
ease to access practical help (U=3.0, p=.003). Similarly total support was associated with mental wellbeing. (Table 18: Social support and mental wellbeing).
Table 18: Social support and mental wellbeing
OSLO-3 Social Support Scale
Mentally well (WHO-5)
Mentally Unwell (WHO-5)
Average Score
Test p-value
Total OSLO-3 score per three categories /14
11.3 sd 2.5 10.2 sd 1.9 10.8 sd 2.2
U= 2.8 p=<.006*
OSLO1: primary support /4 2.8 sd 0.8 2.5 sd 0.8 2.6 sd 0.8, U= 1.5 p=.129 OSLO2: concern from others /5 4.3 sd 0.9 4.1 sd 1.1 4.2 sd 1.0 U= 1.1 p=.274 OSLO3: ease to access practical
help‘s /5
4.3 sd 1.1 3.7 sd 1.0 4.0 sd 2.2
U= 3.0 p=.003*
Differences in Mental Wellbeing (measured using any negative category) were tested using non-parametric Mann Whitney U test.; *p-value of significance set at <.05
Social Connectedness: Social connectedness describes the connectedness to resources and is reflected in the contact with network members, institutions, such as healthcare, organisations or family that can be the source of resources that need to be accessed.
Primary network group and non-kin network groups’ access to resources was examined. Less than half of the respondents (36, 48.0%) responded that they accessed a community group, with 25 (33.3%) respondents having contact with them at least once a week, and of these 17(68.0%) were from the older old group. The main type of contact (30, 88.2%) with the community group was face-to face. In the data collection some residents interpreted religious leader to be the leader in the abstract form, further the questionnaire did not ask if the resident had to access the religious leader through them leaving the residential facility or whether the religious leader came to the facility.
In the primary network it was only with spouses (4, 66.7%) that face-to-face contact was the favoured type of contact, with technologically assisted forms of contact for all other family members. Overall technologically assisted forms of communication were the methods of choice to contact children and great/grandchildren (23, 30.7%
and 23, 30.7%); however a statistically significant difference was evident in how the
younger old and the older old contacted them (U=-3.8, p=<.001 and U=-3.4, p=.001).
The younger old (17, 54.8%) chose to use technologically assisted communication, in particular cellphones as the method of choice to contact, their children while the older old (14, 31.8%) chose the landline. To contact their great/grandchildren the older old (10, 22.7%) preferred to use the landline, and the younger old (15, 48.4%) preferred technologically assisted communication, in particular the cellphone.
Seventy two (96.0%) residents indicated the presence of a friend, while three residents were without a friend. The questionnaire did not ask if the residents had to access their friends through leaving the residential facility or whether the friends came to visit or if friends were fellow residents. This would have been of interest for an intervention. There was a significant statistical difference (p=.011) between the younger old and the older old and how they contacted friends. In the younger old the favoured method was technologically assisted communication (13, 41.9%), while face-to-face contact (21, 47.7%) was the method chosen by older old persons. Apart from friends, all other non-kin network members were contacted through face-to-face contact.
Face-to-face contact with family / friends occurred from once a week to daily for 41 (54.7%) respondents, 22 (29.3%) few times to once a month and 12 (16%) had not had contact in the last month with family/friends. Apart from face–to-face contact, 36 (48.0%) had contact once a week to daily, 30 (40.0%) few times to once a month, while 9 (12%) had not had contact with family or friends in the past month. There was no statistical difference in loneliness when there was no face-to-face contact, however there was a significant difference in the social loneliness of those who had face-to-face contact with family/friends very often (3.5 sd .7), often (3.9 sd .9) and seldom (4.3 sd 1.1) (K=7.0, p=.030). This underlines the value of face-to-face contact (Table 19: Associations between WHO-5 and Social connectedness and Network Dynamics).
Twenty seven (36.0%) respondents reported involvement in cultural or community groups, which is lower than the reported contact with a community group. The figure
is of note that there was no link shown between involvement in activities inside the residence and mental wellbeing. Yet there was a significant difference in the mental wellbeing of respondents who were involved in activities outside of the residence (18.8 sd 4.6) and those who were not (16.1 sd 6.2) (U = 2.7, p=.008).
Self-efficacy: Self-efficacy underpins social and network dynamics. The average score for self-efficacy of the respondents was 7.0 (sd 1.7) out of a possible 10 (range 2 to 10). Self-efficacy was measured by the ability to have a say with family/friends on important issues (50, 66.7%) and the ability to have a say in the residence (37, 49.3%). There was no statistical difference in the demographic variables (age groups, gender, race, home language, and marital status or education level) and self-efficacy and specifically the ability to have a say with family or friends in important matters. However, there were significant differences in the mental wellbeing (WHO-5 score) between those who felt that they had a say in the residence (19.2 sd 5.4), did not have a say (16.1 sd, 5.3) and those who were not sure (15.1 sd, 6.9) that they have a say in matters of importance in the residence (K=13.6, p=.008).