Social support and antenatal clinic attendance among Thai pregnant women in Hatyai, a city in southern Thailand

Abstract

Many studies in western countries have shown that persons who have a high level of social support are likely to have better health behaviours, including use of preventive health services, than those who have low support. The present study aims to investigate the impact of level of social support among Thai pregnant women on their attendance at antenatal care (ANC) clinics. The study was conducted in Hatyai, a city in Southern Thailand, between 1990 and 1991. Relationships between various measures of the women's social support and their use of antenatal clinics were assessed. Open ended and closed ended questions were used to gather information relating to these women's level of social support, including the number of supporters and their age, the percentage of females among the supporters, the sources of support (spouse, kin, friend and health professionals), the frequency of contact, the types of support and the sufficiency of support. Social support indices were constructed: sources of support indices, a social network index, a subjective support index, and a social support index. One hundred and seventy-seven postpartum women were interviewed at their homes. Spouses, relatives and friends were important sources of the four principle types of support, namely emotional, instrumental, information and appraisal supports. Less than 10% of the women studied identified health personnel as providing support. The majority of supporters were women who had daily, face-to-face communication with the women studied. Approximately 76% of the women studied had sufficient support. The majority of supporters, except health personnel, provided all four types of support. Only 47% of the women studied made four or more antenatal clinic visits as recommended by the Thai government. No significant relationship between the indices of social support and the use of ANC clinics was identified. The Thai extended family by its nature generates large numbers of supporters. Little variation in support levels among all the women therefore occurred. Support to the women could have positive and/or negative effects on the women's use of ANC clinics. It was concluded that in Thai communities, social support is not an important determinant of the use of ANC clinics and the indices of social support were not the most appropriate techniques to use in the communities.

Clarification of Social Support

“…Social support is an interpersonal process that is context specific (Coffman & Ray, 1999, 2002; Lackner, Goldenberg, Arrizza, & Tjosvold, 1994; Olsson, 1997; Rose, 1997) and involves the exchange of information. Information as a means to an end consists of facts, advice (Arnault, 2002; Chang & Schaller, 2000; Jirojwong et al, 1999; Laakso & Paunonen‐Ilmonen, 2002; Sandstrom, 1996), words of reassurance (Coffman & Ray, 2002; Michael & Jenkins, 2001; Sandstrom, 1996), positive affirmation (Coffman & Ray, 1999, 2002; Gilliland & Bush, 2001; Gurowka & Lightman, 1995; Simich et al, 2003), empathy (Coffman & Ray, 1999, 2002; Norbeck et al, 1991; Sandstrom, 1996; Whittemore, Rankin, Callahan, Leder, & Carroll, 2000), or similar expressions of support. Although verbal exchange of information is common, social support can also be shared nonverbally through flowers, cards (Gurowka & Lightman, 1995), eye movements, facial expressions (Makabe & Hull, 2000; Neufeld & Harrison 1995), or simply being present (Bolla et al, 1996; Bricker & Fleischer, 1993; Chan et al, 2001; Makabe & Hull, 2000; Rose, 1997).…”

“…Providers of social support serve as advocates by motivating (Hupcey, 2001; Jankowski et al, 1996) and empowering recipients to act on their own behalf (Coffman & Ray, 1999, 2002) and to maintain as much control as possible (Chang & Schaller, 2000; Coffman & Ray, 1999, 2002; Harrison et al, 1995). Reassurance, reinforcement, affirmation, validation, and encouragement are common advocative strategies (Chan et al, 2001; Chang & Schaller, 2000; Coffman & Ray, 1999, 2002; Duffy, 1989; Gurowka & Lightman, 1995; Jirojwong et al, 1999; Murray, 2002; Norbeck et al, 1991; Sandstrom, 1996; Simich et al, 2003; Tichon & Shapiro, 2003), which are employed in an atmosphere of unconditional positive regard and caring (Chang & Schaller, 2000; Coffman & Ray, 1999; 2002; Duffy, 1989; Hildingh et al, 1995; Sandstrom, 1996). Caring includes expressions of understanding, respect, empathy, compassion or love (Chang & Schaller, 2000; Coffman & Ray, 1999, 2002; Duffy, 1989; Hudson & Morris, 1994; Norbeck et al, 1991).…”

“…Instrumental support Instrumental support includes providing tangible goods such as child care supplies (Coffman & Ray, 1999, 2002), furniture (Jankowski et al, 1996), and food (DeJoseph et al, 1996; Gurowka & Lightman, 1995; Jirojwong, Dunt, & Goldsworthy, 1999). Instrumental support also involves providing services such as transportation (Coffman & Ray, 1999, 2002; DeJoseph et al, 1996; Duffy, 1989; Gurowka & Lightman, 1995; Hildingh, Fridlund, & Segesten, 1995; Jankowski et al, 1996), physical care (Gilliland & Bush, 2001; Jankowski et al, 1996; Makabe & Hull, 2000; Norbeck, Chaftez, Skokol‐Wilson, & Weiss, 1991; Stewart, Ritchie, McGrath, Thompson, & Bruce, 1994), and assistance with household tasks (Green et al, 2002; Gurowka & Lightman, 1995; Makabe & Hull, 2000; Norbeck et al, 1991).…”

'Because he loves me': Husbands' involvement in maternal health in Guatemala

“…While they are often cast as one of many barriers women face to better health, husbands also emerge as positive actors. For example, in a recent study of urban Thai women, husbands were found to be the primary sources of pregnancy social support (Jirojwong et al 1999). A few recent studies explore men's attitudes and behaviours towards maternal health directly.…”

Ethical decision-making about older adults and moral intensity: an international study of physicians

“…For example, in India, it was evident from the focus-group transcriptions that pressure from the family with respect to not revealing a diagnosis or not revealing the terminal nature of an illness patient was often encountered. In Thailand, because families are extended, boundary enmeshment sometimes occurs and may contribute to ethical dilemmas related to these issues 40. In Japan, an elderly person is not seen as independent, but rather as a member of the “family” and of his or her community.…”