Journal of Advanced Nursing, 1997, 25, 95–100

Social support: a conceptual analysis

Catherine Penny Hinson Langford MSN
Clinical Associate, School of Nursing, University of South Carolina at Aiken, Aiken,
South Carolina

Juanita Bowsher RNC CS PhD

Assistant Professor of Adult Nursing/Gerontology, Medical College of Georgia, Augusta,
Georgia

Joseph P. Maloney PhD

Professor of Nursing, Austin Peay State University, Clarksville, Tennessee

and Patricia P. Lillis DSN

Associate Professor and Chair of Adult Nursing, Medical College of Georgia, Augusta,
Georgia, USA

Accepted for publication 16 January 1996

HI NSO N LANGFORD C.P., BOWSHER J ., MOLONEY J .P. & LILLIS P.P. (1997) Journal of
Advanced Nursing 25, 95–100
Social support: a conceptual analysis
Using the methodology of Walker and Avant, the purpose of this paper was to
identify the most frequently used theoretical and operational definitions of
social support. A positive relationship between social support and health is
generally accepted in the literature. However, the set of dimensions used to
define social support is inconsistent. In addition, few measurement tools have
established reliability and validity. Findings from this conceptual analysis
suggested four of the most frequently used defining attributes of social support:
emotional, instrumental, informational, and appraisal. Social network, social
embeddedness, and social climate were identified as antecedents of social
support. Social support consequences were subsumed under the general rubric
of positive health states. Examples were personal competence, health
maintenance behaviours, effective coping behaviours, perceived control, sense
of stability, recognition of self-worth, positive affect, psychological well-being,
and decreased anxiety and depression. Recommendations for future research
were made.

lescent first time mothers (Dormire et al. 1989), (c) were

SOCIAL SUPPORT AND HEALTH
divorced women with children (Duffy 1989), and (d) were
Scientists have recognized for many years a positive elders with low vision (Foxall et al. 1994). These studies
relationship between social support and health (Stewart reflect an interest in social support across all age groups
1993). Since the 1970s, investigators have studied the and include both disease-related and health-related topics.
social support of individuals who (a) have experienced Broadly, social support has been defined in the literature
myocardial infarction (Miller et al. 1989), (b) were ado- as the assistance and protection given to others, especially
to individuals (Shumaker & Brownell 1984, Wortman &
Correspondence: J. Bowsher, Assistant Professor of Adult Nursing/ Dunkel-Schetter 1987). Assistance may be tangible as in
Gerontology, Medical College of Georgia, Augusta, Georgia 30912, USA. financial aid, or intangible as in emotional help. Protection

© 1997 Blackwell Science Ltd 95

C.P. Hinson Langford et al.

may present as shielding people from the adverse effects is decreased or inadequate, a sense of social isolation may
of life stress (Cassel 1976, Cobb 1976, 1979, Sarason & ensue, only to produce a state of negative psychological
Sarason 1985). and, subsequently, physiological health (Cassel 1976,
Not only does social support provide assistance and pro- Dixon & Dixon 1984, Powers 1991).
tection, but also it is hypothesized to be reciprocal (House It is within a positive social climate of assistance and
1981, Tilden & Weinert 1987). It is a resource given with protection that the theoretical foundations of social com-
the expectation of reciprocity (Cohen & Syme 1985). parison, social exchange, and social competence operate.
Shumaker and Brownell (1984) describe social support Social climate is defined by Moos & Lemke (1992) as the
as an ‘exchange of resources between at least two personality of the environment.
individuals’ (p. 11).
The purpose of this paper was to review the social sup-
DEFINING ATTRIBUTES
port literature for the most frequently used and most effec-
tive theoretical and operational definitions, antecedents Under the broad umbrella of a positive social climate there
and consequences. The emphasis of this paper was placed is, as evident in literature previously cited, an existing
upon social support in the aged population, as elders gen- typology of four defining attributes of social support into
erally have more health problems, fewer resources and a which investigators suggest that all acts of support can be
greater need for supportive relationships than younger age assigned. These social support attributes are emotional,
groups. The applied methodology was the process of instrumental, informational, and appraisal support (House
concept analysis designed by Walker & Avant (1995). 1981, Barrera 1986, Tilden & Weinert 1987). Within the
Approximately 85 articles were reviewed. process of each defining attribute of social support,
exchange or reciprocity must be present for the support to
continue.
THEORETICAL FOUNDATIONS OF SOCIAL
SUPPORT Emotional support. Emotional support involves the pro-
Social comparison theory. According to Swann & Brown vision of caring, empathy, love and trust (House 1981,
(1990), persons develop their self-concept by comparing Cronenwett 1985a, 1985b, Krause 1986). House presents
themselves to others in their chosen reference groups. emotional support as the most important category through
Such social comparison, an important process in the which the perception of support is conveyed to others.
development of self-concept, enhances coping abilities, Gottlieb (1978) reports that when supportive acts are
emotional adjustment, self-esteem and psychological well- described, emotional acts far outnumber all other types
being (Festinger 1954, Stewart, 1993). However, social of support.
comparison may not be successful in the development of Kahn & Antonucci (1980) and later Norbeck et al. (1981)
self-concept without the process of social exchange. describe the emotional support component of their social
support definition as affective assistance. An affective
Social exchange theory. The importance of social transaction is one which imparts liking, admiration,
exchange is evident in many definitions of social support respect, and love.
(Cobb 1976, House 1981, Shumaker & Brownell 1984, Cobb (1976), reflecting characteristics of emotional
Tilden & Weinert 1987). Tilden & Gaylen (1987) propose social support, suggests that social support is rendered
that social exchange theory explains human behaviour as through communication that leads to the information that
an ‘exchange of mutually rewarding activities in which the one (a) is cared for and loved, (b) is esteemed and valued,
receipt of rewards is contingent on favors returned’ (p. 12). and (c) belongs to a network of mutual obligation. Mutual
Stevens (1992) identified a positive relationship between obligation suggests the reciprocal nature of social support.
life satisfaction and the receiving of social support, as well Somewhat negating this reciprocal characteristic, Moss
as the giving of social support. Social comparison and the (1973) proposes that social support is a ‘subjective feeling
receiving and giving of social support implies some degree of belonging, of being accepted, of being loved, of being
of social competence. needed, all for oneself and not for what one can do’
(p. 237).
Social competence. Pender (1987) and White (1959)
describe competence as the ability to effectively interact Instrumental support. House (1981) and Tilden &
with the environment. Lawton (1983) cites social health Weinert (1987) define instrumental support as the pro-
as a dimension of behavioural competence. Stewart (1993) vision of tangible goods and services, or tangible aid
suggests that social competence is essential to the forma- (Cohen & McKay 1984, Barrera 1986, Krause 1986, Cutrona
tion and maintenance of relationships, an essential part of & Russell 1990). Although the provision of instrumental
social health. Lawton posits that social health is positively support may suggest caring and love for an individual, it
related to psychological well-being. If social competence is distinguishable from emotional support. Tangible aid is

96 © 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 25, 95–100

 Social support

described as concrete assistance; for example, giving fin- atmosphere of helpfulness and protection (social climate),
ancial assistance or performing assigned work for others. social supportive behaviours can not occur.

Informational support. Informational support is defined

CONSEQUENCES
by House (1981) and Krause (1986) as that information
provided to another during a time of stress. According to There are few intervention studies using longitudinal and
Cronenwett (1985a, 1985b), informational support assists experimental designs from which consequences, or out-
one to problem-solve. Cutrona & Russell (1990) and Tilden comes, of social support can be identified (Stewart 1993).
& Weinert (1987) validate the use of informational support From 1987 to 1991 Stewart cites only one longitudinal,
during the problem-solving process. quasi-experimental study identifying the buffering effect
of social support on anxiety. In contrast, many social sup-
Appraisal support. Appraisal support involves the com- port outcomes have been validated by correlational
munication of information which is relevant to self- research. Most often this research has been cross-sectional;
evaluation, rather than problem-solving (House 1981). however, in recent years longitudinal, correlational stud-
Kahn & Antonucci (1980) refer to appraisal support as ies have become more prevalent. Longitudinal designs are
affirmational support. Affirmational support encompasses important in social support research to capture the process
expressions that affirm the appropriateness of acts or of social support across time.
statements made by another (Kahn & Antonucci 1980). Most social support outcomes can be subsumed under
the general rubric of positive health states or behaviours.
Summary of defining attributes. Each of these four defin- Examples are healthy coping abilities (Stewart 1993),
ing attributes of social support is helpful and protective to decreased depression (Buschmann & Hollinger 1994),
the person receiving the support. Each enables an increased personal competence in times of stress (Krause
exchange of reciprocal supportive actions. The defining 1987), generalized positive affect, sense of stability, recog-
attributes occur in the presence of select antecedents. Each nition of self-worth (Cohen 1988), and life satisfaction or
is hypothesized to result in positive health and well-being. psychological well-being (Lambert et al. 1989, Ducharme
1994).
In a small unpublished multiple regression analysis (n=
ANTECEDENTS 89), Langford & Bowsher (1995) identified perceived situ-
Social network. Social network is defined in the litera- ational expectancy of control as an outcome of social sup-
ture as the vehicle through which social support is pro- port. In a different analysis of the same data, perceived
vided (Kahn 1979, Kahn & Antonucci 1980, Hogue 1985). situational expectancy of control was the only variable to
Gottlieb (1983) and Berkman (1984) portray the social net- enter the equation to explain the variance of psychological
work as an interactive field of persons, who provide the well-being (r2=0·16; P=0·0001). Other variables given the
‘give and take’ of helpfulness and protection. Different opportunity to enter using stepwise multiple regres-
from social support, social network is the structure of an sion analysis were emotional, reciprocal, tangible, and
interactive process; social support is the function. Kahn informational social support (Langford & Bowsher 1995).
and Antonucci caution that the presence of a large network The results of the above two analyses led Langford &
does not indicate large amounts of support. Bowsher (1995) to hypothesize that social support
increases psychological well-being by increasing control
Social embeddedness. Social embeddedness is defined (Hollinger & Buschmann 1993, Bowsher 1994, Ducharme
as the connectedness people have to significant others 1994). If future research confirms this hypothesis, sub-
within their social network (Barrera 1986). Some degree sequent investigations may find psychological well-
of connectedness, or social embeddedness, must exist in being to be the ultimate outcome of social support with
order to derive support from the environment. Social previously stated outcome examples subsumed under
embeddedness is the depth and strength of relational ties psychological well-being as defined by Lawton (1983).
between the person and each member of the social
network.
MODEL CASE
Social climate. Social climate is defined as the person- All defining attributes, related antecedents and conse-
ality of an environment (Moos & Lemke 1992). Qualities of quences of social support will be represented in this model
social climate that foster social comparison, competence, case of an episode in Ms Simms’ life. Ms Simms, an
and the exchange of the defining attributes of social support 80-year-old widow of 30 years, has two sons and five
are, as previously stated, helpfulness and protection. grandchildren. She lives alone in the house that she and
Without a structure of people (network) with the quality of her husband built in 1939. Ms Simms is the matron of her
connectedness (embeddedness) required to generate an community. She takes special joy in welcoming new

© 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 25, 95–100 97

C.P. Hinson Langford et al.

residents with flowers from her garden, home-made fruit quality of life reflected a social climate that was void of
preserves and baked goods. Until her recent 2-week hospi- the helpful and protective behaviours needed to sustain
talization due to a fall and resulting fractured hip, she had her competence and sense of control during her more frail
remained active in her garden and bridge clubs and church years. There was no avenue for reciprocal activity.
circle, sharing friendships of many years with several
women.
Related case
Ms Simms was discharged from the hospital to a nursing
facility for intense physical therapy. The walls of her room Companionship is the variable used in this related case.
were dotted with get-well cards from her family and fri- Rook (1990) posits that companionship and social support
ends, as well as church bulletins with her name listed as differ by the way each is motivated. Companionship is
hospitalized. Though her two sons lived several hours hypothesized to be motivated by intrinsic pleasure, but
away, someone from Ms Simms’ family telephoned every social support is stimulated by the need for assistance and
day and visited at least every other day. Family and friends protection that implies a degree of stress. Rook hypothes-
supported Ms Simms not only emotionally, but also by ized that companionship, rather than social support, is
affirming her decisions and answering her questions. directly related to well-being. Alternatively, Rook pro-
In preparation for Ms Simms’ return to home, her sons jected that social support mediates the effects of stress
installed support bars both in and near the bathtub in her upon well-being (Rook 1990). For example, Ida Wood,
home. They added new railings to both the front and back age 71, and Lib Jones, age 75, are companions. They often
porches and hired a sitter to spend week-nights with shop, go to church, or just sit and relax together. They
Ms Simms. Family members made plans to be with her laugh at the same things and sometimes cry together. The
through the weekends. Social club friends developed a defining attributes of social support are not exchanged.
schedule for the delivery of weekday meals. Neighbours Both ladies get a lot of happiness just knowing the other
planned daily visits to ensure that necessary errands were is there. Their relationship is unrelated to stress; it just
performed and home health nurses visited twice weekly exists.
to monitor and guide her progress. Ms Simms thanked her
sons and friends. She wondered how people could
Empirical referents
get along without friends like hers.
This model case demonstrates the integration of help- According to Stewart (1993), only three social support
fulness and protection within a social climate that enabled instruments developed by nurse investigators have
Ms Simms to receive and give the defining attributes of adequate reliability and validity estimates. These are the
social support in this brief episode of Ms Simms’ life. The Interpersonal Relationship Inventory (IPRI) (Tilden et al.
consequence of these supportive behaviours by members 1990), the Personal Resources Questionnaire (PRQ)
of Ms Simms’ social network was to empower Ms Simms (Brandt & Weinert 1981), and the Norbeck et al. (1981)
to return to her pre-hospital functional level of living Social Support Questionnaire (NSSQ). The PRQ and NSSQ
independently in her own home. both measure three of the four critical attributes of social
support defined in this paper: emotional (affect), instru-
mental (aid), and appraisal (affirmation) support.
Contrary case
Informational support is not measured by either instru-
Ms Jonas, a 78-year-old who had lived alone since the ment. Although the IPRI is designed to implicitly measure
death of her sister 6 years ago, was brought into the emerg- emotional, instrumental, informational, and appraisal sup-
ency room by the police. The police, acting upon a tip port, the subscales are support, reciprocity, and conflict
from the mailman, found Ms Jonas lying on the kitchen (Stewart 1993).
floor of her meagerly furnished, wood-frame home. She In addition to addressing three of the four defining attri-
had been on the floor for about 72 hours. Her condition butes of social support, the NSSQ also measures social
was one of severe dehydration. She had a newly developed network as an antecedent of social support. The size, stab-
pressure ulcer on her left side. She had been incontinent ility and availability of the convoy, duration of relation-
and lying on this side for approximately 72 hours. Ms Jonas ships, and frequency of contacts are the dimensions of
was hospitalized for 5 weeks for hydration, treatment of social network included. Because social networks are tem-
her wound and depression. She scored a 23 on the poral, one social network question relates to recent social
Geriatric Depression Scale, suggesting severe depression. network losses.
She had no visitors or inquiries during her hospital stay.
Ms Jonas had failed to build or maintain a social net-
CONCLUSI ONS
work. She had no social relationships or embeddedness.
Without the antecedents of social support, the defining In review of the literature, this investigator suggests social
attributes could not be present. The resulting negative network, social embeddedness and social climate as

98 © 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 25, 95–100

 Social support

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