Social support and health behavior: How to move from well-intentioned to skilled support

By Urte Scholz, University of Zurich and Gertraud (Turu) Stadler, University of Aberdeen

Social support seems to be an exclusively positive thing. What can be bad about a little help? Having someone who cooks healthy meals when you try to eat better, or being comforted when you feel down because your recent attempt at quitting smoking didn’t go so well? These scenarios already give us a feeling that good intentions to support someone may not be enough. A partner who cooks healthy meals for you or your sister showering you with diet tips may also make you feel like they know better than you what is good for you. Did you ask them to help you? Do they not fully trust you to eat healthily on your own? So, is support for changing one’s behavior always a good thing? This text aims to help practitioners advise their clients on how to seek out useful social support. Let’s start with defining what social support is and what it is not.

What is social support?

Social support is help from another person to someone who is confronted with a problem or challenge, such as trying to eat a healthier diet. Support aims at solving the problem or at least relieving the stress associated with the problem. There are three common ways of support that often blend: One way is emotional support, such as comforting the person and making them feel loved, understood, and cared for when they stress about how difficult it is to eat better. A second way is practical support, i.e., taking a concrete action to help the other, such as buying healthy foods. The third way is informational support, such as providing tips on how to eat more veggies. While support can come from literally any other person, research has found that most support comes from close others, such as romantic partners, family, and friends. Important support sources for people with health problems are often health professionals and other people with similar conditions.

There are two different kinds of support, either what support you expect in the future or what support you actually got in the past. People can think about the support they expect to receive from others for stressful situations in the future. For example, a smoker intending to quit can imagine the support that he/she will be offered from others. This type of support is called perceived support. It is more related to people’s optimistic view of the future than to actual support transactions. Perceived support can be a bit lofty, as the support expectations are not necessarily tested by a challenging situation. The second way of looking at support is to ask about what support a person got with a problem. The latter are retrospective reports of actual support transactions. For example, what help someone got during the last week while trying to eat better. These two kinds of support do not necessarily closely relate to each other. You can expect your loved ones to help in times of need, but you might not recall having received much help with your recent stint at trying to eat better.

Skilled support for health behavior change

When looking at research on social support and health behaviors, many studies report positive effects of support for health behavior. When we take a closer look, however, we find that many of these studies focus on the first kind of support described above, perceived support. A positive expectation of support is consistently related to better health behaviors. The second kind of support, actual support transactions, has received much less attention in research, and the available studies found mixed effects. These mixed results sometimes seem to come from a failure to really enhance support in the interventions in the first place. Overall, it seems there is no guarantee that well-intentioned social support is helpful when someone tries to change a health behavior. Instead, the success of supportive actions seems to depend on

  • who is providing the support (sometimes a friend helping is better than a spouse helping),
  • on the gender of the provider (women seem to be the better providers for both men and women),
  • on the fit between support needs and provision, and also
  • under which conditions it occurs (whether the giving and receiving of support is balanced or lop-sided).

In fact, there are studies out there that demonstrate that receiving support might even do harm. Support might contribute to feeling down or to simply not being able to cope with the challenge at hand yourself. Skilled support—support from trusted others that meets your needs and makes you feel understood, valued, and cared for when changing your behavior—may be the best option. Skilled support depends on both sides communicating with each other: The person wanting to make a change should evaluate personal needs and communicate these needs clearly, actively seeking support from persons he or she can fully trust to be responsive. The support provider should aim to meet the person’s needs in a way that is respectful and responsive to the recipient’s needs.

Practical recommendations

So what should people do in order to effectively support someone with regard to a health behavior change? Practitioners advising clients should encourage them to seek skilled support and communicate with their close others and health professionals about it. For effectively supporting another person’s attempt to change a health behavior, keep the following recommendations in mind:

  • Encourage persons who want to make a change to seek support from trusted close others and to talk with them about what would be really helpful for them. This might also include being left alone!
  • Practice with clients to communicate their needs in specific situations and to make suggestions to make the support they receive more helpful to them. For example, practitioners can use role play to go through different scenarios for asking for support. This should also include raising awareness that support is a very individual matter and not always helpful. Thus, the person can practice giving guidance and constructive feedback to support providers to improve the support transactions.
  • Practice to recognize skilled support. As changing one’s behavior is a dynamic process and the needs might change from one day to another this may involve frequent adaptations.