The Social Cure: Improving the health and well-being of your patients

The ‘social cure’ in psychology refers to the fact that social support and social integration are central to quality of life for all adults. Humans are social beings and the most important thing they can do for their physical and mental health is to connect to other humans in the world around them.

A best-selling book called “The New Psychology of Health: Unlocking the Social Cure” by Professor Cath Haslam and colleagues from The University of Queensland makes a strong evidence-based case for the fundamental importance of social connections, particularly through groups, for addressing health-related changes associated with aging, as well as conditions such as depression, trauma, and addiction.¹

Social ties and longevity

Group membership that is meaningful is the key. We are not ‘tied’ to others merely by joining a group. We need to develop a sense of ‘us’ to reap the benefits. To demonstrate the importance, one needs only to look at the results of studies of mortality risk factors.  Social support and social integration are ranked higher than things like quitting smoking, drinking less, losing weight, and doing exercise.

A study reported in the BMJ Open in 2016 really brought home this point.² Steffens et al. looked at risk of death in the first 6 years after retirement in a sample of more than 400 people. They found that if people maintained the same number of groups after retirement, they had a 2% risk of death 6 years later. If they dropped out of 1 group, the risk rose to 5% and if they dropped out of 2 groups the risk increased significantly to 12%. Retirement from full-time work is obviously a pivotal point in people’s lives and this study shows the critical nature of maintaining social connections around that time.

Social ties and cognitive well-being

Maintaining social groups is also beneficial for maintaining cognitive abilities with age. The relationship between hearing and cognition is such a hot topic in audiology that this relationship is very important for us to understand. Basically, the more groups someone is part of, the better their cognition. People aged 80 with extensive group ties have, on average, a cognitive age that is 20 years better than people with limited social ties.

The authors of that research led by Professor Haslam therefore talk about group life being protective of cognitive decline. They suggest that group membership should be ‘prescribed’ to improve health in older adults and have developed a program called “Groups4Health” to do just that. More information about this program can be found here.

Importance of including family in hearing healthcare

I have been working for some time as a researcher and advocate for the key role of families in hearing health care and this social cure research has just reinforced for me how important they are. Social connections are the ‘cure’, and the most common social connection is with family. They are an essential link between hearing well and being well.

Extensive research shows that family help people with hearing loss to:

• seek help
• make decisions about what to do about their hearing loss
• purchase hearing devices
• be successful with hearing devices

Why?? Because the social connection between a person with hearing loss and their family REALLY matters. Hearing loss can negatively impact communication for both the person with hearing loss and their families.  Taking action to alleviate these impacts will improve communication which is central to social connection.

How to include family in your clinic

FCC needs a whole of clinic approach.^3-4 The front of house staff and audiologists both need to welcome family. Set up the clinic waiting area and offices to welcome family – have chairs for them, reading material for them, family pictures on the walls. Think about when you have gone as a family member to a medical appointment and felt welcomed – What did you see? What did people say? How were you included?

Training front line staff

Front line staff are key to increasing family member attendance in the clinics. They need education and coaching to achieve this and the commitment and support of the audiologists in the clinic. In terms of education, they should understand the ‘why’ of using FCC. In terms of coaching, role play and regular reminders are important. Change isn’t easy for anyone and ongoing support and encouragement is needed.

We have worked with front of house staff when talking on the phone to patients to:

• Ask an explicit question e.g., ‘Will you be bringing anyone to the appointment?’ ‘Is there anyone you can bring to the appointment?’
• Use encouragement e.g., ‘We do recommend that you bring someone along.’
• Use supporting arguments or evidence if needed e.g. ‘…because this helps us provide a more comprehensive assessment’ ‘… because hearing loss affects communication with people around you.’

To learn more about how to include family in your clinic, please read previous blog articles by Dr. Katie Ekberg, New study shows that when you include family, you can improve client satisfaction and Three keys steps to improving family-centered care in your audiology clinic.

Training clinicians

We have done similar education and coaching with clinicians but the targets for change have been different. In the appointments we are asking them to:

• Set an agenda for the appointment that includes both the person with hearing loss and their accompanying family member, e.g., ‘Today I’m going to ask you both some questions about the communication difficulties you experience in your daily life.’ Make it clear that everyone gets a turn to talk.
  
• Seek and actively listen to family members’ contributions e.g., ‘How do you see things from your perspective?’ Listen to what they say in response.
  
• Use a decision aid or collaborative goal setting tool to develop shared goals that the person with hearing loss and their family can work on together.  Examples of shared goals could be “setting the TV volume to a level comfortable for both of us”  or “enjoying dinner out at our favorite café”  or “having easy conversations with our grandchildren.”

Final thoughts

I hope this blog resonates with you as both a clinician and as a family member.  Most people when asked about what is important in their lives talk about the connections they have with others and, usually, family are top of the list of ‘others’.  Providing effective hearing interventions can enable those core human connections to thrive – improving quality of life for people with hearing loss and for those around them.  These are important messages to share with your patients, their families, with other health professionals and with the general public.

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References:

1. Haslam, Catherine & Jetten, Jolanda & Cruwys, Tegan & Dingle, Genevieve & Haslam, S. (2018). The New Psychology of Health: Unlocking the Social Cure. 10.4324/9781315648569.
   
2. Steffens, N. K., Cruwys, T., Haslam, C., Jetten, J., & Haslam, S. A. (2016). Social group memberships in retirement are associated with reduced risk of premature death: evidence from a longitudinal cohort study. BMJ Open, 6(2), e010164. https://doi.org/10.1136/bmjopen-2015-010164
   
3. Meyer, C., Scarinci, N., & Hickson, L. Editors (2019). Patient and Family-Centered Speech-Language Pathology and Audiology, New York: Thieme.