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Social Capital

A Concept Analysis

Westphaln, Kristi K. PhD, RN, CPNP-PC; Fry-Bowers, Eileen K. PhD, JD, RN, CPNP, FAAN; Georges, Jane M. PhD, RN

Author Information
doi: 10.1097/ANS.0000000000000296
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Abstract

THE CONCEPT of social capital, characterized as the acquisition of resources in exchange for social interaction and investment, is broadly envisioned as a means to build capacity within and among social networks. In an era striving toward population health, the capacity-building aspects of social capital are especially salient in fostering health. Nurses represent cohesive forces among social networks within the health care delivery system, as they possess abilities to navigate the health care delivery system; effectively communicate with patients, families, and members of health care teams; and foster meaningful compassionate connections. A clearer understanding of the relationship between social capital and nursing may represent a key opportunity to influence and improve population health.

This concept analysis aims to:

  1. Explore the extent to which social capital exists and is applied within the context of nursing.
  2. Critically reflect upon the trends and future implications at the intersection of social capital and nursing.

USES OF THE CONCEPT OF SOCIAL CAPITAL

Historical origin and definition

The term “social capital” is hypothesized to have originated in the 1830s; however, a West Virginian school supervisor named L. J. Hanifan is credited with naming the concept in America in 1916.1 Scholars Pierre Bourdieu,2 James Coleman,3 and Robert Putnam1 propelled social capital into academic discourse. French sociologist Pierre Bourdieu2 became interested in social capital within the context of social order, privilege, and domination. American sociologist James Coleman3 explored factors involving academic outcomes in children from ghettos across America, which led him to consider social capital as a means to promote capacity within vulnerable populations. American political scientist Robert Putnam1 investigated social capital as a means to promote community engagement and preserve American democracy.

Social capital is conceptualized as a positive protective resource by Coleman3 and Putnam.1 Bourdieu2 offered a different perspective, as he was greatly concerned about the negative role of social capital within the context of marginalized populations and power relations. Coleman3 and Bourdieu2 envisioned social capital as involving resources for individuals and communities, whereas Putnam1 viewed social capital as a societal macroresource, whereby benefits accrued from social and political engagement were enacted at a community or societal level. All 3 scholars agree that the resources of social capital are derived via social memberships, connections, and interactions among people.1–3

Consideration of the combined definitions from the online sources of the Oxford Dictionary4 and the free online dictionary5 defines the concept of social capital as resources accrued as a result of membership and interaction within social networks, and consists of structural and functional dimensions.6 The structural dimension of social capital includes the members and types of bonds within a defined social network. Bronfenbrenner's7 socioecological model offers a framework for understanding the structural dimension of social capital, as it organizes social networks by levels that expand across individuals, families, communities, and larger complex systems. Along with group membership, the structure of social capital is also impacted by bonding, bridging, and linking within and among social networks.8,9 The functional dimension of social capital includes a cognitive domain that represents what members within a defined social network think and a behavioral domain that represents what members within a defined social network do.

Further review across the evolution of social capital scholarship within different disciplines reveals that social capital scholars were historically divided between perceiving social capital as an individual attribute (social cohesion perspective) or as a group attribute (network perspective).6,10 Currently, the literature supports that social capital can be conceptualized as an attribute of both individual persons and groups of people.10

Statement of Significance

What is known or assumed to be true about this topic:

The concept of social capital refers to the acquisition of resources in exchange for social interaction and investment. While not a new concept, innovative scholarship continues to explore social capital within a variety of contexts and across a number of disciplines. Shared visions of the concept across disciplines include interaction among socioecological levels and reward for membership and engagement within social networks. Nurses frequently interact on the front lines of patient care while also navigating the complex connections among individuals, families, and the health care delivery system. Nursing and social capital both involve social connection; however, little is known about how the discipline of nursing utilizes the concept of social capital.

What this article adds:

While social capital is often applied within the context of communities in other disciplines, little is known about the use of social capital within nursing. This is the first article to explore social capital, specifically within the context of nursing. This article incorporates Avant and Walker concept analysis methodology to explore the literature, create an operational definition of social capital, offer critical reflections, and highlight the limitations and opportunities associated with future uses for the concept of social capital within nursing.

METHODS

Using the method espoused by Avant and Walker,11 we explored the definitions, uses, and discourse involving social capital and nursing and conducted a review of the literature using CINAHL, PubMed, PsycINFO, Health Source, and Web of Science with the Boolean search phrases of nursing and social capital. While the ERIC and JSTOR databases were included in the initial search, they were omitted due to a lack of relevant content. Criteria for inclusion in the review included publication within an academic journal from 1997 to 2017, availability in the English language, and full-text format. A total of 1031 abstracts were identified in the initial search. The abstracts were reviewed by the first author to assess for inclusion/exclusion criteria and appropriateness of content. Articles with unclear abstracts underwent full-text analysis to determine inclusion or exclusion from the analysis. After removal of repeat articles, the final sample of publications for this analysis included 78 articles.

RESULTS

Analysis of the 78 articles representing social capital and nursing revealed a variety of types of articles, geographic origin, and themes. The sample included 37 quantitative research articles, 23 framework-focused articles, 7 qualitative research articles, 5 literature reviews, 4 evidence-based practice papers, and 2 mixed-methods research articles. The literature featured scholarship from 15 different countries, suggesting an international interest in social capital within the context of nursing.

Research

Quantitative literature

After the articles were sorted into broad categories, social capital and nursing were most frequently featured in quantitative research articles. The quantitative literature was further evaluated for theoretical underpinnings, population of interest, context, and measurement. Social capital theory from 1 of the 3 seminal social capital scholars noted earlier was frequently incorporated into the literature, with the majority of the articles focused on the adult population and Putnam's vision and definition for social capital. Little research involved children and/or families; however, the studies that did focus on the pediatric population consistently adhered to Coleman's theory of social capital.3 The nursing workforce and workplace were the most prevalent themes.12–25 Social capital in the nursing workforce/workplace was explored within the context of nurse-perceived evidence-based practice implementation,12 overall nursing empowerment and quality of patient care,13 nursing job satisfaction,14,15 work engagement,15,22 the nursing work environment,17 organizational culture and customer service,18 burnout,19,24 care coordination,20 medication error reporting,21 risk management,23 and patient safety.25

Additional themes focused on nonnursing health care professionals,26 older adults,27,28 mental health,29–34 chronic illness,35,36 cancer screening,37 students,38 pregnancy,39,40 families,41,42 quality of life,43 and caregiving44 (Table 1).

Table 1. - Social Capital in Nursing Literature: Quantitative Research (N = 37)
Author and Country Purpose Theory Measures Attributes
Shin and Lee12
South Korea
Examine the relationship between EBP and nurses' social capital, and to determine how social capital affects EBP adoption in nurses in South Korea Coleman
Granovetter
Woolcock
SCON-K Trust
Common values
Connectedness—bonding, bridging, linking
Quantity of social relationships
Social norms
Lachinger et al13
Canada
Test a multilevel model examining the effects of work-unit socioeconomic and social capital on perceptions of unit effectiveness and individual nurses' perceptions of patient care quality on their units Nahapiet
Goshal
The Shortell Organizational Culture Scale Frequency of group contact
Trust
Reciprocal interaction
Shared understanding
Shin and Lee14
South Korea
Investigate the effect of social capital on workplace outcomes, such as nurses' job satisfaction and self-reported QOC measure (quality of care) Nahapiet
Ghoshal
SCON-K Trust
Participation
Empowerment
Conflict
Social cohesion
Social networks
Stromgren et al15s
Sweden
Assess the importance of social capital for job satisfaction, work engagement and engagement in clinical improvements among health care professionals and address whether changed magnitude of social capital predicts changed magnitude of job satisfaction, work engagement, and engagement in clinical improvements Putnam
Bourdieu
Coleman
Nahapiet
Ghoshal
COPSOQ II Trust
Reciprocity
Social network
Recognition
Anderson et al16
Denmark
Investigate the effect of physical exercise on workplace social capital in terms of bonding, bridging, and linking in female nurses and nursing assistants Putnam
Woolcock
Four-dimensional questionnaire in Danish Shared norms and values
Social networks
Bonding, bridging, linking
Sheingold and Sheingold17
United States
Develop, field test, and analyze a social capital survey instrument for measuring the nursing work environment Woolcock
Grootaert
SCON Networks
Trust and solidarity
Collective action and cooperation
Information and communication
Social cohesion and inclusion
Empowerment and political action
Hsu et al18
Taiwan
Identify 3 dimensions of social capital, examine their links to organizational commitment, and examine the role of commitment in shaping nurses' customer-oriented proclivity Nahapiet
Ghoshal
Putnam
Adapted measures from previous studies: Smith et al,45 Bettencourt and Brown,46 Leana and Pil,47 Lee et al,48 Social interaction
Trust
Shared vision
Social network
Kowalski et al19
Germany
Examine the association between the social capital in a hospital and emotional exhaustion in nurses Coleman
Putnam
Fukuyama
The Social Capital in Organization Variable Common values
Trust
Group membership
Lee20
United States
Examine the association between social capital and relational coordination in order to validate the specific relational attributes that influence informal coordination Bourdieu
Nahapiet
Ghoshal
Social capital was measured via 3 dimensions:
Structural
Relational
Cognitive
Communication
Supportive relationships
Farag et al21
United States
Examine the relationship among work environment (nurse manager leadership style and safety climate), social capital (warmth and belonging relationships and organizational trust), and nurses' willingness to report medication errors Cook and Wall Organizational Trust Survey: organizational trust
Modified Litwin and Stringer Organizational Climate Survey 2: Warmth and belonging
Warmth
Belonging
Trust
Fujita et al22
Japan
Examine the cross-sectional multilevel association between unit-level workplace social capital and individual-level work engagement among employees in health care settings Kawachi Japanese version of Workplace Social Capital Scale Acceptance
Work engagement
Ernstmann et al23
Germany
Examine the relationship between social capital and clinical risk management in hospitals from nurses' perspective Fukuyama Social Capital in Hospitals Variable Trust
Common values
Reciprocity
Farahbod et al24
Iran
Evaluate and assess the dimensions of social capital and their association with burnout to finally promote health in nurses, patients, and the whole society Social capital questionnaire extracted from a study by Boyas and colleagues49
Chang et al25
Taiwan
Examine the influence of social capital on knowledge sharing, which in turn enhances patient safety, and identify the conditions under which knowledge sharing among RNs is likely to emerge Loury
Burt
Reed
Nhapiet
Ghoshal
Social interaction is measured on a modified 2-item scale developed by Smith et al45
Measures of trust are adapted from Leana and Pil.47 Four items are used to measure trust among RNs
Shared vision is measured using a modified version of the 4-item scale developed by Leana and Pil47
Social interaction
Trust
Shared vision
Kowalski et al26
Germany
Investigate the associations between emotional exhaustion, social capital, workload, and latitude in decision-making among German professionals working in the care of persons with intellectual and physical disabilities Bourdieu
Coleman
The Social Capital in Organizations Variable Common values
Supportiveness
Mutual trust
Ichida et al27
Japan
Investigate the linkage between social capital and health at the level of a small area in Japan, and also to examine whether social capital mediates the relation between income inequality and health. Lin Author created survey Trust
Reciprocity
Informal socialization
Volunteering
Civic participation
Andrew28
England
Investigate whether individual-level social capital is associated with care home residence and with function, mental health, and self-assessed health in older adults. Bourdieu
Putnam
Kawachi
Combination of various indicators Engagement
Trust
Reciprocity
Social support
Participation
Nyqvist et al29
Sweden
Investigate the association between aspects of social capital and loneliness among the very old living at home and in institutional settings
Investigate the association between aspects of social capital and loneliness among the very old living at home and in institutional settings
Putnam Structural indicators and cognitive indicators Trust
Social norms
Social networks
Aminzadeh et al31
New Zealand
Explore the interaction between neighborhood social capital, adolescent well-being, and individual socioeconomic status Kawachi
Woolcock
WHO-5 Wellbeing Index
5 indicators for neighborhood social capital
Trust
Reciprocity
Sense of community
Group membership
Bonding, bridging, linking
Neighborhood characteristics
Kido et al32
Japan
Examine the association between area and individual-based social capital and stigma toward people with mental illness among community residents of 20 cities/municipalities of Tokyo, Japan Uphoff
Putnam
Author created survey Social networks
Values
Norms
Reciprocity
Altruism
Civic responsibility
Wahl et al33
Norway
Explore the relationships between social capital, coping, self-esteem, health, and quality of life in a sample of people receiving social assistance, living in various municipalities in Norway Putnam Measured perceptions of:
1. Trust-worthiness
2. Honesty
3. Helping behaviors of others
Trust
Norms of reciprocity
Participation
Cuca et al34
United States
Examine the relationship between HIV-related stigma and social capital in a sample of WLWH Portes
Bourdieu
Coleman
Social Capital Scale50 Community participation
Trust
Safety
Connections
Feeling of worth to society
Moore et al35
Canada
Hypothesized that higher individual social capital would be associated with having WC, and BMI below at-risk levels Bourdieu
Lin
Social capital was measured via a position generator by assessing ties to persons in specific occupations Bonding, bridging, linking
Trust
Participation
Cohesion
Webel et al36
United States
Extend the previous literature by examining the relationship between self-compassion and social capital and its impact on the current HIV symptom experience in adult PLWH Social Capital Scale50 Participation
Trust
Connection
Value of life
Tolerance of diversity
Moudatsou et al37
Greece
Examine the associations of social capital, when measured at the individual level, with the knowledge of preventive screening tests and the adherence to breast and cervical cancer screening guidelines Bourdieu
Portes
Putnam
Social capital questionnaire
Adapted into Greek (SCQ-G)
What people feel
Trust
Safety
Community
Reciprocity
Social norms
Social support
What people do
Participation
Oranye et al38
Canada
Explore if trust in one's community, belonging to associations, type of associations, and participation in campus activities were associated with academic performance; whether the norms of reciprocity in the community were associated with academic performance; and to determine whether the degree of social cohesion in the community affects academic performance Coleman
Kawachi
Author-made questionnaire Good friendships
Family support
Trust
Safe
Kritsotakis et al39
Greece
Estimate the associations of individual maternal social capital and its subscales with adherence to the Mediterranean diet during pregnancy SCQ-G
Kritsotakis et al40
Greece
Estimate prospectively the effect of individual-level self-reported maternal social capital during pregnancy on postpartum depressive symptoms, measured by the Edinburgh Postpartum Depression Scale, in singleton pregnancies in a cohort of pregnant women in Crete-Greece (Rhea study) Bourdieu
Putnam
Kawachi
SCQ-G Cognitive—what people feel
Structural—what people do
Pascoe et al41
United States
Document the correlates of social capital in a mid-western community of families in the United States whose children were being seen either in their primary care pediatricians' offices or at a developmental clinic within a children's hospital to refine our understanding of the context of individual mother's lives that are related to their perception of their communities' social capital Woolcock
Szeter
Looman's 20-item SCS—in the context of children with chronic health conditions Bonding, bridging, linking
Participation
Sense of belonging
School connection
Spiritual community
Duke et al42
United States
Examine the ability of adolescent connection in family and community contexts to promote an aspect of healthy youth development and transition into adulthood, civic engagement Putnam 1. Influence of connection in family and community contexts
2. Outcomes of civic engagement in young adulthood
Social bonding
Family connections
Engagement
Caperchionea et al43
Australia
Investigate the association between social capital and health-related quality of life in a sample of Australian adults Kawachi British General Household Survey of Social Capital Module Networks
Social norms
Trust
Reciprocity
Papastavrou et al44
Greece
Explore the burden of caregivers of people with dementia and depression in the context of social capital in the Greek Cypriot population Putnam
Bourdieu
Woolcock
SCQ-G Social networks
Social norms
Trust
Connections
Participation
Engagement
Looman51
United States
Develop and psychometrically test the SCS for families of children with special health care needs social capital was conceptually defined as an investment in relationships that facilitates exchange of resources.” Trust
Advocacy
Common community
Social network
Looman and Farag52
United States
Evaluate the psychometric properties and cross-cultural equivalence of the Arabic translation of the SCS SCS
Koutra et al53
Greece
Describe the psychometric validation of the YSCS, establish the factor dimensions of the Greek version of the scale, compare findings with those obtained from the original Australian study Australian Youth SCS Trust
Reciprocity
Mutuality
Yaril et al54
Iran
Investigate the psychometric properties of Onyx and Bullen's instrument among a sample of medical science students in Tehran University of Medical Sciences, Iran, and to compare the factor analysis with findings from 2 previous studies in Australia (15) and the United States (13) Onyx and Bullen Social Capital Questionnaire SCQ50
Abbreviations: BMI, body mass index; COPSOQ II, Copenhagen Psychosocial Questionnaire II; EBP, evidence-based practice; PLWH, people living with HIV; SCON, Social Capital Outcomes for Nurses; SCQ, Social Capital Questionnaire; SCQ-G, Social Capital Questionnaire-Greek version; SCS, Social Capital Scale; WC, waist circumference; WLWH, women living with HIV; YSCS, Youth Social Capital Scale.

Review of the quantitative literature revealed trends including wide variability in the definition of social capital, the measurement of social capital, and the reporting of psychometric properties of instruments that purport to measure the concept. Articles that reported measurement of social capital within the nursing literature relied on the use of scales, indicators, surveys, and/or combinations of these as “by proxy” measures for social capital and generally did not report the psychometric properties of the selected measurement modalities. Many of the scales were author-created for use specifically in their own research and many authors self-selected indicators from a previously made instrument. Within this analysis, only 4 articles addressed the psychometric properties of instruments: the social capital scale for families of children with special health care needs,51 Arabic social capital scale for families of children with special health care needs,52 youth social capital scale in Greek,53 and a Persian version of the social capital questionnaire that measured social capital in medical students in Iran.54 Of these, each used exploratory factor analysis and reported a Cronbach α value.

Results of this analysis support that many researchers within the quantitative literature are operationalizing the concept of social capital in many different ways. This variation contributes to conceptual ambiguity, inability to compare social capital across research studies, and may also suggest that social capital may be better represented as a composite phenomenon rather than a singular concept. Despite social capital representing a relational rather than a psychological concept, the concept of social capital may benefit from having a more uniform means to measure it.

Qualitative literature

Analysis of the 7 qualitative studies involving social capital and nursing did not reveal any common themes across the articles. These studies employed a variety of qualitative methods to explore disparate topics involving nursing management,55 parents of children with special health care needs,56 palliative caregivers,57 diasporic women and the health care system,58 adult street drinkers,59 male Indian immigrants in New York City,60 and program evaluation for implementing a social capital framework in the primary health care setting.61 Many of the articles did not fully report the recommended domains from the consolidated criteria for reporting qualitative research (COREQ) within their research reports; therefore, estimating the rigor and quality of these studies is challenging62 (Table 2).

Table 2. - Social Capital in Nursing Literature: Qualitative Research (N = 7)
Author and Country Purpose Theory Attributes
Manoochehri et al55
England
Explore the role of social capital within the context of the nursing profession in Iran, based on the experience and perspectives of senior nursing managers Trust
Reciprocity
Mutual benefit
Collective action
Lewis et al57
Australia
Explore the nature of social capital in a socioeconomically disadvantaged group of palliative care patients and caregivers, using a social capital questionnaire to guide and frame discussions Structural (network)—what people do
Cognitive (social cohesion)—what people perceive
Bonding, bridging, linking
Network
Values
Norms
Quality of relationships
Sharma and Reimer-Kirkham58
England
Contribute to the growing body of literature that examines the lived religion of diasporic communities and in particular women members who employ their faith to navigate health care work Social networks
Reciprocity
Trustworthiness
Bonding, bridging, linking
Manton et al59
Australia
Draw on the observational data and semistructured qualitative interviews with street drinkers from 3 districts Putnam Social connection
Bonding, bridging, linking
Trust
Reciprocity
Bhattacharya60
United States
Grounded in social capital approach and immigrant health framework, this qualitative, community-based study examined the social networks of immigrant men from India to New York City Belonging
Trust
Mutual concern
Family bonding
Reciprocity
Peer social support
Connectedness
Coping
Solidarity
Ethnic pride
Culture identity
Civic Ties
Community cohesion
Farnum et al61
United States
The purpose of this critical analysis is to evaluate the impact of the Primary Care for the Underserved Conference on practice, research, and education within the conceptual framework of social capital Social networks
Norms of reciprocity
Mutual assistance
Trustworthiness
Looman56
United States
Describe the multidimensional nature of social capital as experienced by parental caregivers of children with special health care needs Putnam
Coleman
Bourdieu
Advocacy
Common good
Community
Trust
The system—seeing health care as more of a process than something that the family is a part of

Literature using mixed methods

Two articles applied mixed-methods approaches to examine social capital in nursing. Coll-Planas and colleagues63 used qualitative and quantitative methods to explore feasibility and long-term loneliness of an intervention that promoted social capital to alleviate loneliness. Baheiraeil and team64 similarly applied interviews and metrics from the World Bank to study the association of health and social capital in women in Tehran. These studies demonstrated a shared emphasis on policy implications of social capital as a means to craft health interventions within adult populations (Table 3).

Table 3. - Social Capital in Nursing Literature: Mixed-Methods Articles (N = 2)
Author and Country Purpose Theory Attributes
Coll-Planas et al63
Spain
  1. Explore the feasibility of the intervention in mixed rural- urban and urban areas of diverse socioeconomic levels

  2. Assess the immediate and long-term effects of this intervention among older participants on: (i) loneliness; (ii) structural and cognitive aspects of individual social capital (participation and social support); (iii) perceived health, health-related quality of life, depressive symptoms and the use of anxiolytics and antidepressants; and (iv) the use of health services.

Putnam
Coleman
Bourdieu
Strength of connections—bonding, bridging, linking
Social networks
Support
Belonging
Baheiraei et al64
Iran
Determine social capital status and its association with health in reproductive-age women in Tehran (capital city of Iran) with its specific social-cultural characteristics Putnam
Coleman
Social networks
Trust
Solidarity
Collective action
Cooperation
Value of communications
Social cohesion
Empowerment
Political action

Framework/conceptual analysis literature

Framework and conceptual analysis articles represented the second most prevalent category of literature involving social capital and nursing, with a total of 7 articles. Despite not representing quantitative or qualitative research, this type of literature offers important insight into discourse that connects social capital and nursing. Similar to the quantitative research articles, the framework/conceptual articles demonstrated a focus on adult populations and predilection for Putnam's vision of social capital. Social capital in the nursing workplace was the primary theme that emerged from the literature,65–69 with additional applications in rural health,70,71 mental health,72 pediatrics,73,74 nursing students,75 social justice,76 end-of-life care,77 older adults/aging,78,79 health promotion,80 public health,81,82 immigrant populations,83 and chronic illness.84 Only 2 articles published during the span covered by this review have analyzed the concept of social capital as applied to nursing; Hsieh85 explored social capital within the context of health and Read69 delved into the concept of workplace social capital (Table 4).

Table 4. - Social Capital in Nursing Literature: Framework Articles (N = 23)
Author and Country Purpose Theory Attributes
Hofmeyer65
Australia
Examine how social capital could be a mediating factor through which managers' leadership positively influences relationships with nurses and quality patient outcomes Putnam
Grootaert
Woolcock
Social norms
Social networks
Trust
Solidarity
Collective action
Cooperation
Information and communication
Social cohesion
Inclusion
Empowerment
Lloyd-Odgers66
Australia
Define the concepts of social capital, primary health care, and health promotion, and discuss their application and relevance to the goals and activities of child and family health nurses in Australia Bourdieu
Coleman
Putnam
Social cohesion
Trust
Cooperation
Mutual benefit
Bonding, bridging, linking
Hofmeyer and Marck67
Australia
Explore if a sound ecological understanding of social capital can guide nursing research, leadership, and practice Cohen
Prusaak
Social norms
Cohesion
Inclusion
Solidarity
Reciprocity
Social network
Collective action
Bonding, bridging, linking
Trust
Cooperation
Read and Laschinger68
Canada
To test a hypothesized model linking authentic leadership and structural empowerment to relational social capital and subsequently to new graduate nurses' mental health and job satisfaction over the first year of practice Nahapiet
Goshal
Trust
Reciprocity
Social network
Read69
Canada
Conduct a concept analysis to identify the attributes of nurses' workplace social capital by conducting a concept analysis using the evolutionary method Networks of relationships at work
Shared assets
Shared ways of knowing and being
Lauder et al70
England
Explore the usefulness of social capital and related theories to help in understanding the function of nurses in rural communities Putnam
Coleman
Bourdieu
Trust
Norms of reciprocity
Brown72
England
Explores the neglected notion of mutuality in the context of mental health care Bourdieu
Coleman
Putnam
Mutual reciprocal relationships
Trust
Social norms
Obligation
Sanctions
Plunkett et al71
Canada
Explore health influences emerging from rural churches using social determinants of health, social capital, and health expertise Rankin
Kawachi
Putnam
Bourdieu
Shared trust
Reciprocity
Social norms
Informal social control
Bonding, bridging, linking
Hean et al73
England
Present the concept of social capital as a cognitive tool to help nurses reflect on why and how supporting these networks is important Bourdieu
Coleman
Putnam
Interpersonal trust
Generalized trust
Internal and external resources
Social norms
Social networks—membership, location of members, heterogeneity (ethnic or cultural mix), and gender composition
Bonding, bridging, linking
Hanks74
USA
Social capital theory, the a priori hypotheses for this case study of a low-income, minority urban neighborhood are that parents will form cohesive networks, agree on children's behavioral norms, and act collaboratively to enforce those norms for all neighborhood children Coleman Social networks
Norms
Bonding, bridging, linking
Taylor75
England
Presents an argument that the development of social capital for individual students and the wider university community enhances the student experience and facilitates success Putnam Social networks
Social norms
Trust
Participation
Drevdahl et al76 Explore social justice and social capital in nursing Bourdieu
Coleman
Reciprocity
Norms
Trust
Rosenberg et al77
Australia
Examination of the place of social capital and community development in the provision of end-of-life care at home Putnam Trust
Belongingness
Social cohesion
Social network
Access to information
Inclusion
Civic trust
Durant78
United States
Assess the utility of an integrated vulnerability and social capital theory for enhancing our understanding of the impact of the Hurricane Katrina disaster on the elderly population of New Orleans, Louisiana Putnam Trust
Associations
Reciprocity
Social networks
Participation
Mutual goals
Reciprocity
Cannuscio et al79
United States
Discuss the implications of the long-term trends in social capital for successful aging in US society, as well as potential solutions for “building” social capital in the community, specifically through examples of options for senior housing Putnam Civic engagement
Participation
Social connections
Trust
Social norms
Mutual aid
Looman and Lindecke80
United States
Explore the utility of social capital as a construct for nursing health promotion Putnam Social networks
Norms of reciprocity
Mutual assistance
Trustworthiness
Kritsotakis and Gamarnikow81
Greece
Following an analysis of theoretical issues surrounding social capital and social support, recent research is used to illustrate how these are affecting health. It is argued that more theoretical development is needed before social capital can be used to form a new community nursing practice Loury Trust
Social support
Muntaner et al82
United States
Critically evaluate the concept of social capital to explore the sources of the connections among different individuals and groups, to understand what is transmitted over those networks that might be plausibly linked to health outcomes Evans
Putnam
Grootaert
Woolcock
Szreter
Strength of ties- bonding, bridging, linking
Bernosky de Flores83
United States
A conceptual framework drawn from social capital theory to study the approaches immigrants use to access health-related resources in new destination communities Portes
Putnam
Reciprocity
Altruism
Sharing
Solidarity
Trust
Collective action
Vassilev et al84
England
Explore the theoretical and empirical links between social networks, social capital and the self-care practices of chronic illnesses within the context of everyday life and with a particular focus on inequalities Critical realism
Hsieh85
Taiwan
Conduct a concept analysis of social capital within a health context Networks
Norms of reciprocity
Trust
Samuel et al86
United States
Systematically survey the empirical use of community social capital concepts to identify and define concepts related to health behaviors and propose a testable conceptual framework that integrates the concepts into existing behavioral theory based on both empirical and theoretical literature Putnam
Bourdieu
Coleman
Access to information
Social norms
Trust
Support
Social network

Reviews of the literature and evidence-based practice

Of the 78 articles reviewed for this analysis, 5 articles represented literature reviews and 4 were evidence-based practice applications involving social capital and nursing. The literature reviews included integrative reviews,87–89 a systematic review,90 and a review of literature with content that encompassed mental health well-being of elders and adolescents,89,90 population health,88 education,87 and the nursing workplace.91 The 4 evidence-based practice articles explored social capital as a means to mitigate suicide risk,92 enhance access to health care in Spain,93 assess the differences in social capital among women living in a suburb of Australia,94 and evaluate the efficacy of building social capital within a group of first-time parents95 (Table 5).

Table 5. - Social capital in Nursing Literature: Literature Reviews (N = 5) and Evidence-Based Practice Papers (N = 4)
Author and Country Purpose Theory Attributes
Royal87
England
Integrative review of the literature on human social and cultural capital from 1986 to the present applied to nurse education Putnam
Coleman
Bourdieu
Social networks
Reciprocity
Trustworthiness
Belongingness
Shared values
Participation
Sistrom and Hale88
United States
The purpose of this integrative review is to explore frameworks for studying the relationship of inequality and population health, ie, income, social capital, and neomaterialism; analyze trends in health disparities research; and discuss the place of nursing in social justice Kawachi Trust
Reciprocity
Mutual aid
Social network
Participation
McPherson et al89
United Kingdom
Identify, analyze, and synthesize primary evidence on the association between social capital and mental health and behavioral problems in children and adolescents
Discuss implications for future research and policy development
Bourdieu
Coleman
Putnam
Members of social network
Shared values
Communication
Social norms
Parent interest in child
Support
Nyqvista et al90
Finland
The purpose of this systematic review was to explore the relationship between social capital and mental well-being in older people Putnam
Bourdieu
Coleman
Trust
Norms
Social networks
Connections: bonding, bridging, linking
Gopee91
United Kingdom
Examine possible ways in which clinical managers can maximize the use of social and human capital in the nursing workforce Putnam Social networks
Trust
Reciprocity
Support
Participation
Shared values
Harris et al92
United Kingdom
Engage relevant regional stakeholders and create local, collaborative networks with the intention of planning for sustainable activity in the event that effectiveness of the intervention was demonstrated
Explore the role of advisory groups in stakeholder engagement and how different models of engagement both influenced implementation and the potential for capacity building and sustainability of an optimized suicide prevention program in 4 European countries
Bourdieu
Putnam
Social network
Norms
Trust
Mutual benefit
Mason93
Spain
Describe a novel strategy using linking social capital to provide health care access to irregular migrants with low literacy, low numeracy, and limited cultural assimilation in a European metropolitan area Szreter
Woolcock
Putnam
Trust
Respect
Bonding, bridging, linking
Griffiths et al94
Australia
Report differences between the baseline levels of social capital and follow-up using the Villawood Icebreaker survey Participation
Trust
Reciprocity
Individual and Community aspects
Fielden and Gallagher95
New Zealand
Identify parent satisfaction with, strengths and weaknesses of, opportunities to build social capital, and the impact of a 2-course pilot health and relationship focused Parenting Education Program—PEPE, designed for first-time parents, on the core work of the well-child nurse/health visitor Putnam
Stone
Grootaert
Social network
Trust
Reciprocity
Shared values

ATTRIBUTES FOR SOCIAL CAPITAL WITHIN A NURSING CONTEXT

Attributes, empirical referents, and operational definition

Analysis of 78 articles yielded a total of 49 attributes that were associated with the concept of social capital and nursing. The attributes were further grouped by frequency of occurrence in the literature: trust (52), social network (47), reciprocity (33), bonds within a social network (27), social norms (20), participation (18), values (13), belonging (12), support (10), communication (8), social cohesion (8), solidarity (6), safety (5), and cooperation (5). Thirty five additional attributes appeared in the search less than 4 times. To remain consistent with published social capital theory, the critical attributes of social capital within the nursing literature were categorized by properties of structure or function. Attributes within the structural dimension of social capital described membership within socioecological networks. Bonds were not mentioned within the nursing literature; therefore, they were not included within the structural dimension of the concept of social capital in nursing. Attributes within the functional dimension of social capital and nursing included trust, reciprocity, shared values, solidarity, social norms, safety, participation, communication, and frequency of social interaction (Table 6). In conclusion, the operational definition of social capital in nursing literature refers to the resources gained through membership (structure) and interaction within social networks (function).

Table 6. - Critical Attributes and Empirical Referents of Social Capital in Nursing Literaturea
Structural Dimension
The structural dimension of social capital includes the members and types of bonds within a defined social network
Attribute N Definition Synonyms
Social network 47 Socioecological framework that encompasses the individual, family, community, and governmental levels
Structure through which resources such as support are provided.
Roles and ties that link people along definable paths
Group membership
Functional Dimension
The functional dimension of social capital includes a cognitive domain that represents what members within a defined social network think and a behavioral domain that represents what members within a defined social network do
Cognitive Domain: What People Perceive
Attribute N Definition Synonyms
Trust 58 Assured reliance on character, ability, strength, or truth of someone/something Assurance, dependence, confidence, faith, hope, certainty, reliance
Reciprocity 46 Quality of mutual dependence, action, or influence Cooperation, mutuality, exchange
Shared values 21 Worth of something, something intrinsically desired Attitude, belief, morals, mores, ethics, character, ideals, scruples
Solidarity 21 Group unity based upon community of interests, objectives, and standards Teamwork, consensus, support, uniformity, comradery, togetherness, unification, alliance, harmony
Social norms 20 Principle of right action binding upon the members of a group serving to guide, control, or regulate acceptable behavior Benchmarks, measures, criteria, rules, model, patterns
Safety 5 Condition of being safe from injury, harm, or loss
Empowerment 4 The state of being empowered to do something: the power, right, or authority to do something Sanction, approval, assent, clearance, seal of approval, go ahead, green light for action
Engagement 4 Emotional involvement or commitment, state of being in gear commitment, obligation, pact, assurance
Behavioral Domain: What People Do
Attribute N Definition Synonyms
Participation 26 The act of participating in an activity as an individual or as a group
May include political action, collective action, volunteering
Attendance, presence, cooperation, sharing, support, aid, assistance, joining in, sharing
Communication 8 Process of information exchange between individuals through a common system of symbols, signs, or behaviors Connection, contact, conversation, transmission, delivery, link
Frequency of social interaction 4 Number of encounters
aResources for definitions and synonyms of attributes:

ANTECEDENTS AND CONSEQUENCES

Membership within a social network is the primary antecedent of social capital within nursing literature. Interaction and/or lack of interaction within and across social networks will influence the development and potency of the empirical referents, combinations of empirical referents, and acquisition of resources. As such, social capital may involve a feedback process in which consequences can also become antecendents.12 While this dynamic nature may complicate the conceptual clarity of social capital, it also aligns with trends that acknowledge the complexity of human interaction and challenges scholars to consider dynamic contextual factors such as in systems dynamic modeling, qualitative research, and other types of dissemination and implementation research methods.

REFLECTIONS: CONNECTING SOCIAL CAPITAL AND NURSING

Measurement

Despite explorations within nursing and other disciplines, the concept of social capital remains unclear. This raises the question whether social capital truly represents a singular concept or a multidimensional phenomenon. Additionally, this may represent an important consideration with the context of the measurement challenges of social capital. The plethora of subjective attributes, variation in measurement modalities, and poor reporting of psychometric properties contribute to criticism of the concept.10,84 Successful application of numerical scaling techniques to subjective measures has increased acceptance of subjective data; however, subjective measures still receive critique for being “softer” than their objective counterparts.96

The majority of social capital instruments found within this analysis measured social capital within a health index format rather than a health profile format. Used commonly within the context of economic analysis and policy decision-making, an index perspective involves data that are collected by generic instruments and then collapsed into a single score.97 Rather than collapsing the data into a single score, the health profile perspective includes all of the scores within the measure for analysis. Health index supporters suggest that health profile types of measurement are not generalizable and therefore cannot be utilized for comparisons.97 Health profile supporters argue that important knowledge is lost when data are collapsed into one score.97 Additionally, the health profile perspective suggests that connections across dimensions may be just as important as the dimension itself.97 Regardless of profile or index measurement types, most of the instruments used to measure social capital examined in this analysis offered questionable reliability and the articles failed to report their psychometric properties. The concept of social capital may be richened through idiographic exploration, as individual experiences and complexity may provide a fuller understanding and better measurement of the concept.

Notably, there are almost as many conceptual/theoretical articles (23) as articles reporting studies using quantitative methods (37). While the copious theoretical “call to action” articles are inspirational and informative, they are also restricted due to limitations of the concept itself such as multiple definitions and lack of a uniform measure for the concept. Only 7 of the 78 articles included in this analysis represented qualitative research, which demonstrates an interesting mismatch between the published conceptual articles and the availability of qualitative data. Further qualitative exploration may offer additional insights regarding a clearer understanding and definition of the concept. This gap supports a clear need for further conceptual clarity regarding the concept of social capital.

Ethical and moral considerations

Drevdahl et al76(p19) write that “public health nurses must be wary of uncritically adopting social capital as a panacea for inequalities as advocating for interventions seeking to build social capital may be as harmful as inequities themselves”; however, very little of the nursing literature addresses the ethical and/or moral criticisms of social capital. The majority of the articles in the sample portray social capital in a positive light and lack discussion of the arguments surrounding the darker side of social capital. The following section discusses ethical and moral implications associated with the darker side of social capital.

Pierre Bourdieu2 was among the first to question the motives behind investment in social capital. His vision of social capital suggested that while social capital offered opportunities for resource acquisition and social mobility, it also held the capacity to keep the powerful members of society in positions of power. Kawachi et al10 caution that social capital must always be considered within context of power relations. Attempts to map social capital without incorporating power relations into the analysis hold the potential for marginalizing diverse and poor communities, which may potentiate the creation of socially constructed communities that are blamed for their problems.2,10 Additionally, Portes and Landolt98 suggest that an abundance of social capital can restrict individual freedoms and negatively impact economic initiatives.

Social capital has been conceptualized in the literature as a positive protective factor as well as a potential liability toward health, whereby social networks have the capacity to help actors transcend or descend from their state of health.99 A second major criticism of social capital involves its use as a political ploy to solve health inequities and inequalities in low-resourced communities without providing financial supports.100 Community health improvement strategies that focus solely upon the poor helping the poor are neither successful nor sustainable.10 Examples of social capital as a negative health influence include restrictions of individual freedoms,67 fostering group dynamics that exclude outsiders,67 or limiting participation in community activities due to pressure from the dominant members within a social network.100 Urban sociologist Xavier de Souza Briggs1 writes that strong group bonds can promote behaviors that have negative influences on health, such as online “health gang” chat rooms that bully and/or promote health misinformation and street gangs that engage in crime and/or other violent acts.

A third criticism of social capital involves the nebulousness of types of interventions that build social capital and how to incorporate these interventions into public policy. Research supports that social capital varies by socioeconomic status and by gender.101 The World Bank attempted to include social capital as a public health strategy in 2004 and was met with hesitancy because the language of social capital does not typically address diversity, gender, or power relations.102 These perspectives represent important ethical/moral considerations involving the concept of social capital and key limitations for this concept analysis. Despite these critiques, social capital continues to offer an approach toward health and wellness that has not yet achieved its full potential.

CONCLUSIONS: CONNECTING SOCIAL CAPITAL AND NURSING

This concept analysis aimed to explore social capital within the nursing literature, craft an operational definition for the concept, and offer critical reflections on use of the concept. A total of 78 articles were included in the analysis, with a wide representation of academic articles and themes. The nursing workforce and workplace (namely hospitals) represented the most common themes within the literature at the intersection of social capital and nursing. As social capital is largely discussed within other health-related disciplines as a social determinant of health, it is interesting that the nursing literature on social capital reflects the nursing workforce and nurse working environment rather than patients or population health.

The empirical referents for social capital within the context of nursing include membership within social networks, frequency of social interaction, trust, communication, shared values, reciprocity, social norms, solidarity, safety, and participation. While a singular definition of social capital may be challenging due to the lack of clarity of social capital as a singular concept or as a multidimensional phenomenon, results of this analysis offer an operational definition of social capital as resources attained by membership and interaction within social networks.

Despite the operational definition derived from this concept analysis, the concept of social capital remains a challenge. The multifaceted attributes associated with social capital are more suggestive of a construct than a concept and the mismatch between the amount of quantitative research articles and qualitative research articles suggests a disconnect between an understanding of the concept itself and the desire to measure it. Findings from the literature on social capital in the nursing workforce suggest that greater social capital improves the work environment.12–25 Further research is needed to understand the utility of social capital within diverse populations, health-related contexts, and as a potential framework for nursing.

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      Keywords:

      community health; concept analysis; connection; nursing; population health; public health; social capital; social cohesion; social network

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