The objective of this study is to characterize the networks and their effects on health-related decisions and behaviors of medically complex individuals who are high utilizers of health services and who have multiple medical, cognitive, or social challenges. Sociological research has documented the importance of social networks for individual health. Social ties may be even more critical for the health of the most vulnerable. Developing a better understanding of the nature and influence of social networks among the underserved will provide insight into social and health disparities, and how the healthcare and social service systems can better partner with network members to improve the health of disadvantaged individuals. The overall goal of this project is to advance scientific knowledge that will strengthen the formal and informal safety net and improve the well-being of individuals in society.

This project will use egocentric social network analysis and qualitative interviews with patients and providers to examine how disadvantaged individuals' networks are shaped by their social and health conditions, and what kinds of formal and informal social interactions facilitate productive engagement with institutions that promote wellbeing. Specifically, network data will be collected from 100 participants and interviews will be conducted with 50 participants to

(1) identify the social network characteristics and complex, interacting social and medical vulnerabilities of individuals in the healthcare safety net;

(2) examine longitudinal relationships among social network dynamics, health behaviors, services utilization, and chronic disease management to identify social mechanisms that foster or undermine patients' engagement with healthcare institutions; and

(3) assess the strengths, functions, and structural positions of formal and informal caregivers to understand the co-evolving roles of institutions and lay persons in patients' networks.

Potential contributions of this study include: (a) transforming our conceptual understanding of the formal and informal safety net among the marginalized and the resources provided by social ties, (b) enhancing our research methods for ascertaining and studying personal social networks in these populations, and (c) amplifying our ability to supplement social networks and leverage them to achieve individual and societal benefits.