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This is to certify that the

thesis entitled

WOMEN'S HEALTH OUTCOMES WITH SOCIAL SUPPORT
FROM FAMILY, FRIENDS AND COMPANION DOGS

presented by

Béla J. Selzer

has been accepted towards fulfillment l
of the requirements for

MaStEY‘ _0_.f_J_SCIen degree in_N_lL[§in_g__

 

 

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WOMEN’ S HEALTH OUTCOMES WITH SOCIAL SUPPORT FROM
FAMILY, FRIENDS AND COMPANION DOGS

By

Bela Joanne Selzer

A THESIS
Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

MASTER OF SCIENCE

College of Nursing
1998

ABSTRACT

WOMEN’S HEALTH OUTCOMES WITH SOCIAL SUPPORT FROM
FAMILY, FRIENDS AND COMPANION DOGS

By

Bela Joanne Selzer

This descriptive correlational study was done to determine if there is a correlation
between human-companion animal bonds, perceived social support from friends,
perceived social support from family, perceived social support from companion dogs, and
health outcomes. The scope of this study was be limited to women dog owners. A
convenience sample of voluntary self selected female dog owners patronizing 4 beauty
salons was surveyed. Surveys were also distributed at the Small Animal Clinic at
Michigan State University.

A significant correlation was found between perceived social support from family
and perceived social support from friends, between perceived social support from friends
and perceived social support from companion dogs, and between perceived social support
from companion dogs and human-companion animal bonds. Perceived social support
from companion dogs did not correlate with social support from family. Women’ 3 health
outcomes did not correlate with any of the variables studied. Implications for including

family pets in any family assessment are discussed.

Copyright by
Béla J. Selzer
1998

ACKNOWLEDGEMENTS

In appreciation of my thesis committee, Linda Spence, chair, Lana Kaiser, Linda
Beth Tiedje, and Jackie Wright who believed in this project from the start and gave me the
encouragement and guidence necessary to get it accomplished. Special thanks to Dr. Sally
Walshaw who took the time to discuss ideas with me and graciously opened up her private
library to me for research. Additionally, a salute to companion dogs everywhere, "He is
your friend, your partner, your defender, your dog. You are his life, his love, his leader.
He will be yours, faithful and true, to the last beat of his heart. You owe it to him to be

worthy of such devotion" -- Author Unknown.

iv

TABLE OF CONTENTS

LIST OF TABLES ........................................................................... vi
LIST OF FIGURES ......................................................................... vii
INTRODUCTION ........................................................................... 1
CONCEPTUAL DEFINITIONS ........................................................... 2
CONCEPTUAL FRAMEWORK ........................................................... 4
REVIEW OF LITERATURE ............................................................... 12
METHODOLOGY ........................................................................... 24
RESULTS ..................................................................................... 27
DISCUSSION ................................................................................ 3O
APPENDICES ................................................................................ 38
Appendix A Letter to Subjects ..................................................... 38
Appendix B Pet Attitude Inventory ................................................ 39
Appendix C Perceived Social Support from Family Survey ................... 43
Appendix D Perceived Social Support from Friends Survey ................... 44
Appendix E Perceived Social Support from Dogs Survey ...................... 45
Appendix F UCRIHS Approval ................................................... 46
REFERENCES ................................................................................ 47

LIST OF TABLES

Table l—Demographics ........................................................................ 28

Table 2-Correlations ........................................................................... 29

LIST OF FIGURES

Figure l-A conceptual framework for nursing: dynamic
interacting systems ....................................................................... 5

Figure 2-The human-companion animal bond adapted within

King’s conceptual framework for nursing within three
interactive systems ....................................................................... 9

vii

INTRODUCTION

The role of perceived social support has been implicated in positive health care
outcomes in recent research (Callaghan & Monissey, 1993; Courtens, Stevens, Crebolder,
Philipsen & 1996; McCauley, 1995; Weinert & Tilden 1990; Yates, 1995). The purpose of
this study is to determine whether or not the presence of the human companion animal bond
is related to perceived social support provided by friend and family social networks,
perceived social support from companion dogs and to health outcomes. Perceived social
support may be more important than actual social support (Wethington & Kessler, 1986).
Thus social support provided by pets may have similar positive health we benefits for
human pet owners.

Pet ownership in the United States is increasing. Over 50% of US. households
currently have pets (Allen, 1996; Cain, 1991; Haggerty-Davis & McCreary Juhasz, 1995;
Jorgenson, 1997). Americans own over 500 million pet creatures, consisting of dogs,
cats, birds, horses, small mammals, reptiles and fish. Americans spend $19 billion on
animal feed, care and supplies (Beck & Katcher, 1996).

As is true with social support, it has only been with in the last twenty or so years
that research has focused on the relationship between companion animals and health. At
least 80% of pet owners state that they receive more companionship from their animals
than from either friends or family members. These people also view their pets as family
members (Cain, 1983; Sussman, 1985). Allen (1996) asserts that when compared to just
the presence or ownership of a pet, relationships with pets in which there is a bond are
associated with favorable health outcomes. With American households having more pets
than ever, health care professionals must learn to incorporate the existence of pets into

their assessment and care of families.

Social support outcomes are affected by gender. Women tend to rely on social

2
support, attend more self help groups, and have larger social networks than men
(Johnson, 1996; Nichols, 1995; Seckel & Bimey, 1996). The scope of this study will is
limited to women and dogs. This descriptive correlational study examines the correlation
between human-companion animal bonds, perceived social support from friends,
perceived social support from family, perceived social support from companion dogs, and
health outcomes. In this paper the human-companion animal bond will be defined and
considered within King’s conceptual framework for nursing.
Research questions: Is there a correlation between the human-companion animal bond
and perceived social support from (a) family, (b) friends, and (c) companion dogs? Is
there a correlation between the human-companion animal bond and health outcomes? Is
there a correlation between health outcomes and the perceived social support from (a)

family, (b) friends, and (c) companion dogs?
CONCEPTUAL DEFINITIONS

Social support has been defined as the existence of social bonds, social networks,
meaningful social contact and the availability of confidants. (Ducharrne et a1. 1994). Some
studies imply that the value of social support lies in the individual’s perception of it’s
existence. People derive the benefits of social support if they believe that it is available to
them, whether or not they utilize it (Wethington & Kessler, 1986). For the purposes of
this paper, social support will be conceptualized as perceived emotional support, which is
one type of social support. Emotional support has been defined as the provision of
affection, love, and empathy (Yates, 1995). Perceived emotional social support will be
divided into that provided by (a) family, (b) friends and, (c) companion dogs.

Health has been defined in many ways. For the purposes of this paper it will be
delineated by the presence of illness, injury or surgeries, reealled sick days and overall
health ratings by individuals. Healthier individuals will experience less instances of sick

days, injuries, surgeries and illnesses than other individuals. Health is the functional

3
ability to carry out daily life in the absence of illness or injury. Psychological indices of
illness such as depression will not be addressed in this study.

“The human-companion animal bond may be defined as an affiliation or attachment
between a human being and an animal” (Baun, Oetting, & Bergstrom, 1991, p. 19). This
bond can be forged between a human and a variety of animals including, but not limited to:
dogs, horses, cats, birds, rodents and reptiles. This definition, while a beginning, does
not address the nature of the attachment between the human and the animal. A more
detailed definition describes the bond between humans and animals as a therapeutic bond
which yields physiologic, psychological, and social benefits as well as providing special
services in the case of working animals (Francis, 1991). While this definition describes
the benefits of the human-companion animal bond, it does not recognize the interactive
components of the relationship. Most of the literature delineates the benefit of the human-
companion animal bond but does not describe the concept adequately. Cain (1991) merely
states, “the relationship between people and pets is known as the human-companion
animal bond” (p.60).

However, these definitions do not completely describe the nature of the bond
between people and their pets. The term therapeutic bond comes closest, but does not
include the benefits that the pet receives. The flow of rewards to both the person and the
pet are an integral part of the human-companion animal bond. For the purposes of this
paper the author defines the “human-companion animal bond” as a synergistic interaction
in which both human and pet give and receive physiologic, psychological, and social
benefits. The benefits that the pet receives include food, shelter, health eare, and exercise.
The benefits that the human receives include orientation, responsibility, positive body
image, increased self esteem, and decreased stress. Mutual benefits include affection,
communication, growth and development, interaction, socialization, and role identity. A

synergistic relationship is one in which the outcome is enhanced or increased as a result of

4
the interaction. By their association, both the human and the pet reap rewards that are
unobtainable without the presence of each other and a bond between them. For the
purposes of this paper the dog is the animal that will be considered as the companion
animal.
CONCEPTUAL FRAMEWORK

The human-companion animal bond can be explored within King’s conceptual
framework for nursing. “Over the years, King has provided explanation, clarification,
and expansion of concepts for what is now referred to as the systems framework for
nursing” (Fitzpatrick & Whall, 1996, p.226). Based on general systems theory, King’s
framework has three dynamic interaction systems: (a)personal systems, (b)interpersonal
systems, and (c)social systems (McQuiston & Webb, 1995). These systems are open
and interactive and yet each system contains concepts which have been defined and plawd
in a specific system. There is some overlap between concepts and systems because they
are interrelated which is a general assumption in systems theory. Because the system
boundaries are permeable, there is exchange between all of the systems and each one
exerts some influence on the others. Therefore, concepts may be relevant to one or more
systems and ean be somewhat interchangeable. While concepts have been grouped by
system, King (as cited in Fitzpatrick & Whall, 1996) describes concepts as having
meaning and as such, concepts can be used across systems. The major elements of the
human-companion animal bond take place in the interpersonal system. (Figure 1)

King (1981) identifies the personal system as composed of individuals and then
describes concepts which pertain to the individual. Individuals are social beings who are
rational and sentient. People share common characteristics which include the ability to
perceive, think, feel, choose between alternative courses of action, set goals, select the
means to achieve goals, and to make decisions. The process of human interactions are an

individual’s reactions to other people, events, and objects in terms of their own

5
perceptions, expectations, and needs. The behaviors of humans are exchanges which take
place in space and time and may range from simple to complex interactions. King
(1981) lists the concepts of perception, self, growth and development, body image, time,

and space under the personal system domain.

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Figure 1. A conceptual framework for nursing: dynamic interacting systems.
Source: King, (1981, p.11).

Interpersonal systems are f onned when ever two or more personal systems
interact Interpersonal systems are dyads, triads and groups of individuals. “Several
concepts are identified and described that are essential to understanding two or more
persons interacting in concrete situations. These concepts are interaction, communication,
transaction, role, and stress” (King, 1981, p. 59). It is within the interpersonal system
that the interaction of the human-companion animal bond occurs. It is f orrned by the

interacting dyad of the personal system belonging to the human and the personal system
of the dog.

6

King (1981) defines the social system “as an organized boundary system of social
roles, behaviors, and practices developed to maintain values and the mechanisms to
regulate the practices and rules” (p.115). Social systems provide the structure for social
interactions which define social relationships, establish rules of behavior and acceptable
modes of action. Beliefs, attitudes, values, and customs are learned and defined by social
systems such as family, school, and church. The key concepts of social systems as
identified by King are organization, power, authority, status, and decision making.
Attitudes and beliefs about companion animals are influenced by social systems. Until
recently, many considered it foolish to mourn the loss of a pet. As pets have been more
widely accepted as companions, support groups for grieving pet owners have been
established. Primary health care providers constitute a large social system in the lives of
people. In order to provide optimal health care to families the APN should recognize the
importance of the human-companion animal bond and acknowledge the role of the
companion animal within the family.

In conceptualizing the human-companion animal bond within King’s systems
framework, the pet is an individual system and the human is an individual system. The
interaction of these two systems, form an interpersonal system dyad which is the basis for
the human-companion animal bond. (Figure 2) Concepts included in human’s personal
system are: perception, orientation (time), responsibility, stress (reduction), self, and body
image.

King ( 1981) describes the concept of perception as an individual ’8 representation
of reality. Perception occurs through both sensory and cognitive processes. Each
individual’s perception is formed by things such as past experience, self image,
inheritance, education, culture and socioeconomic class. Perception gives meaning to
one’s experience, helps define individual reality, and influences one’s behavior and is a

basis for developing a concept of self. Perception is necessary to appreciate the presence

7
of a companion animal and to establish a bond with it. There are many reasons for not
wanting pets. People that do not wish to share their lives with pets may find them messy,
expensive or too time consuming. One must also perceive a human-companion animal

bond as desirable or there will be no impetus to establish one.

 

 

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Figure 2. The human-companion animal bond adapted within King’s conceptual
framework for nursing within three interactive systems.

Self is a very abstract, subjective concept that is perceived in relation to other
people and objects in the environment. Self is what an individual thinks of themselves
and includes all that a person believes themselves to be, past. present and future (King,
1981). King believes that awareness of self is necessary to becoming a sensitive human
being who is capable of forming relationships. In a human-companion animal bond, the

pet provides positive feedback, which allows the human to increase self esteem. The pet

8

accomplishes this by a variety of means. Dogs almost always give their humans warm,
greetings consisting of much tail wagging and licking. They are always available to talk to
and do not criticize. They are non judgmental of human behaviors and forgive minor
transgressions readily. They boost self esteem when they solicit attention, and enjoy the
time spent with their humans. They enhance self perception when they reflect their
humans’ moods. When their human is happy they are bouncy and joyous. When their
human is sad they hover and lay quietly with them (Cain, 1991; Catanzano, 1988;
Francis, 1991). This quality of loyalty is instrumental in the formation of the human-
companion animal bond

Body image is a personal and subjective concept. According to King (1981), body
image is acquired through growth and development and is constantly changing as an
individual’s experience and perception change. King states, “It is a universal principle that
individual ’8 identify self in relation to their body appearance and others’ reactions to them”
(p.32). King also says, “Touch, tactile stimulation, is important for the development of a
healthy body image” (p.72). Dogs provide ample opportunity for the exchange of touch.
They constantly solicit touch or petting by maintaining a close proximity to their owners or
often times by initiating the touch first through nuzzling, licking or leaning on their
humans. This conveys a positive response to the human and helps build a positive body
image and contributes to increased self esteem for both the human and the pet (Cain, 1991;
Kidd & Feldman, 1981). One study found that petting a dog with whom a companion
bond has been established resulted in lower blood pressures (Baun, Bergstrom, Langston,
& Thoma, 1983).

Time is a universal concept that is relational, unidirectional, measurable and
subjective. Time is defined in terms of the observer and gives order to the world (King,
1981). People that experience a disruption in their ability to accurately measure time are

some what disoriented and may become further confused if steps are not taken to reorient

9
them. King suggests that nurses may help patients become time orientated through the use
of clocks and calendars in the environment. A pet may function as a daily clock,
demanding to be fed on time, to be walked, and to be toileted regularly. Providing basic
care for a pet requires that life have a rhythm, and gives structure to the days and nights.
This may be particulariy useful for more isolated individuals.

Responsibility is cultivated by assuming a role of authority, power and decision
making for the welfare of a pet. Successfully meeting the needs of a pet requires
responsible behavior. When the basic needs of a pet, such as shelter, health care, exercise
and food have been provided, a successful human-companion animal bond may be more
easily formed. By meeting these pet needs and being responsible, the human can take
pride in their accomplishments. This increases self image, boosting self esteem.

While this author concedes that animals experience stress and probably have
decreased stress by virtue of the human-companion animal bond, stress as a concept has
been placed in the domain of the personal system of the human, as this is a point of
interest and rationale for the examination of the topic of human-companion animal bonds.
Stress is a concept which manifests itself physiologieally, psychologically, and socially.
“People respond to life events based on their unique perceptions and their interpretation of
the events” (King, 1981, p.98). The negative consequences of stress on health have been
well documented. Many studies indicate that the perceived presence of social support aids
in the reduction of stress (Callaghan & Morrissey, 1993; Cohen & Hoberrnan, 1983;
Jacobson, 1986; Procidano & Heller, 1983; Wethington & Kessler, 1986). If pets are
perceived as providing social support to their owners via the existence of a human-
companion animal bond, then it can be argued that pets play a role in reducing stress. The
presence of a bond with an animal may be a key factor in understanding the ways in which
companion animals may actually influence health, both mental and physical. Researchers

have begun to investigate the influence of companion animals on human health, using

10
methods which consider them as a type of social support (Allen, 1996; Garrity, Stallones,
Marx & Johnson, 1989; Robb & Stegman, 1983; Rosenkoetter, 1991).

Concepts from King’s systems framework which are the most relevant to the
interpersonal dyad of the human-companion animal bond are (1) interaction, (2)
communication, (3) growth and development, and (4) role. When these elements are
present, there is the formation of a human-companion animal bond. This interpersonal
dyad is formed by the interrelationship of the pet personal system and the human personal
system.

Interactions are defined as, “The acts of two or more persons in mutual
presence” (King, 1981, p.85). In the case of the human-companion animal bond
interactions will take place between a person and a dog. Interactions are reciprocal in that
each person reacts to the other. King further states, “there is a mutuality, an
interdependence in the situation in which both achieve goals” (p. 84). Both the pet and the
human interact to achieve the needs identified in their personal systems. The ownership of
pets may also contribute to increased interactions with others. Proper care of a pet
requires regular visits to the Veterinarian. Training a pet may require classes with other
pet owners. Many activities revolve around pets such as obedience or conformation
shows. Often times when walking a pet there is increased interactions with others because
they are drawn to animals or may be out walking their own animals (Messent, 1983).

Communication is a means of exchanging information. Communication may be
both verbal and nonverbal (King, 1981). Communication between humans and pets
consists of both. Once properly trained, dogs respond to both verbal and nonverbal
commands. Dogs are routinely trained to sit, stay, heel, and fetch and come on both
verbal and nonverbal commands. The tone of voice used by the human can convey
meanings such as happiness or anger. Dogs whine, grunt and bark. These vocal

responses, when assessed in the context they are delivered, have various meanings. An

1 l

excited dog barks happily or a dog may bark out a warning at the approach of a stranger.
Nonverbal communication is also an important means of information exchange between
people and pets. Almost everyone has been taught that a wagging tail indicates a happy
dog, Laid back ears and a show of teeth may indicate an animal is fearful or aggressive.
Touch is also used as a form of communication. Petting conveys affection to the pet,
while submitting to petting communicates affection and trust to the human. A pet that
stays in close proximity to it’s owner indicates commitment and affection to the human.

Growth and development is the process by which people develop and refine
their concept of self through genetic endowment, meaningful and satisfying relationships
and an environment conducive to helping individuals move toward maturity. Growth and
development is a process that allows people to utilize their potential and achieve self
actualization (King, 1981). When a human assumes the responsibility for providing a
nurturing and safe environment for a pets’ growth and development throughout its
lifecycle, the human may also experiences growth and development (Katcher & Beck,
1987; Kidd & Feldman, 1981).

Role is a set of behaviors that are expected when occupying a defined position
within a social system. Role is a relationship with one or more individuals (King, 1981).
A role can only exist in relation to another role. Because a role is the occupation of a
social construct, they are learned behaviors. According to King, “Socialization is a
process whereby a person learns values, expected behaviors, rewards, and sanctions so
that he can occupy a role in an organization”(p.94). This requires collaboration,
understanding and communication to accomplish. As the human-companion animal bond
evolves, both human and pet develop roles. The human nurtures, trains, feeds, provides
exercise and shelter for the dog. The dog requires feeding and exercise in a timely
fashion, acts as a social lubricant, provides affection and finds a role within the family

which can take many forms. It may be a playmate or confidant, a hunting companion, a

12
show dog or a house pet. The mutual development of these roles then forms the structure
of the human-companion animal bond, which may be considered a social system.
REVIEW OF LITERATURE
Social Support

The concept of social support is as old as humankind. People have always
depended on one another for survival, as well as companionship. Whether hunting,
harvesting the crops, raising the barn, having a baby, or going to a party, most people
depend to some degree on others, for not only accomplishing tasks, but also deriving
enjoyment or fulfillment in life. For women, these relationships are especially important.
Gilligan (1982) suggests that women tend to see the world in terms of relationships.
Inherently, women evaluate and define themselves in terms of their relationships with
others. When problem solving all other points of view are considered. If relationships
are important for women’ s development under normal circumstances, when women are
stressed by illness or life transitions, these relationships become even more essential
(Friedman, 1993; Harrison, Neufeld, & Kushner, 1995; Nichlols, 1995; Seckel, &
Bimey, 1996). Thus, when providing health care to women, providers must consider
the availability and utilization patterns of social support used by their clients both under
usual circumstances as well as during stressful periods.

In the 1970’s several studies implied that social support could have a beneficial
effect on decreasing the effects of stress and preventing mental disorders (Ducharrne,
Stevens & Rowat, 1994). The concept of “social support” has been used in its current
form since that time. Weinert & Tilden (1990) note, “cumulative findings strongly
indicate that social support can aid in recovery from hospitalization, surgery and illness;
reduce pregnancy complications for women under stress; protect against psychological
distress in adverse situations; and mediate some of the stress of maturational processes”

(p. 212). While there is growing evidence that social support provides a positive effect on

13
health, there have been problems conceptualizing, defining and operationalizing it.

Social support has been defined as the existence of social bonds, social networks,
meaningful social contact and the availability of confidants. (Ducharrne et al. 1994).
Calaghan & Morrissey (1993) suggest that social support may be expressed structurally or
functionally. Social support is expressed structurally as bonds of family, marital status,
and size of support networks and functionally by the offering emotional, physical or
informational support Yates (1995) breaks social support into three dimensions which
are emotional, informational and instrumental support. Emotional support provides
affection, liking, love and/or empathy. Informational support is advice on problem
solving, suggestions about what to do, or where to go to get needed information.
Instrumental support refers to goods and services such as money, help with cooking,
cleaning or transportation.

Because the concept of social support is complex and multifactorial, attempts to
quantify it have often been difficult. For example, some studies have identified the
presence of social support by asking whether or not the client is married. Without
additional inf orrnation about the marital relationship this is a large assumption. Partners
in some marriages may not provide emotional or social support to their spouses and may
in fact be a source of stress. With out agreement on what is being measured and which
aspect of social support is involved, it is difficult to compare results from various studies.
The correlation of positive health outcomes with the existence of positive social support
provides strong motivation to continue studying the phenomenon of social support
(Cohen & Hoberman, 1983; Friedman, 1993; Harrison, Neufeld, & Kushner, 1995).
Callaghan & Morrissey (1993) note that between 1984 and 1991 4,247 papers were

published on the subject of social support in medical and social science journals indicating

a large interest in the topic.

14
Norbeck (1982) puts forth these theoretical assumptions:
(1) Pe0ple need supportive relationships with others throughout the life span to
manage the role demands of day to day living, as well as to cope with life
transitions and stressors that may emerge; (2) Social support is given and received
in the context of a network of relationships; (3) The relationships in the network
have relative stability over time, especially those that comprise the inner circle or
primary ties for the individual; (4) Supportive relationships are basically healthy,
not pathological, in nature; (5) The type and amount of support nwded is
individually determined, based on individual differences and on characteristics of
the situation; (6) The type and amount of support that is available also is
determined by characteristics of the individual and of the situation. (p. 23-24)
Some studies imply that the value of social support lies in the individuals
perception of its existence. People derive the benefits of social support if they believe that
it is available to them, whether or not they utilize it. (Callaghan & Morrissey, 1993;
Cohen & Hoberrnan, 1983; Jacobson, 1986; Procidano & Heller, 1983; Wethington &
Kessler, 1986). Wethington & Kessler (1986) surveyed 1,269 adults asking about recent
stressful life events, perceived social support, received social support and a psychological
distress scale. They found that perceived support had a larger influence on psychological
distress than did received support when stressful life events occurred. Additionally, the
correlation between perceived and received support ranged from 0.02 to 0.20 and
therefore had very little influence on one another. Cohen & Hobennan (1983)
administered a number of instruments to college students. They included a life events
scale, physical and depressive symptoms checklists, and social support surveys. One of
their findings was that as perceived social support increased, depressive symptomatology
decreased. Jacobson (1986) points out that perception of social support plays another

role. If the support is perceived to be harmful or problematic it can cause a significant

15
negative effect on well being.

Two major theories of social support have emerged since the 1970’s. The first
proposes that social support acts as a buffer which protects people from stressful events in
their lives (Cohen & Hoberrnan, 1983). Increased stress has been linked to mental and
physical illnesses. According to the buffer theory of social support while everyone
experiences stress, those with strong social support networks don’t suffer the ill effects of
the stress as much as those without social support. The second theory of social support is
the attachment theory. It postulates that the secure attachments formed in childhood form
the basis for developing socially supportive relationships in adulthood (Bowlby, 1971).

Many studies on social support have focused on female populations. Others,
which included both men and women, found significant differences in the benefit of social
support based on gender. In a study of rural elderly men and women between the ages of
64 and 98, Johnson (1996) found that married women and women between the ages of 64
to 74 had larger social support networks, more support and enjoyed better health than the
other study participants while widowers over 75 with the least social support had the
poorest health. Nichols ( 1995) had a similar finding with regard to gender in a study of
adolescents, social support and coping. In her study females reported greater use of
social support and psychological coping than did males. In a study of social support of
women undergoing breast biopsies, Seckel & Bimey (1996) found that women with
decreased social support strength reported higher stress related to their breast biopsies.

Gilligan (1982) observes,

For boys and men, separation and individuation are critically tied to gender identity

since separation from the mother is essential for the development of masculinity.

For girls and women, issues of femininity or feminine identity do not depend on

the achievement of separation from the mother or on the progress of individuation.

Since masculinity is defined through separation while femininity is defined through

l6

attachment, male gender identity is threatened by intimacy while female gender

identity is threatened by separation. (p.8)

This theory may serve to explain why women may have larger support networks than
men. It may also explain why women appear to benefit more from the bonds of social
support For men the use of social support networks, particularly outside the bonds of
family is not as socially acceptable as it is for a woman. Throughout their lives most
women have strong ties to both family and friendship networks that provide social
support. Women are also more likely to avail themselves of structured types of social
support from such areas as self help groups, health care providers and community
resources.

While social support is complex and multifaceted, studies indicate that it is an
important element to assess when providing health care and services to women. Harrison,
Neufeld & Kushner (1995) examined women’s social support in the context of life
transitions. Transitions studied were returning to work after an absence of 3 years,
childbirth and retirement. Seventeen women ranging in age from 2465 years, identified
support as someone to talk to, listen and explore ideas with. Listeners were considered as
supportive if they were reliable and available when needed. Additionally, they had to
allow the inf orrnant to make her own choices. Another finding was that women wanted
support that was volunteered as opposed to support that had to be requested. Of interest is
the fact that only one new mother identified help with child care or household tasks in their
definition of social support. Some women viewed requests for help as an admission of
inadequacy or dependence. This perception of burden on others is identified as a barrier to
providing social support to women. This perception is increased if the woman needing
social support feels unable to reciprocate in any way. In order to negotiate these life
transitions these women had to change their perceptions and ask for the support in

anticipation of stress, rather than waiting until it had reached crisis proportions. In other

17
words, the existence of social support is not enough. Women must be taught that it is
acceptable to avail themselves, indeed even ask for support when necessary.

In order to provide comprehensive health care to women providers should assess
the social support available to clients, as well as how these supports are utilized by the
clients. Women should be encouraged to make full use of these supports. If social
support is unavailable or absent the client should be directed to other sources of emotional
support such as support groups, community agencies, or to another client with similar
concerns. Ensuring that clients have access to sources of social support prior to a crisis
increases the probability that they will be used when needed. Social support is an integral
part of a women’s life experience and should be included and assessed whenever health
care is provided to women. Because of reciprocity issues and the need for non judgmental
support, a dog may be the ideal source of social support for many women.

Human-Companion Animal Bond

The human-companion animal relationship is as old as domesticated animals.
Based on archeological evidence, the first animal species to become domesticated was
Canis lupus (the wolf), around 12,000 to 14,000 years ago (Coren, 1994; Serpell, 1996).
Most scientists agree that the domesticated dog descended from the wolf. Research is
showing that animal companionship not only improves the quality of life for many people,
it can even create positive health outcomes for certain populations (Jorgenson, 1997). The
literature can be divided into two types, studies based on pet ownership and studies in
which animals have been used therapeutically.

Studies based 0L animals used therapeug'callv:

The first published reports on the use of animals in therapeutic settings is usually
attributed to Dr. Levinson, a child psychiatrist who used his dog Jingles in treating
children. He thought that Jingles helped children to be more at ease and facilitate

communication by displaying unconditional acceptance (Levinson, 1965). Since then

18
animals have been used in a variety of settings including nursing homes, rehabilitation
centers, mental institutions and jails. They have gained acceptance as service animals to
the blind, wheel chair bound and the hearing impaired. As animals were used in
therapeutic settings, anecdotal evidence emerged to support the idea that associations with
animals were beneficial. About 20 years ago the topic was recognized as worthy of study.
Three veterinarians and a physician founded the Delta Foundation which was established
to study the interactions between people and animals. They coined the term “human
animal bond” to describe a relationship that was more than simply maintaining an animal.
This organization has grown into the Delta Society which has helped form many programs
to develop and use the knowledge generated from the study of the human companion
animal bond. The Delta Society has funded research on this topic as well. Membership in
1991 was about 2,600. Membership consisted of approximately a third veterinarians and
human health care professionals, a third in academia and a third in veterinary technicians,
volunteers and pet owners (Strimple, 1991).
Studies based on pet ownersh_ip_:

One of the earliest quantitative research studies Friedmann, Katcher, Lynch &
Thomas (1980) explored the relationship between animals and health. They found a
positive relationship between pet ownership and one year survival after discharge from a
coronary care unit after a heart attack or severe angina pectoris. Twenty eight percent of
the non-pet owners died while only 6% of the pet owners died. Pet ownership was more
highly correlated to survival than was marital status or family contacts The finding of
decreased mortality with pet ownership prompted many other studies to try and define the
variables that would account for positive health outcomes. Another study had subjects
reading and petting a dog they had not met before and their own dog. Both systolic and
diastolic blood pressures were reduced when petting a dog. There was a larger drop in

blood pressure if the dog was one with which there was a bond rather than a dog they did

19
not know (Baun, Bergstrom, Langston & Thoma, 1984), suggesting that the presence of
a relationship with the dog has additional beneficial effects.

The presence of a bond with an animal may be a key factor in understanding the
ways in which companion animals influence both mental and physical health. Researchers
have begun to investigate the influence of companion animals using methods which
consider companion animals as a type of social support (Allen, 1996; Ganity, Stallones,
Marx & Johnson, 1989; Robb & Stegman, 1983; Rosenkoetter, 1991). Allen,
Blascovich, Tomaka, & Kelsey (1991) compared women’s autonomic responses to stress
in the presence of a self selected friend, in the presence of their own pet dogs, and with
only the researcher. Women under stress exhibited significantly less autonomic reactivity,
measured by heart rate, skin conductance response and blood pressure, in the presence of
their pet dogs as compared with their friends or the researcher alone. Allen (1996)
postulates that the presence of the pet dog provided a non evaluative type of social support
that buffers physiological responses to acute stress. Findings from a national probability
sample of elderly persons age 65 and older found that pet attachment and depression were
significantly and inversely related (Ganity et al., 1989). They also found that
retrospective measures of physical health, measured by doctor visits and hospitalization,
were not influenced by pet ownership, but strong attachment to the pet was associated
with enhanced physical health when human support was unavailable. Among respondents
who were grieving and lacked a confidant, both pet ownership and pet attachment were
associated with less depression. Siegel (1991) prospectively studied the utilization of
physician services by elderly persons aged 65 and older. Pet owners reported fewer
doctor contacts over a one year period than non pet owners. In this study pets also
appeared to help buffer the effects of stress. The number of pre-baseline stressful life

events was associated with increased doctor visits for non pet owners but not for pet

owners.

20

Many people believe that having animals in their lives is beneficial and studies
support this belief. As more studies are done, the definition of the relationship between
pets and people is being further refined. It is clear that many people feel attached to their
pets. Many feel that the quality and strength of attachment in the human-companion
animal bond is an important predictor in obtaining the health benefits associated with pet
ownership. Evidence of the strength of the human-companion animal bond exists in the
literature. Cain ( 1983) found that eighty seven percent of pet owners perceived their pet to
be a member of their family. Ten percent said they did not and three percent said both yes
and no. Thirty six percent said that they thought of their pct as a person. Eighty one
percent considered their pets “tuned in” to the feelings of the family members. Lockwood
(1983) asked undergraduates to describe people in pictures. They were asked to interpret
relationships and activities. They were either given pictures with just people or an
identical set of pictures which included animals in non-interactive roles. The people in
pictures with animals were perceived to be friendlier, happier, bolder and less tense. Ory
& Goldberg (1983) found no relationship in elderly women between pet ownership and
life satisfaction. There was actually a higher percentage of persons with household pets
found to be unhappy. Eight percent of pet owners reported being unhappy compared to
five and a half percent of non-owners. Once the subjects were separated based on
reporting feeling attachment to their pets the results changed. They did find a significant
relationship between pet ownership and happiness. While statistically significant, it
should be noted that 45.2% of attached owners report being very happy compared to
43.2% of non owners and 31.4% of unattached pet owners. This finding points out a
very important consideration of pet ownership. The simple owning of a pet may not
indicate that the pet is providing any form of support. Owning pets may be considered a

burden or stressful to some people.

Another benefit of pet ownership is increased communication with others. Indeed,

21
pet ownership may actually facilitate the development of friendships. One study looked at
the socializing effects of service dogs for people with disabilities that required them to be
in a wheelchair. Subjects reported that they received a significant increase in social
greetings, both from adults and children while out on routine trips with their service dogs,
as compared to trips with out the animals. They also reported an increase in the number of
outings that they took after having the dog (Hart, Hart, & Bergin, 1987). Messent (1983)
looked at social contacts made by pet owners walking with and without their dogs.
Subjects were asked to walk through a park and some of the surrounding streets. He
found that the dogs acted as a “social lubricant”, by increasing the number of contacts
between the subjects and strangers. The contact rate at the park was high compared to that
on the surrounding streets, but only when the dog was present. Messent (1983)
concludes that the study suggested friendships soon develop with others using the same
area and that other dog owners are especially likely to become friends because on average
the conversations with this group lasted longer than for those without dogs. He also
found that the walks with dogs lasted longer. This may have some additional health
benefit to people in the f cm of increased exercise.

Owning and caring for a pet requires a person to f ill the role of owner and nurturer
to a dependent animal. The sense of responsibility most owners feel for the care and
welfare of their pets allows people to gain the pleasure of nurturing. A happy companion
animal gives feedback by loving their owner unconditionally. This also helps build self
esteem (Kidd & Feldman, 1981). Companion animals are not concerned with appearance,
abilities, age or economic status. They can be a constant, non-judgmental source of
support. They may also become a source of caring, affection, humor and comfort
(Rosenkoetter, 1991). Siegel (1993) states,

Positive responses are initially elicited from tactile contact or the good feelings that

are generated when a pet shows enthusiasm for seeing its owner. The continued

22
pairing of the pet with good feelings then leads the owner to view the animal as a
source of comfort (p.163)
Summg

There is growing evidence that companion animals can enhance human existence
(Jorgenson, 1997). They do this by providing companionship, social support, and
interactions which help orient their owners to time, self, others, and increasing self
esteem. They can facilitate the reduction of stress and loneliness as well.

Clearly, there are many people that can benefit from associations with companion
animals. In order for the APN to properly assess a family, they must understand when the
pet is perceived as an integral part of the family system. It is especially important not to
discount the relationship or the human companion animal bond when the pet may
constitute the only family an individual has and to consider that concern for a pet may
override concern for self. Unless the role of the companion animal is considered in
assessments and strategies for wellness, clients may be non compliant with some aspects
of their care. Sick individuals may delay seeking care or refuse care because they are
concerned about who will care for their pets in their absence. Elders may resist assisted
living arrangements if it means abandoning a pet. Children may pine for pets that they
cannot visit with during hospitalizations. Health care workers often recommend that
people with compromised immune systems give up their pets. Many AIDS patients have
faced the prospect of having to give up their pets. Acknowledging the importance of the
human-animal companion bond, many people have banded together to enable AIDS
patients to keep their animals. One such organization is Pets are wonderful support or
“PAWS” (Gorczyca, 1990). Veterinarians have come up with guidelines to reduce the
risk of zoonotic illnesses for immunocompromised patients (Gill & Stone, 1992). As pet

ownership continues to increase, health care workers must remain cognizant of these

issues.

Critique of literature

One of the most obvious limitations of this literature is the paucity of studies. This
is a topic that is only now coming into favor. While the topic has popular appeal, the
number of studies are relatively limited. Until recently, most of the studies have been
observational rather than empirical. As with any new field of study, ideas are being
developed independently with little communication between scientific disciplines. Some
are interested in therapy animals or visiting animal programs. Others are interested in
companion animals.

Many of the concepts inherent in human-animal studies are subjective and difficult
to measure and this has limited the number of empirical studies. Even the concept of
human social support has been plagued with this problem. Until concepts such as
bonding, pets, support and companionship can be defined and measured this will remain a
confounding problem. Another limitation of the research is that it is generalizable only to
the population of people who enjoy the company of animals. If positive benefits of pet
ownership are to be utilized, we must be able to determine what segments of the
population this is acceptable for. Most researchers involved in these studies are working
from the premise that human companion bonds are desirable and therefore are less likely to
look for or identify the negative aspects of companion animal ownership.

Other diff iculties encountered in human-companion animal research occur because
many different disciplines are attempting to quantify and measure it. This topic is of
interest to human medicine, veterinarian medicine, nursing, physical therapy, social work,
psychology, pet owners and animal behaviorists to mention but a few. Each discipline is
somewhat segregated by politics, competing theories and jargon. It is essential that
information be made available to all interested parties in a form that is readily

understandable to all. Collaboration and communication must be achieved in order to

enhance the efforts of all.

METHODOLOGY

This study determines if there is a correlation between human-companion animal
bonds, perceived social support from friends, perceived social support from family,
perceived social support from companion dogs, and health outcomes.

S_ar_n.P£

The convenience sample consisted of 47 voluntary self selected women dog
owners, whose dogs live with them. They were over 18 years of age and were able to
read English. These women were recruited at 4 beauty salons. These salons were located
in Ann Arbor, and E. Lansing. Stylists at each establishment asked clients if they owned a
dog and were interested in participating. Another site for distributing questionnaires was
the Small Animal Clinic at Michigan State University. The receptionist asked female
clients if they owned a dog and were interested in participating. An explanatory letter to
subjects containing a brief description of the study and contact numbers was provided.
(Appendix A)

Procedures

Packets with questionnaires were distributed and collected by the beautician in
the salons and returned by mail from the Small Animal Clinic. Those willing to fill out the
survey returned them in the packet envelop to ensure confidentiality. Participants were
asked to fill out four surveys. The first questionnaire was the Pet Attitude Inventory.
(Appendix B) The remaining tools measure perceived social support from family
(Appendix C), perceived social support from friends (Appendix D), and the fourth survey

measures perceived social support from dogs. (Appendix E) It took 15-20 minutes to

complete the surveys.
Instruments

The first tool is the Pet Attitude Inventory (Wilson, Netting & New, 1987). This
is a two track instrument designed for pet owners and non-pet owners. It was designed to

24

25
measure pet ownership attitudes and attachment levels. For this study, only the Pet
Attitude Inventory for pet owners was used. It contains seven common demographic and
self -rated health questions and 44 pet attitude questions. Additional questions added to the
survey asked participants to recall the number of days of work missed due to illness, the
number of doctor visits for illness, and whether they have experienced a serious physical
illness, injury or surgery within the last year. A question on income level was also added.
According to the authors, the Pet Attitude Inventory has significant content validity as
determined by experts in public health, veterinary medicine, psychology, social work, and
aging. It has not been tested for reliability. This study used a total of 55 of the questions
from the pet owner survey. Demographic data was collected for a description of the
sample.

The rest of the instruments are designed for the measurement of perceived social
support (Procidano & Heller, 1983). These tools measure perceived social support from
both family (PSS-Fa ) and friends (PSS-Fr). Each section has 20 items which are scored
based on yes, no or don’t know answers. For the purposes of this study these items were
administered as a 5 point likert scale. Additionally, a third section was added to measure
the perceived social support provided by companion dogs (PSS-D). (Appendix E) This
was an adapted version from the perceived social support from friends scale. In the
construction of the perceived social support scales for friends and family, Procidano &
Heller (1983) report internal consistencies with a Cronbach’s alpha of .88 and .90
respectively. A pretest indicated a high test-retest reliability (r=.83).
erationalization of variables

The variables in this study are health outcomes, dog ownership, human-animal

companion bond, and perceived social support from friends, family and dogs.

26

Health outcomes was measured by the self health rating, number of sick days
recalled during the last year, number of doctor visits for illness and number of serious
physical illnesses, injuries or surgeries reported from questions # 7-10 of the pet attitude
survey.

Human-comwion animal bond was measured by the response to questions about
attachment to the dog, time the dog spends indoors, whether time spent with the dog and
touching the dog is enjoyable, whether the dog helps the subject to feel better when
physically ill, or sad, whether the subject talks to their dog, noting whether or not the dog
responds when talked to, and whether or not the dog provides companionship from the pet
attitude inventory, # 27, 28, 31-34, 39, 42 and 49.

Perceivedfsociai support from friends was the score from the PSS-Fr instrument

Perceived social support f mmmilv was the score from the PSS-Fa instrument.

Perceived social support from dogs was the score from the PSS-D instrument.
Data analysis

A correlational analysis was done on the variables of health outcome, PSS-Fr,
PSS-Fa, PSS-D, and human-companion animal bond. Descriptive statistics were used to
examine the demographic data.

Human Subjects

The subjects in this study participated voluntarily as indicated by filling out and
returning the questionnaires. Cover letters explaining the project and providing contact
phone numbers were provided at the individual sites for potential volunteers to read.
(Appendix A) Confidentiality was provided by having no identifying information put on
the collected materials as well as providing an unmarked envelop to return the
questionnaires in. Results are reported as a group. Results of the study are available to
participants upon request. There are no known benefits or risks associated with filling out

these surveys. The proposal was submitted to and approved by the Michigan State

27
University committee on Research Involving Human Subjects. (IRB#98-176, Appendix F)
RESULTS
Demgggphics

Of the 125 surveys left at 5 sites, 47 were completed and returned. One site in E.
Lansing did not distribute any of the questionnaires at all. This was a 38% response rate.
Respondents came from the Michigan State Small Animal Clinic in E. Lansing (N=28),
Salon #1 in Ann Arbor (N=12), Salon #2 in E Lansing (N=3), and Salon #3 in E.
Lansing (N=4). (Table 1) Average yearly income ranged from under $10,000 to over
$200,000 with 26% of those surveyed falling into the $26,000-$50,000 category (N=12)
and 32% in the $51,000-S75,000 category (N=15). Twenty-eight percent of respondents
were never married (N=13) and 55% were married (N=26). Eighteen percent were
divorced, separated or widowed (N=8). The highest level of education completed ranged
from high school to postgraduate with 34% (N=16) in the postgraduate category. Twenty
one percent (N=10) were college graduates, 30% (N=14) had 1-3 years of college and
15% (N=7) had completed high school. No respondents reported an educational level of
less than high school graduate although it was a choice on the survey. Ages ranged from
24 years to 79 years, with a mean age of 43 years. Health outcome scores ranged from I
to 51 with a mean of 10.

In answer to the first research question, is there a correlation between the human-
companion animal bond (BOND) and perceived social support from family (SSFA),
perceived social support from friends (SSFR) and perceived social support from
companion dogs (SSDO) the results are mixed. There was a significant correlation
between the human-companion animal bond and perceived social support from dogs
(r=.57, p=.00). (Table 2) The human-companion animal bond did not correlate

significantly with any of the other variables in this study.

Table 1: Demographics

Site

MSU Small Animal Clinic
Salon #1, Ann Arbor
Salon #2, E. Lansing
Salon #3, E. Lansing

Average yearly household income

Under $10,000

3 10,000-25,000
$26,000-$50,000

$51 ,000- $75,000
376,000-5 100,000

$ 10 l .0003 150,000

$ 176,000-$200,000
Greater than $200,000

Marital Status
Never Married
Married

Divorced/Separated
Widowed

Highest level of Education completed

High School
College 1-3 years
College Graduate
Postgraduate
Mean
Age in years 43
Mean
Health outcomes 10

Frequency

28
12
3
4

Frequency

3
4
12

NHUJQG

Frequency

13
26
4
4

Frequency

7

14
IO
16

Percent

26

Percent

6
9
26
32
15
6
2
4

Percent

28
SS
9
9

Percent

15
30
21
34

Minimum Maximum

24

79

Minimum Maximum

1

51

29
Table 2: Conelations

I-IEAOUT BOND SSFA SSFR SSDO

HEAOUT 1.00
(46)
BOND .22 1.00
(44) (45)
SSFA -.04 . 17 1.00
(45) (44) (46)
SSFR -. 16 .16 .32* 1.00
(46) (45) (46) (47)
SSDO .20 .57* .28 .29* 1.00
(46) (45) (46) (47) (47)
* p s .05

The second question asks, is there a correlation between the human-companion
animal bond and health outcomes (HEAOUT)? The correlation was not significant (r=.19,
pz. 18). The third question, is there a correlation between health outcomes and the
perceived social support from family, friends and companion dogs also turned out to be
not significant. Interestingly, health outcomes did not correlate significantly with any
other variable in the study.

The correlations among the three social support scales also revealed interesting
results. The well established perceived social support from family and friends correlated
well with each other (tr-.32, p=.03). The newly constructed perceived social support
from companion dogs correlated with perceived social support from friends (:29,
p=.05). Perceived social support from dogs was not significantly conelated with

perceived social support from family (r=.28, p=.06).

DISCUSSION

Perceived social support from friends correlated with perceived social support from
companion dogs. This suggests the possibility that the perceived social support provided
by friends and companion dogs may be similar in nature. The fact that perceived social
support from dogs correlated significantly with perceived social support from friends and
approached significance with perceived social support from family may indicate that with
some revisions this scale could be used to assess for social support from dogs, much in the
same way human social support is evaluated.

The correlation with perceived social support from dogs and the human-companion
animal bond suggests that a relationship exists between the two variables. This
relationship deserves further exploration. It suggests that the presence of a human-
companion animal bond may be necessary to perceive social support from companion dogs.
It is also possible that it does not. Perhaps using the perceived social support from
dogs scale may be useful in determining if a human-companion animal bond exists.

The correlation between perceived social support from friends and perceived social
support from family suggests that there is a relationship between these two types of
support. Perceived social support from companion dogs correlated with perceived social
support from friends and approached significance with perceived social support from
families (re—.28, p=.06). It is possible that with some adjustment of the perceived social
support from companion dogs scale that it will correlate more strongly with the perceived
social support from family scale. It is also possible that the lack of a significant correlation
between perceived social support from dogs and perceived social support from family
suggests that the support provided by dogs is different than that provided by family.

The lack of significance in the correlation between health outcomes and social
support may be a result of not determining the presence of stress in the lives of the
respondents. According to the buffer theory of social support, the presence of social

30

3 1
support is only beneficial during times of high stress and of no significance when there are
no stressors present (Cohen & Hoberrnan, 19$). There may also be other variables

which have not been considered and which may confound the variables considered in this

study.

The respondents in this study were very homogeneous. They were well educated
and all of the respondents were white. The sample was also very small. A larger sample
with more diversity may yield different results. A control group of female non pet owners
may also shed some light on some of these correlations. Gathering data in a non-
university town may also help increase the diversity of the sample. Further statistical
analysis of the created perceived social support from dogs scale may help strengthen its
usefulness and identify items that are more appropriate for use. In analyzing responses it
was clear that some of the questions regarding dogs were difficult to interpret. Question
number 12 of the social support from friends survey is, “My friends are good at helping
me solve problems”. Only 4 respondents (9%) answered “don’t know” and 40 (85%)
“agreed” or “strongly agreed”. Question number 12 of the perceived social support from
dogs is, “My dog helps me to solve problems”. Twenty of the respondents (43%) replied
“don’t know” and 14 (30%) “agreed” or “strongly agreed” on this item. Perhaps a
question about attachment would work better.

Implications for future research

As human—companion animal bond research has progressed, increasing attention is
being focused on the human social support paradigm. Because a significant correlation
was found between the human-companion animal bond and the perceived social support
from dogs, the perceived social support from companion dogs scale may well provide an
adequate measuring tool for predicting the presence of a human—companion animal bond

for future research or to help develop a separate scale for it. The relationship between

32
perceived social support from companion dogs and the human-companion bond warrants
further study to determine if there is causality. Must a human-companion animal bond
exist in order to perceive social support from companion dogs? The lack of a significant
correlation between the perceived social support from family and companion dogs
indicates that some refinement of the perceived social support from dogs scale is needed.
If this can be accomplished, research can more easily follow the path of human social
support studies to see if social support from companion dogs can confer the same type of
health benefits as reported in the literature on human social support. Future research in
this area will depend on empirical measurement of human-companion animal bond. A
valid measure of the human-companion animal bond would also be useful in other studies
involving the interaction of companion animals and humans. The development of a survey
tool depends on the consistency and validity over time and in multiple studies.

As pointed out earlier the lack of a correlation between health outcomes and social
support may be a result of a lack of measurement of stress in the lives of the respondents.
According to the buffering theory of social support, the presence or absence of social
support is unimportant unless stress is experienced. Future research should address this
by measuring respondents for stress. A larger sample from a more diverse population is
also necessary to strengthen results.

Future research should also evaluate whether or not social support from dogs has
an impact on men’ s health. Other direct benefits of dog ownership such as its impact on
depression, physical fitness, and loneliness should also continue to be studied. It would
also be of interest to see if social support from other species of pets can be measured in the
same manner as that of dogs. Another area to investigate would be to determine if social
support from dogs conveys any benefits to respondents who lack human social support.

A tool that can measure social support from dogs would make this possible.

33
Implications for the APN

Recognizing the significance of a family pet when assessing a family is an
important part of understanding the family as a whole. With over 50% of households
owning a pet (Allen, 1996; Cain, 1991; Haggerty-Davis & McCreary Juhasz, 1995;
Jorgenson, 1997) and at least 80% considering these pets family members (Cain, 19$;
Sussman, 1985) it is apparent that any time an assessment of support or family is
necessary the presence of pets and their importance to the family should also be assessed.
Relationships between the human and the pet can be used to encourage specific behaviors.
Some one embarking upon an exercise program may enjoy walking more if they take the
dog along. Stroking dogs has been shown to lower blood pressure levels. Perhaps
something as simple as telling a patient to pet their dog to relax can help to lower blood
pressures.

Lonely, depressed or isolated individuals may benefit from the company of a
companion animal. In this survey 84% (N=38) reported meeting people within the last
month because of their dog. The number of contacts reported ranged from 2 to greater
than 50.

For many, the rigors of pet ownership such as the expense, the training
requirements, and maintenance needs may present substantial obstacles to pet ownership.
Supporting the human-companion animal bond may necessitate finding additional
resources with in the community for patients. Additional precautions may be necessary
for clients with diseases that cause immuno-supression. Since the onset of the AIDS
crisis, guidelines have been developed to allow those with suppressed immune systems to
continue to enjoy the benefits of pet ownership. Pet walking services are available in
many communities or a neighbor can be utilized to do this chore. Some communities have
reduced fees for veterinary services at shelters or scholarship type funds for families with

low incomes to help cover the cost of veterinary care. Some veterinarians will make

34
house calls. The APN should be familiar with these resources in their communities in
order to make appropriate referrals. Recognizing and supporting the human-companion
animal bond is akin to providing the same type of services for other family members.

A good working knowledge of the human-companion animal bond may allow the
APN to tailor interventions for health outcome goals to specific families. The APN should
be familiar with community resources to help support the human-companion animal bond.
In the case of the immuno-supressed patient, the APN should be aware of current
guidelines for the maintenance of pets to ensure the safety of the patient. Understanding
the importance of the human-companion animal bond will help the APN to support the
relationship rather than recommend that the client get rid of a pet who has become a family
member. It is a more realistic goal to ensure that the pet is parasite free and clean than to
expect the surrender of a pet. Before recommending that a client acquire a pet, the APN
should research the animal and the client to ensure a good fit or refer the client to someone
more knowledgeable such as a veterinarian or the local animal shelter.

Before discussing the acquisition of a pet, the APN must consider a number of
factors. A knowledge of different species as well as different breeds of animals is
important, as well as an understanding of the expense and maintenance required for
upkeep. Indeed, not everyone wants or likes animals. This raises the question of how to
assess clients to determine if a companion animal may be appropriate. Studies have
shown that adults attitudes are highly correlated with previous exposure to pet animals
during childhood (Kidd & Kidd, 1980; Serpell, 1981). In this study 44 of the 47
respondents had pets during childhood. It also appears that people prefer as adults the
same type of pets that they had in childhood (Serpell, 1981). Therefore, assessing the
past pattern of pet ownership may yield important information about the possible benefits
of owning a pet for certain clients. Paul & Serpell, (1993) gave a questionnaire to college

students and asked them to indicate any pets they had in childhood and to quantify the

35

importance of the relationship they had with their pets. Those that reported having more
important pets in childhood also described their parents attitudes to pets as being more
positive. This suggests that while a pet may be an appropriate intervention for a child or
adolescent client, it may not work if the parents are not positively inclined. The
implication of this for the APN reiterates the need to assess the whole family for attitudes
towards companion animals before suggesting the acquisition of a pet. Other
considerations are things such as age of family members, allergies, environment, patient
lifestyle and resources. There may be young children in the home that could be
endangered by an animal or they may not be old enough to treat an animal with gentleness
and there by endanger the animal. If any family members have allergies to an animal, it
may be harmful to their health to bring an animal into the home. Certain pets such as dogs
require frequent walks and interaction with their owners. A person considering getting a
dog must be prepared to return home regularly for letting the animal outside. They need to
be aware that boarding a dog can be expensive. Pets are not welcome in many places and
therefore may limit travel. Caring for a pet can become very expensive. They require
veterinary care, medications, food, supplies and training. Before bringing a pet home,
families should be aware of these expenses.
Implications for nufirsingeducation

Nursing schools, at both the undergraduate and graduate levels must teach about
the importance of the human—companion animal bond. Over time the definition of family
has changed. Families may now be two same sexed partners, or close friends living
together whose biological family lives too far away for day to day support. More people
are living alone and there are more single parent families. We must expand our view of
families to include all of these possibilities and teach nursing students to include pets in
this constellation. By including pets in the definition of family, it is also inherent that they

must be included in the assessment of any family.

36

Nurses are taught to tailor interventions to individuals. They need to understand
the role of the family pet so that the human-companion animal relationship can be
incorporated into specific interventions such as being oriented to time, the need for
exercises or for biofeedback to reduce stress or blood pressure. An elderly client that has
difficulty remembering to take blood pressure medication could be instructed to take their
pill when they feed the dog. Clients may be more willing to walk if they understand the
importance of exercising the dog. If a hypertensive individual enjoys petting their dog,
they may find that it is easier to become relaxed if instructed to pet the dog when they are
stressed. Petting the dog may be useful for centering using bio-feedback techniques that
help reduce blood pressure.

The trend of increasing home care makes it imperative that nurses be taught about
zoonotic illnesses. A section on these should be added to pathophysiology classes. A
better understanding of the fact that the pet is a family member and the knowledge of how
to reduce the risk of zoonotic illnesses is necessary to prepare realistic therapeutic
interventions and goals. Nurses need to have a passing knowledge of immunizations for
pets and what is needed in time and financial commitments for acquiring, training and
maintaining a pet. They should be taught the current accepted guidelines for keeping pets
in the homes of clients that are immuno-supressed. Lectures on trauma and child safety
should include the dangers and consequences of animal bites. When discussing child
proofing a home for a new child, safety around pets should be included. Young children
should never be left alone with the family dog for example. In some instances it may be
necessary to remove an animal from the home as when a clients allergies and asthma are
aggravated or a specific animal is not tolerating a new family member. Nurses should be
taught that there may be community resources for pets available in their communities.
Many are unaware that there are organizations which provide funds for veterinary care for

low income people. Reduced cost spaying and neutering may be available at local

37
shelters. There are organizations which assist in the placement of pets into new homes.
Nurses should be instructed to develop collaborative relationships with veterinarians as
well as other health care professionals.

Conclusion

It is hoped that this study has delineated the importance of the human-animal
companion bond. Further it is hoped that a contribution has been made toward empirically
defining the human-companion animal bond. Animals have played a role in the
development of human civilization. It is time for the scientific community to recognize the
contribution of pets to our well being and to develop scientific theories to describe these

relationships. Only then can the actual risks and benefits of the human-companion animal
bond be determined.

Appendix A

38

APPENDIX A

Letter to Subjects

Attention Women Dog Owners,

Do your family, friends and pets influence your health? Studies have shown that
having friends and family available for support is helpful for healthy coping with everyday
life as well as during stressful times. Other studies are starting to show that pets can also
have a positive influence on our health. I am a graduate student in the College of Nursing
at Michigan State University. I am conducting a study for my thesis on the effects of
owning a dog and the effects of having human social support on women’s health. The
results of this study may help health care workers to develop strategies in care giving that
assess and use a larger arsenal of support for women.

Your voluntary agreement to participate is indicated by completing and returning
these questionnaires in the envelope that has been provided. The questionnaires will take
15—20 minutes to complete. Please do not write your name on the questionnaires. All
personal information provided by you will be treated confidentially. If you desire, I
would also be happy to share the results of the study with you.

If you have any further questions about this study, please feel free to call me at
(734) 663-4571 or Linda Spence, PhD, RN., my advisor at (517) 353-8684.

Thank you for your consideration.
Bela J. Selzer, RN

Appendix B

APPENDIXB

Pet Attitude Inventory

Directions: Circle the appropriate response.

I. What is your marital status?
1. Nevermarried
2. Married
3. Divorced/Separated
4. Widowed

2. On your last birthday, how old were you?
Write in,

 

3. What is your race?
. Black
White
Hispanic
Native American
Asian

Other. specify

99:959.“—

 

4. What is the highest level that you
completed in school?
1. Middle School
2. High School
3. College, 1-3 years
4. College graduate
5. Postgraduate

5. In what kind of housing do you live?

Single family

. Apartment

. Trailer

. Townhouse/Condo

. Institutional (e.g. nursing home)
. Other

N!"

GUI-Fm

6. What is your household average yearly
income?

Under $10,000

310,000-325,000

326,000-550,000

351,000-375,000

. $76,000-S 100,000

. $101,000-3150,000

31510006200000

Greater than $2(X),OOO

«somewwr

7. How would you rate your health over the
past year?
1. Excellent
2. Good
3. Fair
4. Poor

8. How many days have you been sick
in the last year? (Include colds, infections
hospitalizations. etc)

(Number of days)

9. How many times in the last year did you
see a Doctor because of illness?
(Number of times)

10. Have you had a serious physical illness,
injury or surgery in the past 12 months?
(Circle all that apply)

1. Serious physical illness
2. Injury

3. Surgery

4. None

Pet Survey

11. Did you grow up with pets?
I. Yes
2. No

12. When did you first have responsibility
for the care of a pet? (If answer is NEVER
go to question #16)
1. Never
2. Childhood (1-12 years)
3. Adolescence (13- 18 years)
4. Yormg Adult (19-30 years)
5. Middle Adult (31-61)
6. Older Adult (62 and older)

13. What kind of pet was it?
1. Bird
2. Cat

3.Dog
4.0ther

14. How attached were you to this pet?

1. Very attached
2. Attached
3. Not very attached

15. What happened to this pet?

I. Died
2. Gave it away (Reason)

3. Ranaway (disappeared)
4. Other

 

 

16. At what stage of your life did you have
pets? (Circle all that apply)

1. Childhood (1-12 years)

2. Adolescence (13-18 years)
3. Yormg Adult (19-30 years)
4. Middle Adult (31-61)

5. Older Adult (62 and older)

17. How many animals do you have now?

If you have more than one dog now, which one

1 Number of birds

2 Number of cats

3. Number of dogs

4 Number of other animals

are you the most attached to? (If you

cannot pick a favorite. choose the dog that you

have had the LONGEST.)

18. What is the name of this dog?

 

19. Why did you give it this name?

1. Don t know why

2. First name that came to mind

3. It looked like it’s name (e.g. Spot
because it had spots)

4. Named it after a friend or relative

5. To explain a characteristic (e. g.
Trouble since he was always in

trouble)
6. Was already named when I got it
7. Other

 

20. Have you ever had another pet with this

name?

I. Yes
2. No

21. Is this dog male or female?

1. Male
2. Female

22. Is this dog spayed or neutered (fixed)?

26.

27.

29.

(If YES. go to question #24)
1. Yes
2. No

If NO, what is the primary reason?
. Want puppies

. Don’t like the idea

Makes them fat

Makes them lazy

Too expensive

Too much trouble

Other

HQMPPN"

 

How long have youhadthis dog?
1. Lessthanoneyear
2. 1-5years
3. 6-10 years
4. Morethan 10 years

How old is your dog now?
1. Less than one year
2. 1-5 years
3. 6-10 years
4. More than 10 years

How did you get this dog?
Adopted from a shelter
Born to a dog I already own
. Bought the dog

Gift

. Stray (just showed up)
Other

.O‘U'P‘NNE"

 

People have different attachments
to their dogs. How attached are you
to your dog?
1. Very attached
2. Attached
3. Not very attached
4. Not attached

. How often does your dog stay inside

your house or apartment?
I. Always stays inside
2. Frequently stays inside
3. Seldom stays inside
4. Never allowed inside

Who usually takes the most care of
this pet?
I. Yourself
2. Other household member

30. How much time (on an average daily
basis) do you spend doing something
with or for your dog, such as grooming,
petting, walking, or feeding it?

1. One hour or less
2. More than one hour

31. Is the time spent in these activities...
I. Enjoyable?
2. Somewhat enjoyable?
3. Not enjoyable?

32. Does touching your dog...
I. Make you feel better?
2. Make no difference in how
how you feel?
3. Make you feel worse?

33. When you physically feel bad. does
your dog...
I. Make you feel better?
2. Make no difference in how
how you feel?
3. Make you feel worse?

34. When you are feeling sad, does your

1. Make you feel better?

2. Make no difference in how
how you feel?

3. Make you feel worse?

35. If you were to take a trip, would
you most likely...

1. Board the dog?

2. Find someone to care for the
dog in their home?

3. Have someone come into your
home to care for the dog?

4. Take the dog with you?

5. Other

 

36. Do you worry about your dog’s
future if something were to happen
to happen to you?

I. Yes
2. No

41

37. If you were hospitalized, who would
take care of your dog?
1. Family
2. Friend or neighbors
3. Kennel
4. No one
5. Other

 

38. If you could find someone who
would care for your dog in a loving
manner, would you give it up?

I. Yes
2. No
3. Don’t know

39. Doyoutalktoyourdogotherthan
giving it instructions such as sit, come,
etc?? (If NO. go to question #44)

I. No
2. Yes

40. If YES, when do you talk to your
dog? (Circle all that apply)
1. When I am upset
2. When I am happy
3. When there is no one else
to talk to.
4. Other

 

41. How often do you talk to your dog?
I. A lot
2. A little

42. Does your dog respond when you
talk to it?
1. Yes
2. No

43. Do you confide in your dog? (If NO,
go to question #46)
1. No
2. Yes

44. If YES, do you confide in your dog
more easily than a person? (If No.
go to question #46)
1. No
2. Yes

45. If YES, why?
1. Does not judge me
2. Doesnotalkbacktome
3. Loves me regardless of
what I say
4. No one else to talk to
5. Other

 

46. Have you interacted with people
because of your dog? (e. g. do you talk
to your neighbors when out walking
the dog?) (If NO. go to question #48)

1. Yes
2. No

47. If YES, how many different people
have you spoken to in a month’s time
because of the dog?

(Number of people)

48. Do you talk with other people about
your dog?
I. Yes
2. No

49. How much companionship does
your dog give you?
1. A lot
2. A little
3. None

50. If your dog died. would you get another
one?
I. Yes
2. No
3. Maybe

51. Is owning your dog a burden? (If
NEVER, go to question #53)
1. Never
2. Sometimes
3. Always

52. If SOMETIMES or ALWAYS. why?
1. Costs too much
2. It is a nuisance
3. Hard to get away from home
4. Tears things up
5. Other

 

42

53. What is your reason(s) for having a
dog? (Circle all that apply)

1.

S"

I enjoy (love) animals

2. I want a pet for protection
3.
4. I want something to take

I want some companionship

care of.
I want something to keep me
busy
I was given this dog
Other

 

54. Ofalloftheresponsescircledin
question #53, which is the MOST
important reason? (Enter the number
from the answer in #53)

 

This is the end of the Pet Attitude Inventory.
Please continue and fill out the Family, Friends
and Dog support questionnaires on the next few

pages»-

 

Appendix C

43
APPENDIX C
Perceived Social Support from Family Survey
Directions: The statements which follow refer to feelings and experiences which occur to most people at

one time or another in their relationships with family. For each statement there are five possible answers:

Strongly agree, agree, don’t know, disagree and strongly disagree. Please check the answer that you choose
fcr each item.

strongly don’t strongly
a as: know Mam

 

 

1. My familygives me the moral support I need.

2. I get good ideas about how to do things or
make milgs from my familL

3. Most other people are closer to their family
than I am.

4. When I confide in members of my family who
are closest to me, I get the idea that it makes

them uncomfortable.

5. My family enjoys hearing about what I think.

6. Members of my family share many of my
mterests.

7. Certain members of my family come to me

when they have problems or need advice.

I rely on my family for emotional support.

9. There is a member of my family I could go to
if I were just feeling down. without feeling

funny about it later.

10. My family and I are very open about what we

think about things.

11. My family is sensitive to my personal needs.

12. Members of my family come to me for
emotional support.

13. Members of my family are good at helping
me solve problems.

14. I have a deep sharing relationship with a
number of members of my family

15. Members of my family get good ideas about
how to do things or make thirgs from me.

16. When I confide in members of my family, it
makes me uncomfortable.

17. Members of my family seek me out for
companionship.

I8. I think that my family feels that I’m good at
helping them solve problems.

19. I don’t have a relationship with members of
my family that is as close as other people’s
relationships with family members.

20. I wish my famileere much different.

 

 

 

 

 

 

 

9°

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix D

44

APPENDIX D

Perceived Social Support from Friends Survey

Directions: The statements which follow refer to feelings and experiences which occur to most people at
one time or another in their relationships with friends. For each statement there are five possible answers:

Strongly agree. agree. don’t know. disagree and strongly disagree. Please check the answer that you choose
for each item.

strongly

 

My friends give me the moral support I need.

don’t strongly

know diam m

 

 

N!"

. Most other people are closer to their friends

thanlam.

 

My friends enjoy heant about what I think

 

Certain friends come to me when they have

problems or need advice.

 

I rely on my friends for emotional support.

 

If I felt that one or more of my friends were
upset with me, I’d just keep it to myself.

 

I feel that I’m on the fringe in my circle of
friends.

 

There is a friend I could go to if I were just

feeling down, without feeling funny about it
later.

 

My friends and I are very open about what we
think about things.

 

10.

My friends are sensitive to my personal
needs.

 

11.

My friends come to me for emotional
support.

 

12.

My friends are good at helping me solve
problems.

 

13.

I have a deep sharing relationship with a
number of friends.

 

14.

My friends get good ideas about how to do
things or make things from me.

 

15.

When I confide in friends, it makes me feel
uncomfortable.

 

16.

My friends seek me out for companionship.

 

I7.

I think that my friends feel that I‘m good at
helping_them solve problems.

 

18.

I don’t have a relationship with a friend that

is as intimate as other people’s relationships
with friends.

 

19.

I’ve recently gotten a good idea about how to
do someminjimm a friend.

 

 

20.

I wish my friends were much different.

 

 

 

 

 

 

 

Appendix E

45

APPENDIXE

Perceived Social Support from Dogs Survey

Directions: The statements which follow refer to feelings and experiences which occur to most people at
one time or another in their relationships with dogs. For each statement there are five possible answers:

Strongly agree. agree, don’t know, disagree and strongly disagree. Please check the answer that you choose
fa each item.

strongly don’t

 

My Mes me moral support.

 

821—123!“ know disa%

strongly
m

 

N!"

. Mostotherpeopleareclosertotheirdogthan

Iam.

 

My dogem’oys it when I talk to him/her.

 

My dog expects me to care for him/her, and
needs my assistance.

 

.V'

I rely on my dog for emotional support.

 

It would not bother me if my dog were upset
with me.

 

>3

I am not important to my dog.

 

Icanspendtime withmydogwhenlam
feeling down, with out feeling funny about it
later.

 

Icanbeveryopenaboutwhatlthinkandfeel
with my dog

 

10.

My dog is sensitive to my feelings.

 

II.

My dog comes to me for emotional support
(love. affection).

 

12.

My dongelps me to solve problems.

 

I3.

I have a sharing relationship with my dog.

 

14.

My drrgiearns how to behave from me.

 

15.

When I confide in my dog. it makes me
uncomfortable.

 

16.

My dog seeks me out for companionship.

 

I7.

I think that my dog appreciates the life that I
give him/her.

 

18.

My relationship with my dog is not as close
as other people’s relationships with their
dogs.

 

I9.

I have recently learned something from my
d g.

 

 

20.

I wish my dog was much different.

 

 

 

 

 

 

 

Appendix F

 

OFFICE or
RESEARCH
AND
GRADUATE
STUDflfii

U niversity Committee
Research Involving
Human Subjects
(UCRIIIS)

Michigan State University
246 Administration Building
East Lansing. Michigan
4&ucmm

517355-2180
FAX: 517/432-1171

7‘2 Uirniqrn Stile Unimsrtv
IDEA rs Institution)! DivaSIly'
harm it Add!

P. .’SU '3 It Him-£11m.
6.;me minim

   
  
  

46
APPENDIX F
UCRIHS Approval

MICHIGAN STATE

 

lJ b1 I‘V

March 25.

E II S I 'I Y

1998

TO: Linda S ence_
A230 Li e Sc1ences

RE: IRBII:

98-176

TITLE: WOMEN'S HEALTH OUTCOMES WITH SOCIAL SUPPORT FROM

FAMILY, FRIENDS AND COMPANION DOGS

REVISION REQUESTED: N/A
CATEGORY: l-C
APPROVAL DATE: 03/19/98

The University Committee on Research Involving Human Subjects'IUCRIRS)
review of this project is complete.. I am pleased to adv1se that the
rights and welfare of the human subjects appear to be adequately
protected and methods to obtain informed consent are appropriate.

herefore,
above.

RENEWAL:

REVISIONS :

PROBLEMS /
CHANGES :

If we can be of any future hel

the UCRIHS approved this project and any rev1Sions listed

UCRIRS approval is valid for one calendar year, beginning with
the approval date shown above. Investigators planning to
continue a project beyond one year must use the green renewal
form (enclosed with t e original approval letter or when a_
project is renewed) to seek u date certification. There is a
maximum of four such expedite renewals p0551ble. Investigators

wishing to continue a project beyond that time need to submit it
again or complete reView.

UCRIHS must review any changes in procedures involving human
subjects, prior to initiation of t e change. If this is done a:
the time or renewal, please use the green renewal_£orm. To
revise an approved protocol at any other time during the year,
send your written request to the CRIHS Chair, requesting revised
approval and referencing the project's IRE # and title. Include
in your request a description of the change and any revised
instruments, consent forms or advertisements that are applicable.

Should either of the following arise during the course of the
work, investigators must notif UCRIHS promptly: (1) roblems
(unexpected side effects, comp aints, etc.) involving uman
subjects or (2) changes in the research environment or new
intormation indicating greater risk to the human subjects than
ex1sted when the protocol was previously reviewed and approved.

lease do not hesitate to contact us

at (517)355-2180 or FAX (517)4gé- 171.

Sincerely,

DEW : bed

. l‘r

vid E. Wright, P .D.
CRIHS Chair ‘

cc: Bela J. Selzer

 

LIST OF REFERENCES

 

47

List of References

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Allen, K.M., Blascovich, J.. Tomaka, J., & Kelsey, RM. (1991). Presence of
Human friends and pet dogs as moderators of autonomic responses to stress rn women.

Beck, A. & Katcher, A. (1996). Between Pets and People. IN: Purdue
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Baun, M.M., Bergstrom, N., Langston, N.F., & Thoma, L. (1984).

Physiological effects of human/companion animal bonding. Nursin Research 33(3),
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Baun, M.M., Oetting, K., & Bergstrom, N. (1991). Animals in relation to the
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Cain, A0. (1983). A study of pets in the family system. In: A.H. Katcher, &

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Callaghan, P. & Morrissey, J. (1993). Social support and health: a review.
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Cohen, S. & Hoberrnan, HM. (1983). Positive events and social supports as
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Coren, S. (1994). The Intelligence of Dogs. NY: The Free Press.

Courtens, A.M., Stevens, F.C.J., Crebolder, H.F.J.M. & Philipsen, H. (1996).
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Ducharme, F., Stevens, B. & Rowat, K. (1994).. Social support: conceptual and
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Fitzpatrick, J.. & Whall, A. (1996). Conceptual models of nursing: analysis and
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48

Francis,G.M. (1991). “Here come the puppies”: the power of the human-animal
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Garrity, T.P., & Stallones, L, Marx, M.B., & Johnson, T.P. (1989). Pet
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Gill, D.M. & Stone, D.M. (1992). The veterinarian’s role in the AIDS crisis.
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Gorczyca, K. (1990). Special needs for the pet owner with AIDS/HIV. 31.9. i, _
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Haggerty-Davis, J., & McCreary-Juhasz, A. (1995). The preadosescent/pet
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Harrison, M.J., Neufeld, A. & Kushner, K (1995). Women in transition: access
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