O R I G I N A L A R T I C L E Assessment of health, well-being and social connections: A survey of women living in Western Sydney Rhonda Griffiths RN CM B.Ed(Nursing) M.Sc(Hons) DrPH Professor, Director, South Western Sydney Centre for Applied Nursing Research, University of Western Sydney, Penrith South Distribution Centre, and South Western Sydney Area Health Service, Liverpool, New South Wales, Australia Jan Horsfall RN BA(Hons) MA(Hons) PhD Senior Lecturer, University of Western Sydney, Penrith South Distribution Centre, New South Wales, Australia Margo Moore RN BA(Hons) MPH Area Coordinator of Women���s Health, South Western Sydney Area Health Service, Liverpool, New South Wales, Australia Di Lane RN BA Program Manager of Women���s Health, South Western Sydney Area Health Service, Liverpool, New South Wales, Australia Veronica Kroon RN CN BA Cert. Clinical Nurse Consultant of Women���s Health, South Western Sydney Area Health Service, Liverpool, New South Wales, Australia Rachel Langdon BAppSci BA(Hons) Research Assistant, South Western Sydney Centre for Applied Nursing Research, University of Western Sydney, Penrith South Distribution Centre, and South Western Sydney Area Health Service, Liverpool, New South Wales, Australia Accepted for publication 4 May 2006 Griffiths R, Horsfall J, Moore M, Lane D, Kroon V, Langdon R. International Journal of Nursing Practice 2007 13: 3���13 Assessment of health, well-being and social connections: A survey of women living in western sydney Strengthening the physical and social environment has been shown to support health and strengthen community action for health. In an attempt to improve the social factors that influence the health of individuals and the community, community interventions increasingly include strategies to build networks and social capital and develop resilience. This study was undertaken to identify the most appropriate strategies to strengthen friendships and the social support networks for women aged 18���39 years living in Villawood, an area of high disadvantage in South Western Sydney, Australia. Although the majority reported positively on their health, one-third reported feeling isolated, experienced low energy levels and felt unhappy and anxious over the past month. Women who described themselves as unemployed felt more isolated than women in home duties. Women who were employed or engaged in home duties had more contact with neighbours, and had more in common with their neighbours. Those who reported more contact with their neighbours perceived their mental health Correspondence: Rhonda Griffiths, SWS Centre for Applied Nursing Research, Locked Bag 7103, Liverpool BC, NSW 1871, Australia. Email: rhonda.griffiths@swsahs.nsw.gov.au International Journal of Nursing Practice 2007 13: 3���13 doi:10.1111/j.1440-172X.2006.00606.x �� 2006 The Authors Journal compilation �� 2006 Blackwell Publishing Asia Pty Ltd

level as being higher. These results indicate that community development initiatives should include consultation with the community and consider the needs of socially isolated groups and those with the poorest health status. Key words: community support, social disadvantage, social support, vulnerable groups. INTRODUCTION Health outcomes for individuals and communities are influenced by geographical, socioeconomic and other social variations and, as a consequence, certain groups in society suffer poorer health outcomes than others.1���3 Nurses play an important and expanding role to identify situations that have the potential to compromise the well- being and functioning of individuals, families and commu- nities and to initiate remedial actions before they manifest as mental and physical disorders or injury. The research was undertaken at Villawood, a suburb of high social and economic disadvantage within the Bank- stown Local Government Area of South Western Sydney, New South Wales (NSW). Nearly two-thirds (61.9%) of the people living in that area earn $25 480/year (the lowest income quartile) compared with 25% in the greater Sydney area and 30.8% for NSW.4 The overall unemployment rate is 19.8%4 compared with a national average of 5.0%.5 The suburb is characterized by a high proportion of public housing and single parent families, and 52.4% of residents speak a language other than English at home.4 Study aims There were two primary aims in undertaking the research reported here. The first was to obtain data to inform development of a community-support programme to be established by Women���s Health Nurses. The second was to determine whether women living in an environment of high social and economic disadvantage also report poor mental and physical health, a lack of social cohesion in the community and weak personal social supports. The survey focused on describing: ��� Perceptions of social cohesion and networks ��� Perceptions and extent of physical and mental well- being, including a comparison to the Australian Longi- tudinal Study 6 ��� Knowledge of and access to local community services ��� Safety and perceptions of safety and ��� Community strengths and weaknesses. Ethics Ethics approval for the study was obtained from both the South Western Sydney Area Health Service Research Ethics Committee and the University of Western Sydney Human Research Ethics Committee. Literature review The factors influencing health differentials and inequities have been described extensively in both Australian7���10 and international literature.3,11���17 The findings are conclusive: in all situations, socioeconomic status is strongly associ- ated with a nation���s mortality and life expectancy.18,19 The most disadvantaged quintile of the Australian population has the highest rates of premature death for both men and women, and those who are unemployed have poorer physical and mental health than people who are employed.11,14,19,20 Similarly, those who have a lower education level are also more likely to have poorer physi- cal and mental health.21 Finally, people from ethnic and cultural minority groups may not have equal access to health care.22���24 Mental health disorders have also been linked with poverty, powerlessness, stress and alienation.25���27 Unem- ployed women and those working in low-status jobs with little power and control report the highest level of men- tal28 and physical health problems.17 A longitudinal study conducted by Women���s Health Australia6,29 found that among women aged 18���25 years, the most common causes of stress were work or employment issues, money and study. The stress associated with physical and sexual assault, sexual harassment and discrimination, unwanted pregnancy, divorce, poverty and powerlessness also con- tribute to the development of depression in this group. The most common way of coping was talking to a good friend.30 However, women living in the areas of higher unemployment have been found to have less contact with local friends.3 In Australia, there has been a shift in the focus of health care from institutional (hospital) based care to community-based care.31 The role of community health nurses has expanded to include responding to potential 4 R Griffiths et al. �� 2006 The Authors Journal compilation �� 2006 Blackwell Publishing Asia Pty Ltd