1 Research Report: An Evaluation of the Wheelchair Tennis Development Fund Emma Richardson & Dr. Anthony Papathomas, Loughborough University 1. Introduction and rationale Physical disability can cause significant psychological trauma including depression, anxiety and low self-esteem . Persons with a disability are also more at risk of isolation from society . These psychological and sociological consequences can have a damaging effect on a disabled individual s quality of life. Research has shown that disabled people in developing countries also face economic and cultural difficulties. These include lack of education and employment, high levels of poverty, prejudice and ostracism from society . Such challenges place an additional strain on an individual s psychological well-being, general health and quality of life. To combat these negative outcomes, tool in enhancing psychological well-being and quality of life . However, there is currently limited evidence to support the role of playing wheelchair tennis in improving the lives of disabled people. Furthermore, research has rarely explored the impact of sport on disabled individuals from developing nations. The following report therefore represents one of the first scientific studies to address how participating in wheelchair tennis effects the lives of individuals across a variety of developing nations. The setting for this research was the work of the Wheelchair Tennis Development Fund (WTDF) an International Tennis Federation (ITF) initiative that seeks to provide life-enhancing wheelchair tennis opportunities in nations where such opportunities are limited. research has found sport to be an effective
2 Aims and objectives The broad aim of this study was to conduct the first formal evaluation of the WTDF. Specifically, the objectives of the study were to Explore the perceived impact of playing wheelchair tennis. Explore the psychosocial benefits of playing wheelchair tennis. Identify the perceived strengths of the WTDF as noted by players, coaches and officials. Identify perceived areas for improvement for the WTDF as noted by players, coaches and officials. Provide the WTDF with recommendations for future practice. 2. Methodology This research was granted formal ethical approval from Loughborough University s Ethical Advisory Board. All procedures are guaranteed to meet stringent ethical standards. Semi-structured interviews served as the main form of data collection. A semistructured interview is an open interview allowing participants the freedom to speak about topics they feel are important. However, researchers still have the ability to guide the interview to guarantee specific areas of interest are covered. This ensures reliable, comparable data is generated . To ensure a complete and rigorous investigation, a sample of wheelchair tennis players, coaches, National Governing Body (NGB) officials and WTDF officials were consulted. In total, 32 participants were interviewed; 16 players, 6 coaches, 5 NGB officials and 5 WTDF officials. Within this sample, a total of 10 different countries were represented. Accessing a variety of participating nations worked to ensure a
3 diverse range of experiences could be explored and a more balanced and intricate evaluation achieved. Full participant demographics are displayed in Table 2. Participants were interviewed either face to face or via Skype due to the large geographical area covered in this study. Thirty interviews were conducted face-toface in four different locations; a development tournament in Turkey, the British Open in Nottingham, the LTA National Tennis Academy in Roehampton and the All England Lawn Tennis Club in Wimbledon. Two participants were interviewed via Skype. Interview duration was between 20 minutes and two hours. After the interviews were conducted, they were transcribed verbatim and analysed using a recognised 6 Stages Thematic Analysis process. Table 1 highlights the details associated with each stage. Table 1: Stages of Thematic Analysis 1. Immersion in the data Familiarisation with the interview data through full transcription and repeated readings. 2. Initial coding of data Generating a list of ideas through noting concepts of interest. 3. Searching for themes Grouping identified concepts into areas of commonality/similarity to form themes and sub-themes. 4. Review of themes Reviewing themes to ensure they fully reflect data. 5. Naming of themes Naming themes to reflect their content. Sub-themes are also reviewed to determine if they have been placed in the right theme. 6. Producing report A comprehensive report is produced to present results.
4 Table 2: Participant Demographics Name Gender Age Country Role Injury Years Current level Represented in WT Kim F 25 British WTDF None 4 N/A Official Andrew M British WTDF None 32 N/A Official David M British WTDF None 5 N/A Official Michael M British WTDF None 10 N/A Official Ahmad M 30 Iran Player Polio 15 National Fahrrouk M 58 Iran Coach None 15 N/A Mansoor M 36 Iran Player Polio 15 National Sanjaar M 50 Iran Official Double 1 N/A amputation Johan M Mexico Official None 8 N/A Youssuf M 23 Morocco Player Virus 6 National Helen F Netherlands WTDF Acquired 22 N/A Official Catalina F 29 Romania Coach None 7 N/A Andrei M 21 Romania Player SCI <1 National Dimitri M 28 Romania Player SCI <1 National Stanislav M 33 Romania Player SCI <1 National Kifensi F 27 South Africa Player Congenital 7 National (Quad) Dikelidi M 26 South Africa Player Triple 6 National (Quad) amputation Francois M South Africa Official None 16 N/A James M Tanzania Official None 5 N/A Jasmine F 18 Turkey Player Congenital 4 National Liz F 62 Turkey Official None 8 National Nursen F 31 Turkey Player Spinal cord 3 National injury (SCI) Raquel F 25 Turkey Player Polio 2 National Barak M 33 Turkey Player Double 7 National amputation Hakan M 40 Turkey Player Polio 1 Development Salim M 36 Turkey Coach None 6 N/A Kaan M 32 Turkey Player Polio 7 National Osman M 42 Turkey Coach Congenital 10 N/A Turan M 28 Turkey Coach Congenital 9 N/A Jamil M 50 Yemen Coach None 30 N/A Mohammad M 35 Yemen Player Polio 2 Development Yasser M 22 Yemen Player Hip injury >1 Development
5 3. Results Four key themes emerged from the data analysis; 1.) Psychological benefits of wheelchair tennis 2.) Social benefits of wheelchair tennis 3.) Strengths of the WTDF and 4.) Areas for WTDF development. These themes are now discussed in detail. disability and d.) improved physical health. a.) Increased self-confidence Self-confidence is a person s belief in their own abilities: I can do everything myself. I don t need anyone. I can sit in this chair, get in my bed and go to university I don t need my mum to take me. I can do everything now. Jasmine, Turkish Player Increased self-confidence was viewed as a consequence of Psychological Benefits of Wheelchair Tennis The psychological well-being of participants was significantly impacted in four definitive ways; a.) increased selfconfidence b.) increased opportunities and independence c.) improved perceptions of participating in wheelchair tennis but something that also transferred to other life domains such as home and school life As my self-confidence improved, so did my performance at school. I was able to interact with people and communicate in
6 new ways and this greatly increased my circle of friends and acquaintances. opportunities and facilitated personal independence. Turan, former player (now coach). WTDF officials also recognised the impact of wheelchair tennis on player selfconfidence: And I ve seen lots of people who were Sports scholarships to university. Three players won sports scholarships to attend university through their participation in wheelchair tennis: like not feeling very well, they feel like a disabled person, very unlucky, to all of a sudden achieving something Get them some self-confidence, make them fitter and because of all these positive effects they achieve a much better life. That s what the Silver Fund is all about their disability is not their main obstacle anymore but just something that belongs to them and they have to deal with it. Helen, WTDF official. b.) Increased opportunities and independence Players reported the ways wheelchair tennis contributed to work and education it (wheelchair tennis) gave me my scholarship which is an opportunity. So it s not only for tennis but also for your life. Kifensi, South African player. Enhanced independence. Involvement in wheelchair tennis was seen as a means to develop transferable life-skills that supported increased independence. It teaches them independence and stuff So like getting in and out of the car. Ok there are some techniques to getting in and out, put arms here and push yourself or getting in and out and putting the chair in the car there are some techniques which makes it a lot easier The 21 year old girl,
7 it took about 45 minutes to get her from the chair into the car and then the chair into her car. right now she is doing it in less than 2 or 3 minutes. Johan, Mexican official. opportunity to travel independently and experience different cultures: It was my first time on a plane. I was 18. It really was something new for me. The plane, the sky, looking at from higher Employment gained through wheelchair tennis. Former players have gained employment as coaches due to their experiences of wheelchair tennis and being supported to complete coaching qualifications. Fulfilling ambitions. Coaches also noted how they were given the opportunity to fulfil their goals and ambitions: place I like to discover different cultures, how they live, how they see life, what is different between our food and their food, clothes, something like this I see that I can travel. It s difficult in Morocco to travel. Youssuf, Moroccan player. Almost as a gift from God, wheelchair tennis helped me to accomplish my biggest dream. Ozman, Turkish coach c.) Improved perceptions of disability Increased opportunity to travel independently. Players reported the value presented by the Wheelchair tennis has the potential to improve self-perceptions and socialperceptions of disability.
8 Improved perception of self. Wheelchair tennis players stated that the sport helped improve their own disability perceptions and duly increased their feelings of selfworth: participation in wheelchair tennis questioned this belief: many people believe that God did this to them and the reason that they are disabled is something that s a punishment. So if we get them out the house to the centre it I had the (negative) mentality of Romanians because I lived among them. But, as time goes, I grow up and I realize that I don t have to be ashamed of myself. I am who I am. I have a brain. I can think. So I have a disability, a physical disability but I can almost do anything everybody else can do. Many, many, many times I forgot that I have one disability Dimitri, Romanian Player Challenging disability prejudice. In some countries, the occurrence of disability is explained as a punishment from God leading to isolation and prejudice. Players and coaches noted that changes how people think about what it is, why a disability is there. Fahrrouk, Iranian Coach. Increased empowerment for women. The role of the WDTF in facilitating female empowerment was acknowledged by an official: Society changes in some of the countries as well especially when you re looking at the Middle East region. Women don t have any rights so suddenly if they ve got a right to play tennis that s a right that they don t have in society so it s not even tennis. It s looking at the whole foundation, their whole society that they actually start to have a bit of empowerment. Kim, WTDF official.
9 Theme Summary Disabled individuals supported by the WTDF report numerous psychological benefits associated with playing wheelchair tennis. Players stated that participation in wheelchair tennis led to increased self-confidence, increased opportunities and independence and improved perceptions of disability. In summary, wheelchair tennis has a positive Particular mention was given to the following key areas a.) improved social life b.) perceived social support from coaches and officials, and c.) knowledge exchange opportunities a.) Improved social life Players noted that their social life was greatly improved through participation in wheelchair tennis. impact on overall psychological health and quality of life. Social Benefits of Wheelchair Tennis Making friends from different cultures. Through travelling to different tournaments, players met others from different countries and cultures forming friendships. Friends from own country. Players also met new, like-minded friends from within their own squad. before the times I am not ok because I think that I didn t walk and that maybe Wheelchair tennis also positively impacted the social well-being of players. nobody would talk to me but after tennis we are a team and we improved our social
10 life you know all the tournament people come to the organization and then I know new people all of my friends, maybe my one of my priorities because she has put so much time into it and give something back to her. Stanislav, Romanian player. best friends. Kaan, Turkish player. b.) Perceived Social Support from Coaches and Officials Players highlighted their appreciation for the dedication, commitment and sacrifices made by coaches and officials to provide wheelchair tennis programmes. For example many coaches and officials work as volunteers. Some have quit fulltime, paid employment to provide coaching for players. These sacrifices make players feel wanted, supported and worth someone s time and effort. An example of the types of sacrifices made is highlighted below: She loves the game so much that she doing this for volunteer I feel I should pay her something for she comes all the times to train us and she could do something else I don t want to disappoint the coach. This again is c.) Knowledge exchange opportunities Participating in wheelchair tennis provided the players with an opportunity to interact with other people with physical disabilities. For some of the players this was a valuable way to learn about how others managed a disability. Knowledge and ideas could be shared across cultures: you talk a lot about tennis but you can learn much more about something else than tennis if you really want. I met a guy from Scandinavia and we talked about prosthetics about new types of prosthetic
11 only available in Sweden Andrei, Romanian player. Theme Summary Disabled individuals supported by the WTDF reported several social benefits associated with playing wheelchair tennis. Players stated that participation in wheelchair tennis led to an improved social life and to feeling valued due to the sacrifices of others. Further, the wheelchair tennis circuit provided an opportunity for disabled individuals from developing nations to learn more about the nature of their disability and effective ways to manage it. In summary, wheelchair tennis has a positive impact on overall social health. Strengths of the WTDF Players, coaches and officials identified two broad strengths of the WTDF: a.) effective social support provision and b.) structural strengths. a.) Effective social support Social support involves the provision of supporting behaviours from one individual to another. Receiving effective social support is associated with better psychosocial health. Players, coaches and officials described the work of the WTDF as providing wheelchair tennis development players with 4 different types of support. Emotional support concerns support related to emotions. It can take the form of active encouragement, positive reinforcement or simply listening. One player identified the emotional support of the WTDF to be as vital as financial support: The encouragement that the WTDF does...the encouragement of course! Everyone thinks you can have all the new equipment in the world but what the WTDF is, is that it keeps people, it s the
12 encouragement and the people that comes and the encouragement and the support and the training Fahrrouk, Iranian official. that comes it s not monetary you can have all the equipment in the world and it s not enough it s the (pats interviewer on the shoulder) it s that and that s what the Development Fund does. Raquel, Turkish player Information support concerns support related to knowledge and education provision. Coaches and official noted this type of support invaluable to the development of wheelchair tennis programmes. Tangible support concerns support related to concrete provisions such as finance or equipment. All participants were aware of the monetary support given by the WTDF (e.g. wheelchair donations, development camps and tournament assistance): Through the guidance of the WTDF, players coaches and officials were better informed on how to use wheelchairs, disability in general, how to coach and how to run programmes: Michael went to Nigeria with one of the coaches and went to a house where a girl the ITF has 2 different development camps with us. They also donated 15 chairs for our development they didn t give us money. They gave camps and the who did have a nice wheelchair but she didn t want to do it or know how to use it. Now she s playing wheelchair tennis. Helen, WTDF official. training and also with the invitations it was actually the people who came to visit
13 be able to meet them. You would never be able to introduce yourself to them and so it s our language for friendship Sanjaar, Iranian official b.) Structural Strengths Companion support concerns support related to the presence of strong relationships and personal bonds. This type of support increases feelings of belonging, Players, coaches and officials noted strengths within the structural composition of the WTDF. This ranged from the aims and objectives of the programme to the developmental processes in place. support and social well-being. Inclusion of women Players, coaches and officials stated that they felt part of a family within the WTDF: we feel like part of the family we feel like a child of the ITF Development Fund look at all the friends and joy I ve gotten from this tournament, it s not possible I mean how would we have met each other Because the sport becomes your language, without it you would never find all these people together. You would never Although a taken-for-granted assumption for many, the promotion of female participants was identified as definite strength: It s not just men, new men, not just juniors, that was the big thing 25%, I saw that 25% women. That one of the goals the foundation principles is that increasing in the participation is participation of women. And so all of a sudden I thought well if I can t get these
14 juniors out of school what about the women who aren t working Now we have a women s national team with two people in the top 30, this is all in the last 4 years another one in the, you know the junior, then they can believe that they can go on and they might go to school, they might go to university, they might actually suddenly believe that they have aspirations. Kim, WTDF official 50s. I mean, it s not all about ranking but what ranking shows you is that something has changed in their ability to travel. Liz, Turkish official. Reward based structure. Players highlighted that the requirements set by WTDF increased their motivation to train and improve Promotion of juniors. The emphasis on junior inclusion was highlighted as key structural strength. It was considered vital to the sustainability of wheelchair tennis in developing nations. It was also considered essential for disabled individuals to reap the wider benefits of wheelchair tennis as early as possible: getting the juniors involved is vital for the future of the sport you ve also got such an ability to influence their lives as a before the next tournament. Further, the requirement for developing nations to get women and juniors involved and to target holding their own tournament was an additional source of motivation to those benefiting from the WTDF: Some of the requirements that the WTDF gives to us motivate us to go out and work harder if we do those things we ll reach more and more people Racquel, Turkish player. junior. If you can make a difference to a
15 Some coaches acknowledged their accountability to continue the work of the WTDF: development tournament or camp allowed players an opportunity to compete formally, travel and also raise how could you find a bigger success? In able bodied tennis can you give any example of this kind of success? Absolutely not. There isn t The ITF are the ones who opened this road or this door now it s the federations, it s the sponsor, it s up to us to help keep it going. Ozman, Turkish coach. awareness of themselves as tennis players: Development has helped them in the futures tournament. By having a futures tournament you can get points. And you have points to get on the ranking. And once you re on the ranking then people can see you and that s how it helps Development camps pathways. A development. Mansoor, Iranian player. key structural strength noted by players was opportunities to attend development tournaments and camps. Attending an organised Development camps were also acknowledged as a key means to achieving the previously identified psychological and social benefits that come from playing wheelchair tennis: In that first year, I attended the Cruyff Junior Camp in the Netherlands. I met new coaches and children from many countries and many cultures. Everyone encouraged me so much. It was really great. These
16 opportunities and changes made me and my family very happy The junior camps are the biggest example of what the WTDF do. Tarin, Turkish former player. Theme summary Players, coaches and officials described numerous strengths of the WTDF initiative. These included effective social support provision in the shame of emotional (encouragement), tangible (financial), information (knowledge and education) and companion (relationships) support. Several structural strengths were also identified. For example, the inclusion and promotion of women and junior participants; the reward-based structure to support provision; and the use of development camps to provide opportunities and experience. Areas for WTDF Development The final theme concerns areas for development and improvement of the WTDF as identified by players, coaches and officials. The majority of issues highlighted related to increasing and/or progressing what is already being provided by the WTDF. This included a.) coaching improvements, b.) playing opportunities, c.) tangible support, and d.) increasing awareness. a.) Coaching Improvements Participants identified several means by which coaching or coach education could be improved. Wheelchair skills. Players noted that when wheelchairs initially arrived they had no knowledge of how to manoeuvre them. Further, WTDF officials also had minimal wheelchair skills. You know they have wheelchairs but the people who provided them didn t know
17 what to do. They had them, the ITF give the chairs, but they didn t know what to do with them. Mohammad, Yemeni player. about all the problems for athletes and who can help us. Catalina, Romanian coach. Coaching in wheelchairs. Some players identified the need for more coaches with physical disabilities and/or coaches who could play tennis in a wheelchair to a competent level: a coach for coaches. How to do them and make them play in wheelchair so coaches know what it is like in wheelchair Mohammad, Yemeni player. Better coach education. Some coaches felt that their passion for knowledge and their intense desire to improve professionally could not always be met: I want to learn more things about wheelchair tennis and how I can coach better I would like to learn more about everything if possible. I want to know b.) Playing opportunities Although the provision of playing opportunities was considered a positive role of the WTDF, players were always hungry for more. More tournaments. Players stated a desire for more tournament/ competitive opportunities. They can t just practice, practice, practice it s boring. When you play a sport you have to do competition to enjoy If you play new tournaments every match you are in another country. For example, in April I was in South Africa, this month I am in Turkey, next month somewhere else so you see different country, new people Youssuf, Moroccan player. c.) Tangible support
18 Despite recognising the financial donations made by the WTDF, almost all members of developing nations identified the need for more tangible support. racquets, paid for travel expenses and coached voluntarily. First year I taught them I taught for free, there wasn t any money, nothing, so I put More WTDF visits. A visit from the WTDF was largely considered to be a highly regarded and esteemed event. It was said to breed motivation and increase the aspirations of local players from developing nations. all my time to get it started Right now we have actually put my costs. I m playing my own hotel bill and food and everything, I don t have a sponsor right now so I m paying right now the rest. And other players also. Johan, Mexican official. d.) Increasing awareness more than 1 Silver Fund per year once a year is good then next year come back to see if the job going on or not and this make players to because they know that another Silver Fund come and they have to show then they are good player or they are ready to learn to know more about tennis Youssuf, Moroccan player. There was an identified need to increase public awareness of wheelchair tennis, as well as the WTDF itself. Lack of awareness of wheelchair tennis. Few players knew about the sport before they were recruited. I didn t know disabled people could play Financial sacrifices. Coaches and officials reported using their own money at various points during their work. Coaches bought chairs, this sport. I thought I could only play table tennis. Jasmine, Turkish player. WTDF exposure and promotion. Many perceived more could be
19 done in terms of enhancing the profile of the WTDF. Media exposure, more information about the fund, its goals, players and coaches are needed to raise this more of that qualitative story telling kind of information back to actually support what they were trying to do which was show that they were doing a good job David, WTDF official. awareness. it needs more publicity. That s one. Especially publicity with the media and sponsors. They should also make more of the successes. I think they could use South Africa more and half the knowledge is just the communications department of the ITF. Andrew, WTDF official. Confused WTDF identity. During interviews, a common occurrence was that players and coaches from developing nations were unaware of the work of the WTDF or the aims/structure of the programme. Most had heard of the ITF or Cruyff Foundation but were Raising awareness of WTDF also needs to be improved. This is in relation to players and coaches as well the general public. on the kind of reporting side looking at you know being able to actually promote what we were doing so actually getting detailed reports of stuff that was happening so you could promote it through the website reports so getting unaware of the Silver Fund or WTDF. There was a confused identity over who was providing the support and how the WTDF was organised: I: Do you know the WTDF? M: No I: The Silver Fund? M: No, I don t think so.
20 I: Ok. What about the ITF or Cruyff Foundation? M: Yes, yes I know. Johan Cruyff gives money to wheelchair tennis. Mansoor, Iranian player Theme summary Players, coaches and officials discussed several areas where the WTDF could progress and improve. These included coaching improvements, playing opportunities, tangible support and increasing awareness. Most of these areas for improvement simply suggested building on existing practices and doing more of the same. For example, providing more equipment or delivering increased opportunities. The most critical area for improvement referred to the need for a more transparent WTDF identity and public profile. Recommendations for Future Practice Based on the findings of this research, and drawing on existing disability sport research, the following recommendations are offered. 1. Increase the number of coaches coaching in a wheelchair. There is research to suggest that some disabled athletes prefer to be coached by a coach with a physical disability. Observing skills performed in a wheelchair may also provide a specific working model for learners. 2. Develop an online network to facilitate interaction. Coaches and officials stated that if a communicative network were in place then advice, support and possibilities for match arrangements could occur. This would further increase the quality of coaching, the running of programmes and relationships between coaches and officials from other countries. This can
21 be done online where coaches can discuss issues, problems and difficulties as well as share ideas and contact details to organise matches. This could be accessed through the WTDF webpage. 3. Increase investment in junior and female players. This research identified an overwhelming emphasis on increasing the number of juniors and number of females involved in wheelchair tennis. Success in this area will provide a major boost to the WTDF community and it would represent a clear signal that the project is tailored to the needs of its primary benefactors. 4. Improve understanding of WTDF aims, objectives and structure. Although officials were aware of the aims and structure of the WTDF, Educating coaches and players in regards to these aims will bring a greater understanding and ownership to individual programmes. Explaining these fundamentals will bring a deeper appreciation of the WTDF and its objectives. This can be done through working with officials to try and educate coaches and players about the philosophy of the WTDF. 5. Improve brand identity. There needs to be a more overt and recognisable identity to the WTDF. Confusion surrounding the contributory roles of the ITF and Cruyff foundation dilutes understanding of the specific aims and objectives of the WTDF. Further, the name Wheelchair Tennis Development Fund may also be considered unduly long and lacking punch. 6. Expansion of the WTDF. coaches and players were not.
22 This research demonstrates that the unique work of the WTDF can provide hugely important psychological and social benefits to the lives of physically disabled individuals in developing countries. As such, continued expansion of the WTDF is crucial if more people are to benefit. 7. WTDF in Central Africa. Central Africa may be a region where expansion can take place. Participants in South Africa noted the lack of wheelchair tennis in other African countries, particularly central Africa. If programmes were implemented in these countries South Africa would have more opportunities to compete in their own continent and possibly develop an African championship. Conclusion All participants perceived the WTDF to play an important role in increasing quality of life in people with a physical disability in developing countries. According to the qualitative research outlined in this report, the work of the WTDF can improve psychological wellbeing, social well-being, and overall quality of life. Given this overt success, continued progression and expansion of the WTDF initiative represents a sound and worthwhile use of resources. References  Mitra, S., & Sambamoorthi,U. (in press). Disability prevalence among adults: estimates for 54 countries and progress toward a global estimate. Disability and Rehabilitation. Retrieved from 09/  Livneh, H. (2012). On the origins of negative attitudes toward people with disabilities. In R. P. Marinelli & A. E. Dell Orto (Eds.), The psychological and social impact of disability (pp ). New York: Springer.
23  Mitra, S., & Sambamoorthi,U. (in press). Disability prevalence among adults: estimates for 54 countries and progress toward a global estimate. Disability and Rehabilitation. Retrieved from 09/  Sporner, M. L., Fotzgerald, S. G., Dicianno, B. E. Collins, S., Teodoreski, P. F., Pasquina, P. F., &Cooper, R. A. (2009). Psychosocial impact of participation in the National Veterans Wheelchair Games and Winter Sports Clinic. Rehabilitation in Practice, 31(5),  Weiss, R. S. (2008). Learning from strangers: the art and methods of qualitative interview study. New York: Simon and Schuster.  Wills, T.A. (1985). "Supportive functions of interpersonal relationships". In S. Cohen, & L. Syme. (Eds) Social support and health (pp ). Orlando, FL: Academic Press.
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