Holly B. Shakya

Social network predictors of latrine ownership.

Poor sanitation, including the lack of clean functioning toilets, is a major factor contributing to morbidity and mortality from infectious diseases in the developing world. We examine correlates of latrine ownership in rural India with a focus on social network predictors. Participants from 75 villages provided the names of their social contacts as well as their own relevant demographic and household characteristics. Using these measures, we test whether the latrine ownership of an individuals social contacts is a significant predictor of individual latrine ownership. We also investigate whether network centrality significantly predicts latrine ownership, and if so, whether it moderates the relationship between the latrine ownership of the individual and that of her social contacts. Our results show that, controlling for the standard predictors of latrine ownership such as caste, education, and income, individuals are more likely to own latrines if their social contacts own latrines. Interaction models suggest that this relationship is stronger among those of the same caste, the same education, and those with stronger social ties. We also find that more central individuals are more likely to own latrines, but the correlation in latrine ownership between social contacts is strongest among individuals on the periphery of the network. Although more data is needed to determine how much the clustering of latrine ownership may be caused by social influence, the results here suggest that interventions designed to promote latrine ownership should consider focusing on those at the periphery of the network. The reason is that they are 1) less likely to own latrines and 2) more likely to exhibit the same behavior as their social contacts, possibly as a result of the spread of latrine adoption from one person to another.

Association Between Social Network Communities and Health Behavior: An Observational Sociocentric Network Study of Latrine Ownership in Rural India

OBJECTIVES We identified communities of interconnected people that might serve as normative reference groups for individual-level behavior related to latrine adoption. METHODS We applied an algorithmic social network method to determine the network community from respondent-reported social ties of 16 403 individuals in 75 villages in rural Karnataka, India; data were collected from 2006 to 2008. We used multilevel modeling to test the association between latrine ownership and community-level and village-level latrine ownership. We also investigated the degree to which network cohesion affected individual latrine ownership. RESULTS Three levels of social contacts (direct friends, social network community, and village) significantly predicted individual latrine ownership, but the strongest effect was found at the level of social network communities. In communities with high levels of network cohesion, the likelihood was decreased that any individual would own a latrine; this effect was significant only at lower levels of latrine ownership, suggesting a role for network cohesion in facilitating the nonownership norm. CONCLUSIONS Although many international health and development interventions target village units, these results raise the possibility that the optimal target for public health interventions may not be determined through geography but through social network interactions.

Intimate partner violence norms cluster within households: an observational social network study in rural Honduras

BackgroundIntimate partner violence (IPV) is a complex global problem, not only because it is a human rights issue, but also because it is associated with chronic mental and physical illnesses as well as acute health outcomes related to injuries for women and their children. Attitudes, beliefs, and norms regarding IPV are significantly associated with the likelihood of both IPV experience and perpetration.MethodsWe investigated whether IPV acceptance is correlated across socially connected individuals, whether these correlations differ across types of relationships, and whether social position is associated with the likelihood of accepting IPV. We used sociocentric network data from 831 individuals in rural Honduras to assess the association of IPV acceptance between socially connected individuals across 15 different types of relationships, both within and between households. We also investigated the association between network position and IPV acceptance.ResultsWe found that having a social contact that accepts IPV is strongly associated with IPV acceptance among individuals. For women the clustering of IPV acceptance was not significant in between-household relationships, but was concentrated within households. For men, however, while IPV acceptance was strongly clustered within households, men’s acceptance of IPV was also correlated with people with whom they regularly converse, their mothers and their siblings, regardless of household. We also found that IPV was more likely to be accepted by less socially-central individuals, and that the correlation between a social contact’s IPV acceptance was stronger on the periphery, suggesting that, as a norm, it is held on the periphery of the community.ConclusionOur results show that differential targeting of individuals and relationships in order to reduce the acceptability and, subsequently, the prevalence of IPV may be most effective. Because IPV norms seem to be strongly held within households, the household is probably the most logical unit to target in order to implement change. This approach would include the possible benefit of a generational effect. Finally, in social contexts in which perpetration of IPV is not socially acceptable, the most effective strategy may be to implement change not at the center but at the periphery of the community.

An exploratory comparison of name generator content: Data from rural India

Since the 1970s sociologists have explored the best means for measuring social networks, although few name generator analyses have used sociocentric data or data from developing countries, partly because sociocentric studies in developing countries have been scant. Here, we analyze 12 different name generators used in a sociocentric network study conducted in 75 villages in rural Karnataka, India. Having unusual sociocentric data from a non-Western context allowed us to extend previous name generator research through the unique analyses of network structural measures, an extensive consideration of homophily, and investigation of status difference between egos and alters. We found that domestic interaction questions generated networks that were highly clustered and highly centralized. Similarity between respondents and their nominated contacts was strongest for gender, caste, and religion. We also found that domestic interaction name generators yielded the most homogeneous ties, while advice questions yielded the most heterogeneous. Participants were generally more likely to nominate those of higher social status, although certain questions, such as who participants talk to uncovered more egalitarian relationships, while other name generators elicited the names of social contacts distinctly higher or lower in status than the respondent. Some questions also seemed to uncover networks that were specific to the cultural context, suggesting that network researchers should balance local relevance with global generalizability when choosing name generators.

Exploiting social influence to magnify population-level behaviour change in maternal and child health: study protocol for a randomised controlled trial of network targeting algorithms in rural Honduras

Introduction Despite global progress on many measures of child health, rates of neonatal mortality remain high in the developing world. Evidence suggests that substantial improvements can be achieved with simple, low-cost interventions within family and community settings, particularly those designed to change knowledge and behaviour at the community level. Using social network analysis to identify structurally influential community members and then targeting them for intervention shows promise for the implementation of sustainable community-wide behaviour change. Methods and analysis We will use a detailed understanding of social network structure and function to identify novel ways of targeting influential individuals to foster cascades of behavioural change at a population level. Our work will involve experimental and observational analyses. We will map face-to-face social networks of 30 000 people in 176 villages in Western Honduras, and then conduct a randomised controlled trial of a friendship-based network-targeting algorithm with a set of well-established care interventions. We will also test whether the proportion of the population targeted affects the degree to which the intervention spreads throughout the network. We will test scalable methods of network targeting that would not, in the future, require the actual mapping of social networks but would still offer the prospect of rapidly identifying influential targets for public health interventions. Ethics and dissemination The Yale IRB and the Honduran Ministry of Health approved all data collection procedures (Protocol number 1506016012) and all participants will provide informed consent before enrolment. We will publish our findings in peer-reviewed journals as well as engage non-governmental organisations and other actors through venues for exchanging practical methods for behavioural health interventions, such as global health conferences. We will also develop a ‘toolkit’ for practitioners to use in network-based intervention efforts, including public release of our network mapping software. Trial registration number NCT02694679; Pre-results.

Affect and well-being similarity among older Indian spouses

Objectives: Previous work suggests that husbands and wives are likely to share affective states so that depression or happiness in one spouse is predictive of depression or happiness in the other. Studies that have examined spousal affect similarity, however, have been concentrated in the Western world where the meaning of marriage may be different than it is in other cultural contexts. Marriage in India, unlike that in the United States, is focused on the extended family so that love and intimacy between spouses are downplayed. This study examined affect and well-being similarity between 603 older married couples in India using pilot data from the Longitudinal Aging Study of India. Method: We ran linear regression models to assess the relationship between the well-being states of husbands and wives using dyadic observations for four different measures: depressive symptoms, dissatisfaction with daily life, social isolation, and overall life satisfaction. Results: Across all four measures, the well-being scores of one spouse were positively and significantly associated with the well-being scores of the other. These associations did not vary by marital satisfaction, but were slightly stronger for respondents reporting poor health. Conclusion: Our increased understanding of social connectedness has prompted a shift from the consideration of single individuals to a broader understanding of individuals in the context of their social environments. The results of this study suggest that interventions designed to foster well-being among older adults in India might benefit from a focus on couples as a unit rather than individuals.

Social network correlates of IPV acceptance in rural Honduras and rural Uganda

We investigated the household-level social network correlates of acceptance of intimate partner violence (IPV) in rural, agrarian settings of Honduras and Uganda, two low-income countries with unequal access to resources based upon gender. We collected complete social network data in each location (Honduras in 2014 and Uganda in 2012), across a diverse range of relationships, and then created a measure of household cohesion by calculating the degree to which members of a household nominated each other as important social connections. Our measure of IPV acceptance was based on 4 questions from the Demographic Health Survey to assess the conditions under which a person believes that it is acceptable for a man to perpetrate physical violence against his wife or partner and we coded a person as positive on IPV acceptance if they answered positively to any of the four questions. We used logistic regression to calculate the odds that an individual accepted IPV given (1) household level cohesion and (2) the proportion of the household that accepts IPV. We found individuals from more cohesive households were less likely to accept IPV controlling for the overall level of IPV acceptance in the household. Nevertheless, those in households more accepting of IPV were more likely to personally accept IPV. In stratified analyses, when household IPV acceptance was especially high, the benefit of household cohesion with respect to IPV was attenuated. The design and implementation of interventions to prevent IPV should consider household structure and norms rather than focusing only on individuals or couples.

Spousal discordance on reports of contraceptive communication, contraceptive use, and ideal family size in rural India: a cross-sectional study

BackgroundPersistent low rates of spacing contraceptive use among young wives in rural India have been implicated in ongoing negative maternal, infant and child health outcomes throughout the country. Gender inequity has been found to consistently predict low rates of contraception. An issue around contraceptive reporting however is that when reporting on contraceptive use, spouses in rural India often provide discordant reports. While discordant reports of contraceptive use potentially impede promotion of contraceptive use, little research has investigated the predictors of discordant reporting.MethodsUsing data we collected from 867 couples in rural Maharashtra India as part of a men-focused family planning randomized controlled trial. We categorized couples on discordance of men’s and women’s reports of current contraceptive use, communication with their spouse regarding contraception, and ideal family size, and assessed the levels of discordance for each category. We then ran multinomial regression analyses to determine predictors of discordance categories with a focus on women’s empowerment (household and fertility decision-making, women’s education, and women’s knowledge of contraception).ResultsWhen individuals reported communicating about contraception and their spouses did not, those individuals were also more likely to report using contraception when their spouses did not. Women’s empowerment was higher in couples in which both couples reported contraception communication or use or in couples in which only wives reported contraception communication or use. There were couple-level characteristics that predicted husbands reporting either contraception use or contraception communication when their wives did not: husband’s education, husband’s familiarity with contraception, and number of children.ConclusionsOverall there were clear patterns to differential reporting. Associations with women’s empowerment and contraceptive communication and use suggest a strategy of women’s empowerment to improve reproductive health. Discordant women-only reports suggest that even when programs interact with empowered women, the inclusion of husbands is essential. Husband-only discordant reports highlight the characteristics of men who may be more receptive to family planning messages than are their wives. Family planning programs may be most effective when working with couples rather than just with women, and should focus on improving communication between couples, and supporting them in achieving concordance in their reproductive preferences.Trial registrationClinical Trials Number: NCT01593943, registered May 4, 2012 at clinicaltrials.gov.

Leisure-Time Physical Activity and Characteristics of Social Network Support for Exercise Among Latinas

Purpose: To examine the association between characteristics of social support for exercise and moderate-to-vigorous leisure-time physical activity (LTPA) among Latinas. Design: This cross-sectional study used baseline data from a cluster randomized controlled trial. Setting: The study was conducted in 16 churches located in San Diego County. Participants: Participants (N = 436) were Latinas between 18 and 65 years old who did not self-report >150 minutes or did not exceed 250 minutes of moderate-to-vigorous PA per week measured by accelerometer. Measures: Latinas listed up to 6 individuals who had provided support for exercise within the past 6 months, including their gender, relationship with the respondent, types of support provided, and respondent’s satisfaction with support. Self-reported LTPA was dichotomized (none vs any). Analyses: We generated dyads between Latinas who named ≥1 supporter (n = 323) and each supporter they named (n = 569 dyads). Logistic regression analyses were conducted using generalized estimating equations to adjust for multiple observations per participant. Results: Having an exercise partner (odds ratio [OR]: 2.16; 95% confidence interval [CI]: 1.01-4.62), help with household duties (OR: 2.70; 95% CI: 1.35-3.38), being “very much” satisfied with support (OR: 2.33; 95% CI: 1.26-4.30), and naming >2 supporters (OR: 2.57; 95% CI: 1.06-6.25) was positively associated with LTPA. Conclusions: Findings suggest specific aspects of support for exercise that should be targeted in future interventions to promote LTPA.