Social network influences on reproductive health behaviors in urban northern Thailand

Urban Family Planning in Low- and Middle-Income Countries: A Critical Scoping Review

Health agendas for low- and middle-income countries (LMICs) should embrace and afford greater priority to urban family planning to help achieve a number of the global Sustainable Development Goals. The urgency of doing so is heightened by emerging evidence of urban fertility stalls and reversals in some sub-Saharan African contexts as well as the significance of natural increase over migration in driving rapid urban growth. Moreover, there is new evidence from evaluations of large programmatic interventions focused on urban family planning that suggest ways to inform future programmes and policies that are adapted to local contexts. We present the key dimensions and challenges of urban growth in LMICs, offer a critical scoping review of recent research findings on urban family planning and fertility dynamics, and highlight priorities for future research.

Using Trellis software to enhance high-quality large-scale network data collection in the field

Trellis is a mobile platform created by the Human Nature Lab at the Yale Institute for Network Science to collect high-quality, location-aware, off-line/online, multi-lingual, multi-relational social network and behavior data in hard-to-reach communities. Respondents use Trellis to identify their social contacts by name and photograph, a procedure especially useful in low-literacy populations or in contexts where names may be similar or confusing. We use social network data collected from 1,969 adult respondents in two villages in Kenya to demonstrate Trellis' ability to provide unprecedented metadata to monitor and report on the data collection process including artifactual variability based on surveyors, time of day, or location.

Role of social network in decision making for increasing uptake and continuing use of long acting reversible (LARC) methods in Pakistan

INTRODUCTION

Despite evidence from recent Demographic Health Surveys that show 98% of the adult Pakistani population have an awareness of at least one modern contraceptive method, only 25% of married couples in Pakistan used a modern method of contraception. Of the modern contraceptive methods, LARC usage has increased only from 2.1 to 3%. This low uptake is puzzling in the context of high awareness of LARC methods and its availability through public sector facilities at subsidized costs. This study aimed to understand the social influences in initiating and continuing use of an LARC methods for contraception in a rural setting in Pakistan.

METHODS

In-depth interviews were conducted with 27 women who were using a LARC method for contraception. Data was managed using NVivo 12 and themes were identified using a content analysis approach to analyze the transcripts.

RESULTS

Four key themes, supported by sub-themes relating to a temporal model, were identified to explain women's experiences with initiating and continuing use of a LARC. The themes were (i) Use of trusted networks for information on LARCs; (ii) Personal motivation and family support in decision to use LARC; (iii) Choice of LARC methods and access to providers; and (iv) Social and professional support instrumental in long term use of LARC. Results highlight the significant role of immediate social network of female family members in supporting the women in initiating LARCs and maintaining the method's use.

CONCLUSION

This study contributes to an in depth understanding of the decision-making process of women who adopted LARC and maintained its use. Women who proceeded to use an LARC and who persisted with its use despite the experience of side effects and social pressures, were able to do so with support from other female family members and spouse.

Nativity Homogeneity in Social Networks and Prostitution Patronage Among Male Migrant Laborers

Previous studies have repeatedly found the association between network homogeneity based on native-place and sexual risk behaviors among migrants. However, it remains unclear why such a simple numerical property of network composition can be correlated with a sexual risk behavior. Using a dataset (n = 1591) with detailed information on the sexual behaviors among male migrant laborers in the two Chinese provinces with the highest migrant inflows, we confirmed network homogeneity is significantly associated with prostitution patronage. With structural equation modeling, we further found that half of network homogeneity’s impact on prostitution patronage is mediated by three factors: peer deviance, family bonds, and hedonistic subcultural beliefs. In addition, network homogeneity’s association with hedonistic subcultural beliefs is fully mediated by peer deviance. Although the nativity homogeneity in social networks is still associated with prostitution patronage, more proximate psycho-social factors are found responsible for the network effect. Health policies seeking to integrate migrant laborers, removing the policy barriers against family bonds, and providing alternative sources of social support are highly promising for reducing sexual risk behavior among this population.

Interpersonal communication regarding pregnancy-related services: friends versus health professionals as conduits for information

Background

Social network characteristics influence a wide range of health behaviors but few studies examine the relationship between social network characteristics and pregnancy-related outcomes.

Methods

Using a baseline survey from a behavior change pilot project in the Upper West region of Ghana, we examine four outcomes: (1) early antenatal care, (2) having at least four antenatal care visits, (3) skilled birth attendance, and (4) postpartum care. We collected demographic and network data from 1606 women of reproductive age who had a child in the five years preceding the survey. We estimated associations by regressing the four pregnancy-related outcomes on the demographic and network characteristics.

Results

The results suggest that there is little interpersonal communication about pregnancy-related issues, as 60.2% of respondents reported talking to no one. For those women who did talk to someone, communication with a health professional had the strongest association with accessing services (e.g., Adjusted Odds Ratio [AOR] = 8.02, p < 0.01, for having a facility birth). Communicating with friends was also significantly associated with outcomes (AOR = 4.23, p < 0.0, for having a facility birth).

Conclusions

This study provides evidence that there was little social communication about pregnancy-related issues in these communities at that time, indicating that an intervention to promote such communication could be successful. In addition, women who reported discussing pregnancy-related issues with friends or a health professional were more likely to access a birth facility and have a skilled birth attendant than those who reported discussing the same topics with their partner.

Interplay between geo-population factors and hierarchy of cities in multilayer urban networks

Only taking into consideration the interplay between processes occurring at different levels of a country can provide the complete social and geopolitical plot of its urban system. We study the interaction of the administrative structure and the geographical connectivity between cities with the help of a multiplex network approach. We found that a spatially-distributed geo-network imposes its own ranking to the hierarchical administrative network, while the latter redistributes the shortest paths between nodes in the geographical layer. Using both real demographic data of population censuses of the Republic of Kazakhstan and theoretical models, we show that in a country-scale urban network and for each specific city, the geographical neighbouring with highly populated areas is more important than its political setting. Furthermore, the structure of political subordination is instead crucial for the wealth of transportation network and communication between populated regions of the country.

Midwives' cell phone use and health knowledge in rural communities

This study developed and tested a theoretical model that explains the underlying process through which the use of cell phones can facilitate the capacity of community health care workers in developing regions. On the basis of a study conducted on 223 midwives in rural regions of Indonesia, the results showed that cell phone use was positively associated with midwives' access to institutional and peer information resources. Access to institutional resources was positively associated with midwives' health knowledge. Further, access to peer resources was associated with higher self-efficacy, which was positively associated with health knowledge. The study provides implications for technology intervention strategies targeted to community health workers in rural communities.

Using peer education to increase sexual health knowledge among West African refugees in Western Australia

Ten bilingual West African peer educators conducted a 3-hour workshop on sexual health for small groups of West African refugees (N = 58) who recently had settled in Perth, Western Australia. There were significant increases in the participants' knowledge of sexually transmitted infections and HIV, how these infections are spread, and how to protect against infection. In addition, attitudes toward condom use became more positive. We conclude that the peer-education approach was successful in assisting a new and emerging community to work effectively on sexual health topics generally considered "taboo" or too sensitive to discuss.

Keepers of the secret: desires to conceal a family member's HIV-positive status in Namibia, Africa

When people learn that they have tested positive for HIV, they may share their news with a family member; and this family listener may want them to keep their diagnosis a secret. This study extends privacy management research (e.g., Petronio, 2002) by investigating variables related to family members' desires to keep HIV-status secrets. Two studies, 2 years apart, included adult-respondents (N = 1,358) in northern Namibia, where HIV is prevalent. Two factors predicted potential co-owners' desires to keep a family member's HIV-positive status secret: (a) the sense of an environment inappropriate for disclosure, and (b) a lack of efficacy to oppose it. These findings suggest that many factors translated from disclosers to co-owners and from (primarily) Western studies of disclosure to southern Africa. From this investigation, one might consider the contexts that redistribute power so that confidants may limit discloser's rights to share his or her own information.

Talking the talk, walking the walk: social network norms, communication patterns, and condom use among the male partners of female sex workers in La Romana, Dominican Republic

Male partners of female sex workers are rarely targeted by HIV prevention interventions in the commercial sex industry, despite recognition of their central role and power in condom use negotiation. Social networks offer a naturally existing social structure to increase male participation in preventing HIV. The purpose of this study was to explore the relationship between social network norms and condom use among male partners of female sex workers in La Romana, Dominican Republic. Male partners (N =318) were recruited from 36 sex establishments to participate in a personal network survey. Measures of social network norms included 1) perceived condom use by male social network members and 2) encouragement to use condoms from social network members. Other social network characteristics included composition, density, social support, and communication. The primary behavioral outcome was consistent condom use by male partners with their most recent female sex worker partner during the last 3 months. In general, men reported small, dense networks with high levels of communication about condoms and consistent condom use. Multivariate logistic regression revealed consistent condom use was significantly more likely among male partners who perceived that some or all of their male social network members used condoms consistently. Perceived condom use was, in turn, significantly associated with dense networks, expressing dislike for condoms, and encouragement to use condoms from social network members. Findings suggest that the tight social networks of male partners may help to explain the high level of condom use and could provide an entry point for HIV prevention efforts with men. Such efforts should tap into existing social dynamics and patterns of communication to promote pro-condom norms and reduce HIV-related vulnerability among men and their sexual partners.

Developing scales for measuring gender behaviors in reproductive health in rural China

This article introduces two scales for measuring the gender-specific burden of family planning (FP) and reproductive health (RH) in rural China, following the implementation of a client-oriented approach to FP/RH. One scale (GHRHS-SC) measures FP/RH clients to examine whether gender influences FP/RH behaviors. The other scale (GHRHS-SP) measures service provider interactions with service clients to gauge whether FP/RH institutions are fulfilling the client-oriented mandate. The content of scales was developed through inductive analysis conducted on data generated from focus groups and in-depth interviews. The validation of the scales was confirmed with item analysis, exploratory factor analysis, and confirmatory factor analysis. To generate data for validation purposes, we employed a stratified cluster sampling method for a sample of service providers and a stratified multistage method for a sample of service clients. The analytical results indicate that the scales possess good internal consistency, reliability, and overall validity. The construct validity for the GHRHS-SP needs some improvement. Both the GHRHS-SC and GHRHS-SP are valid instruments for measuring gender differences in FP/RH behavior, though further refinements would be beneficial.

Young Thai women who use methamphetamine: intersection of sexual partnerships, drug use, and social networks

BACKGROUND

Given high rates of methamphetamine (MA) use among young people in Thailand and evidence of an association between MA and increased sexual risk behaviour, we examined the association between women's recent sexual partnerships, social network characteristics and drug and alcohol use.

METHODS

Female participants (n=320) in an HIV behavioural trial among young (18-25 years) MA users in Chiang Mai completed a drug and sexual behaviour survey and social network inventory. Multinomial regression analyses accounting for clustered data examined individual and network characteristics associated with recent sexual partnership category. We compared women with only one male partner in the past year (39%) to those with multiple male partners (37%) and those with only female partners (24%).

RESULTS

Differences in levels of drug and alcohol use and social and sexual network characteristics were dependent on recent sexual partnership profiles. The multiple partner group reported an average of five male partners in the past year; 12% reported consistent condom use in the past 30 days. Compared to both groups, women with multiple male partners used MA more frequently, had larger non-sex networks with more MA users, were more likely to have an MA-using sex partner, and received less emotional support from their partners. Women with multiple male partners and only female partners reported more frequent alcohol use.

CONCLUSIONS

Policy and intervention efforts targeting drug use and sexual behaviour among young Thai women are drastically needed and may benefit from consideration of the diversity within the population. These data point to the need for targeted prevention approaches that take into account the varying characteristics and social influences of these different groups of women.

Social sides of health risks: stigma and collective efficacy

Health threats may not occur in a vacuum; one may need others' support to address a given health condition. For example, in Namibia, parents dying from AIDS-related illnesses leave their orphaned children in need of adoption. If people do not feel threatened by HIV personally, social threats might motivate them to action. We extend the extended parallel process model (Witte, 1992) to include 2 social perceptions: (a) stigma and (b) collective efficacy. We found that Namibian respondents (n = 400) who did not feel threatened by HIV personally showed a relationship between these social perceptions and their willingness to support those living with HIV and their willingness to adopt AIDS orphans. These effects appeared for those who did not assess HIV as a health threat, suggesting that social threats, combined with efficacy, may motivate intentions to adopt recommended actions. Practical applications and intervention designs are discussed.

Emergence and Robustness of a Community Discussion Network on Mercury Contamination and Health in the Brazilian Amazon

Information exchanges, debates, and negotiations through community social networks are essential to ensure the sustainability of the development process initiated in participatory research. The authors analyze the structural properties and robustness of a discussion network about mercury issues in a community in the Brazilian Amazon involved in a participatory research aimed at reducing exposure to the pollutant. Most of the villagers are connected in a large network and are separated from other individuals by few intermediaries. The structure of the discussion network displays resilience to the random elimination of villagers but shows vulnerability to the removal of one villager who has been a long-term collaborator of the project. Although the network exhibits a structure likely to favor an efficient flow of information, results show that specific actions should be taken to stimulate the emergence of a pool of opinion leaders and increase the redundancy of discussion channels.

Thailand's response to the HIV epidemic: yesterday, today, and tomorrow

Thailand's comprehensive national response to the HIV/AIDS epidemic has been extensively documented since the beginning of epidemic. Substantial progress in the fight against HIV/AIDS has been made because awareness of the problem was raised. Top-level political commitment and multisectoral strategies mobilized funds and human resources to implement the control program at all levels. Behavioral change resulting in increased condom use in brothels on a national scale rose from virtually nil to more than 95%. This was accompanied by a 90% reduction of the sexually transmitted disease rate. In parallel, the rate of new HIV infections dropped by 80%. Despite these achievements, there remains an urgent need to continue efforts to ensure universal and unfailing condom use. Further, Thailand needs to establish pragmatic innovative approaches to reduce transmission, especially among injection drug users, women, and youth, as well as to develop effective strategies for implementation of antiretroviral treatment. Further strategies also need to consider the changing cultural, social, and economic characteristics of the Thai populations.

Can evaluation studies benefit from triangulation? A case study

BACKGROUND

Information and communication technologies (ICTs) are increasingly being used in health care. Rigorous evaluations of ICT applications during both introduction and routine use are of great importance for decision makers and users. Within evaluation research, two main (and often rather distinct) traditions can be found: the objectivistic and the subjectivistic tradition.

METHODS

The theory of triangulation deals with the integration of methods and approaches as to conduct better evaluation studies. In evaluation research, triangulation in general means the multiple employment of various sources of data, observers, methods, and/or theories in investigations of the same phenomenon. We applied triangulation aspects in the analysis of the effects of a computer-based nursing documentation system.

RESULTS

We discuss, based on this case study, what benefits can be obtained from applying triangulation in an evaluation study. We show how both the validation of results and the completeness of results can be supported by triangulation.

DISCUSSION

The decision whether triangulation may be useful for a given research question, and how it may be correctly applied, requires-like other evaluation methods-intensive training and methodological experience. Medical informatics evaluation research may profit from this well-established theory.

Condom use and partner characteristics among young adult males in urban Ghana, aged 15-24

Addressing male sexual behavior and condom use is a high priority for adolescent health programs. Using the 1997 Ghana Psychographic Survey, the aim of this study is to explore the factors related to current, partner-specific condom use, by Ghanaian males aged 15-24 years. A multivariate regression analysis reveals an independent association between psychographic attitudes, peer network characteristics, sexual partner characteristics, and some level of condom use with a nominated sexual partner. The most important predictor for both condom use consistently as well as condom use at least sometimes was respondents' knowing someone who died as a result of AIDS. This finding suggests that future interventions should aim to personalize the risk of HIV/STIs, promote condom use with a range of partner types, and educate youth about the importance of consistent use.

Exploring similarity between peer educators and their contacts and AIDS-protective behaviours in reproductive health programmes for adolescents and young adults in Ghana

This analysis explores the similarity between peer educators and their contacts. To examine interpersonal communication in the context of peer education, this study tested a new approach using multiple semi-structured interviews and network analysis to collect data from 106 peer educators and 526 of their contacts. These evaluation activities were conducted at three sites in Ghana during April 1998, in peri-urban and rural locations, and in in-school and out-of-school targeted settings. It was found that in their peer counselling and peer promotion activities peer educators tend to reach people who are like themselves (53% within 2 years of age, 59% same sex, 70% same ethnicity, and 65% same school status) however, this trend is not uniform among all youth and varies by demographic characteristics and their cultural environment. By examining the social networks of peer educators, it is possible to gain a better understanding of the process of peer education counselling in the context in which it occurs. The study also shows that controlling for other factors, contacts of peer educators who are highly similar regarding age, sex, ethnicity, and school status, are 1.74 times more likely (95% CI: 1.18, 2.56) to have done something to protect themselves from AIDS in the past three months. The results have relevance for programme managers and planners, researchers, and international agencies serving youth.

Developing socio-spatial knowledge networks: a qualitative methodology for chronic disease prevention

Chronic disease is a significant and costly social problem. The burden is even more pronounced in communities with high rates of a particular chronic disease. Assessment of health belief systems and the local geographies of health beliefs can assist community health planners to create cost-effective strategic intervention programs where populations are at high risk for chronic diseases. In this paper, we elaborate the concept of socio-spatial knowledge networks (SSKNs) and demonstrate that SSKNs can be useful in informing the design of health care prevention strategies. In our project, we demonstrate how to identify key socio-spatial information for intervention strategies which will prevent or delay the onset of a particular chronic disease, Type 2 diabetes. Our qualitative framework allows us to determine which sites might be best characterized as socio-spatial knowledge network nodes for sharing diabetes information and which sites might be less suited to such exchange. Our strategy explores cross-cultural similarities, differences, and overlap in a multi-ethnic rural North Carolina context through simple techniques such as mapping social networks and sites in which people share their knowledge and beliefs about diabetes. This geographical analysis allows us to examine exactly where health knowledge coincides with other social support, and where such resources may be improved in a particular community. Knowing precisely what people in a community understand about a chronic disease and its treatment or prevention and knowing where people go to share that information helps to (1) identify strategic locations within a community for future interventions and, (2) evaluate the effectiveness of existing interventions. The geographical approach presented here is one that can serve other communities and health practitioners who hope to improve chronic disease management in diverse local environments.