Kin Network Experiences, Mortality Perceptions, and Health Behaviors in Malawi

点击翻译按钮获取中文摘要

Project Summary Child mortality rates have declined dramatically over the past 40 years, especially in African countries like Malawi. Yet, research shows that many individuals in the communities experiencing this swift change do not perceive it but think instead that mortality levels are far higher than empirically true or even increasing. We lack a comprehensive assessment of the social experiences that encourage these distorted perceptions of community mortality conditions. Additionally, key but untested hypotheses hold that mortality perceptions may be entwined with schemas of healthcare; if elevated mortality perceptions correspond with lower trust in and use of formal healthcare, they could feed a cycle of stalled population health improvements. Given mortality perceptions are a causal lynchpin in theories of demographic change and may be a harbinger of skepticism about formal healthcare, identifying the social factors that inform such perceptions is of critical importance. Grounded in life course theory and social learning theory, the proposed study will leverage detailed kin history data to offer the first empirical analysis of whether kin network mortality experiences are principal determinants of mortality perceptions in adulthood. The project will also offer the first empirical assessment of whether mortality perceptions are intimately entwined with schemas of formal healthcare and use of health services. The project will rely on data from Tsogolo la Thanzi, a study of women in Balaka, Malawi (2009-2019), which features full kin history data; subjective probabilities elicited with an interactive technique; comprehensive information on women’s healthcare use; and rich measures of women’s recent network mortality, sociodemographic factors, personality traits, health, and additional subjective perceptions. The study will offer a comprehensive, life course overview of experiences of kin loss, including the type, intensity, and timing of deaths from before one’s birth through young adulthood (Aim 1). With multiple indicators of kin loss generated through the completion of Aim 1, the study will identify which experiences of kin loss pattern women’s subjective perceptions of community mortality conditions (Aim 2). The study will then establish how both kin mortality and mortality perceptions relate to perceptions and use of formal healthcare (Aim 3). Together, the results from this research will address a longstanding puzzle in demography by clarifying whether kin network experiences can complicate the potential for individuals to readily perceive and react to mortality decline and will clarify the broader relevance of this for population health. Given evidence that adults’ perceptions are modifiable, the proposed research will offer critical knowledge for the implementation of effective interventions in Malawi.