Leveraging Social Networks and Linkage to Care to Foster Healthy Aging in a Low-Income Context

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PROJECT SUMMARY Sub-Saharan African low-income countries (SSA LICs) have yet to develop effective and viable policies and health systems responses to foster healthy aging among a growing elderly population that is poorly served by overstretched health systems. While behavioral and health system change is challenging in any context, this challenge is exacerbated in SSA LICs as non-communicable diseases (NCDs) and aging-related diseases are an emerging—rather than established—disease burden. As a result, there prevails a poor understanding of risk factors, symptoms, treatment and prevention options. In addition, health systems are often limited with inade- quately trained health providers and frequent resource scarcity available to meet the aging-related health needs of older people. This project leverages the Mature Adults Cohort of the Malawi Longitudinal Study of Fami- lies and Health (MLSFH-MAC), one of the very few ongoing longitudinal population-based aging studies in a SSA LIC, for explorative research with the ultimate goal to inform the development of cost-effective and sus- tainable interventions that target social networks and social diffusion as an effective strategy to foster healthy aging among older persons. We focus specifically on the 3Cs: cardiovascular diseases (CVDs), poor cognitive and mental health, and chronic musculoskeletal pain. These 3Cs are among the most demanding and socially costly, but generally malleable health burdens for aging populations in SSA LICs and globally. The Overall Aim is to understand social interactions about healthy aging, identify the social processes affecting health-knowledge and health-seeking behavior related to the 3Cs, and generate much needed evidence that will inform innovative intervention designs that leverage social dynamics to foster healthy-aging through sustained behavioral changes and linkages-to-care for older people most at risk and/or most affected by the 3Cs. Specific Aim 1 will identify individual, community and health-system factors promoting healthy aging in a SSA LIC context characterized by low life expectancy and high burden of diseases, including high prevalence of HIV/AIDS. Specific Aim 2 will investigate the pathways through which 3Cs-related health information is diffused through social networks in rural LIC communities characterized by low knowledge about risk factors, disease symptoms, treatment options, and limited exposure to 3Cs-related preventive care. Based on the generated evidence from MLSFH-MAC and guided by theories of behavioral change, Specific Aim 3 will initiate the development of an innovative social- network-based intervention design to foster healthy aging among the elderly in rural SSA LICs contexts, with the focus on pathways for: (a) improving 3Cs-related health-knowledge through social diffusion of information and behavioral norms, and (b) using social networks to enhance the linkage-to-care of the elderly affected by the 3Cs who are most likely to benefit given available 3Cs-related resources at local clinics.