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

项目摘要 儿童死亡率在过去40年中大幅下降，特别是在非洲国家， 马拉维.然而，研究表明，在经历这种迅速变化的社区中， 但实际上，死亡率水平远远高于经验上的真实水平，甚至还在上升。我们缺乏 对鼓励这些扭曲的社区观念的社会经历进行全面评估 死亡条件。此外，关键的但未经检验的假设认为，死亡率的看法可能是封闭的， 与医疗保健模式;如果死亡率的看法与对正式医疗保健的信任和使用程度较低相对应， 医疗保健，他们可以养活一个停滞的人口健康改善周期。鉴于死亡率的看法是一个 人口变化理论中的因果关系关键，可能是对正式人口变化理论持怀疑态度的先兆。 在医疗保健方面，确定影响这种看法的社会因素至关重要。扎根于生活 课程理论和社会学习理论，拟议的研究将利用详细的亲属历史数据， 亲属网络死亡经验是否是死亡率的主要决定因素的首次实证分析 成年后的感知该项目还将提供第一个实证评估， 人们的看法与正规保健和使用保健服务的模式密切相关。项目 将依赖于Tsogolo la Thanzi的数据，这是一项对马拉维巴拉卡妇女的研究（2009-2019年）， 亲属史数据;用交互技术引出的主观概率;关于 妇女的医疗保健使用;以及妇女最近的网络死亡率，社会人口因素， 人格特质、健康和其他主观感知。这项研究将提供一个全面的， 亲属丧失经历的概述，包括出生前死亡的类型、强度和时间 1.青年期（Aim 1）随着多个指标的亲属损失产生通过完成目标 1、本研究将确定哪些经历过亲属丧失模式的女性对社区的主观感知 死亡率（目标2）。这项研究将建立如何亲属死亡率和死亡率的看法有关 对正规医疗保健的认知和使用（目标3）。总之，这项研究的结果将解决一个 通过澄清亲属网络经验是否会使潜在的复杂化， 个人容易感知和应对死亡率下降，并将澄清这一更广泛的相关性， 人口健康。鉴于有证据表明，成年人的看法是可以改变的，拟议中的研究将提供关键的 为在马拉维实施有效干预措施提供知识。

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.