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

项目摘要 在过去的40年里，儿童死亡率大幅下降，特别是在非洲国家，如 马拉维。然而，研究表明，在经历这种快速变化的社区中，许多人并没有 意识到这一点，但要相反地认为，死亡率水平远远高于经验上的真实水平，甚至是不断上升的水平。我们缺少 对助长这些扭曲的社区观念的社会经历的全面评估 死亡条件。此外，关键但未经检验的假设认为，人们对死亡率的看法可能是相互交织的。 对于医疗保健的模式；如果死亡率的提高与对形式的信任和使用的降低相对应 在医疗保健方面，它们可能会助长人口健康改善停滞不前的循环。鉴于死亡率的认知是一种 人口变化理论中的因果关键，可能是对正式的怀疑论的先兆 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，建议的研究将利用详细的亲属历史数据来提供 亲属网络死亡经历是否是死亡率的主要决定因素的首次实证分析 成人期的认知。该项目还将首次对死亡率进行实证评估 人们的看法与正规医疗保健和医疗服务使用的模式密切相关。该项目 将依赖于Tsogolo la Thanzi的数据，这是一项针对马拉维巴拉卡妇女的研究(2009-2019年)，该研究以完整的 亲属病史数据.用交互技术得出的主观概率.综合信息 妇女保健使用情况；以及妇女近期网络死亡率、社会人口因素、 人格特征、健康和额外的主观认知。这项研究将提供一个全面的、生活的过程 亲人丧亡经历概述，包括出生前死亡的类型、强度和时间 通过青壮年(目标1)。通过完成AIM而产生多个亲属损失指标 1、本研究将确定哪些失亲经历模式的女性对社区的主观感知 死亡条件(目标2)。然后，这项研究将确定亲属死亡率和死亡率认知之间的关系。 对正规医疗保健的认知和使用(目标3)。总而言之，这项研究的结果将解决 通过澄清亲属网络经历是否会使潜力复杂化，这是人口学中长期存在的难题 让个人容易地感知死亡率下降并对其做出反应，并将阐明这一点与 人口健康。鉴于有证据表明成年人的认知是可以修改的，这项拟议的研究将提供关键的 在马拉维实施有效干预的知识。

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.