Conducting Social Network and Social Norm Research in Low-Resource Settings: Food Insecurity, Depression, and HIV Testing in Rural Uganda

Abstract

This dissertation examines the role of social networks and social norms in health outcomes and behaviors among low-and middle-income countries (LMICs), with a particular focus on Uganda. Paper 1 presents a systematic review of sociocentric network studies conducted in LMICs on health-related outcomes and other development topics. I first discuss the sociocentric network study designs employed in 36 selected papers, and provide a catalog of 105 name generator questions used to measure social ties. Second, I show that network composition, individual network centrality, and network structure are associated with health behaviors and health and development outcomes in different contexts across multiple levels of analysis and across distinct network types. Lastly, I highlight opportunities for health researchers and practitioners in LMICs to 1) design effective studies and interventions that account for the sociocentric network positions of certain individuals and overall network structure, 2) measure the spread of outcomes or intervention externalities, and 3) enhance the effectiveness and efficiency of aid based on knowledge of social structure. Papers 2 and 3 exploit a population-based dataset on eight villages from rural Southwest Uganda, arising from a pilot study which myself and colleagues designed to collect sociocentric network data. There were a total of 1,669 adults interviewed representing a response rate of 96%. Paper 2 assesses the relationship between food insecurity and depression symptom severity in the general adult population, and the potential confounding or moderating roles of social network position, structure, and composition in that relationship. I find that severe and moderate food insecurity was associated with greater depression symptom severity among both men and women, and that none of the social network characteristics were directly associated with the outcome. Moreover, there were no interactions between food insecurity and network characteristics among women. For severely food insecure men, however, personal network centrality was positively associated with symptoms and personal network poverty composition was negatively associated with symptoms. Findings reveal that nutrition interventions aimed at improving food security in rural areas may have significant beneficial effects in terms of mental health outcomes for the whole population. I discuss the possible role of shame in affecting depression among severely food insecure men with wealthier networks and in more central network locations. Paper 3 examines the extent to which individuals underestimate the prevalence of HIV testing in their village and misperceive the norm, and also assesses the relationship between perception of the HIV testing norm in one’s village with personally never having been tested. I find that although a majority of people had been tested in each of the villages, a majority of people underestimated the actual prevalence and thought that testing was not normative. Men who perceived testing as not normative were much more likely to never have been tested, and both men and women who felt they didn’t know anything about the norm were also more likely to never have been tested. Results suggest that interventions promoting true HIV testing norms may help increase uptake of testing.