Lauren B. Frank

Background: This study identified social and structural factors associated with maternal health care access and utilization in Bangladesh. Methods: Data were collected in early 2014 using a nationally representative, face-to-face survey of 3000 Bangladeshi mothers to infants between 0 and 9 months. Participants reported their knowledge, attitudes, discussions, social norms, structural barriers, agency, and practices for their most recent pregnancy and their self-efficacy for future pregnancies. Hypothesized conceptual models were tested separately for new mothers and for those who previously had children. Results: For both groups, more helpful discussions were associated with more supportive social norms, knowledge, attitudes, and increased antenatal care; perceived barriers to medical care were negatively associated with agency. Although the social and structural environments were important for both new and established mothers, the pattern of relationships was distinct. Conclusions: A woman's attitude and her perceptions around what others in her family and community do or think influence her own antenatal care practices. However, our results suggest that for women who already have a child, interventions should address barriers and women's own perceptions. For first-time mothers, it may be especially important to target other key influencer groups (such as husbands and mothers-in-law) to improve antenatal care practices.

Interpersonal contacts play important roles in women’s health decisions. By using personal network analysis with a focus on specific role relationships, we can better examine interpersonal influences on health decision-making. Data were collected through face-to-face surveys of Hispanic women (N = 1632). Using an ego network name generator and name interpreters, participants detailed their personal networks for discussion about women’s health issues. Participants reported a mean of 1.99 (SD = 1.33) social network contacts with whom they discuss women’s health issues, of whom the most commonly reported contacts were female friends, sisters, mothers, and husbands, boyfriends, or partners. Many of the contacts nominated were family members, yielding a high personal network density (M = 0.84, SD = 0.32). Controlling for participant demographics and other forms of social influence, role relations’ encouragement to get a Pap test and personal network exposure to Pap test discussions were associated with Pap test status. Personal network analysis should leverage information on specific role relations. Given the importance of personal network contacts for women’s health status, health educators and medical professionals must account for women’s personal social networks in developing health interventions.

The purpose of this study is to advance theorizing about how small groups understand health issues through the use of social network analysis. To achieve this goal, an adapted cognitive social structure examines group social norms around a specific health issue, H1N1 flu prevention. As predicted, individual’s attitudes, self-efficacy, and perceived social norms were each positively associated with behavioral intentions for at least one of the H1N1 health behaviors studied. Moreover, collective norms of the whole group were also associated with behavioral intentions, even after controlling for how individual group members perceive those norms. For members of work groups in which pairs were perceived to agree in their support for H1N1 vaccination, the effect of individually perceived group norms on behavioral intentions was stronger than for groups with less agreement.

Increasingly, health communication practitioners are exploring the use of narrative storytelling to convey health information. For this study, a narrative film was produced to provide information about the human papillomavirus (HPV) and cervical cancer prevention. The storyline centered on Lupita, a young woman recently diagnosed with HPV who informs her family about HPV and the availability of the HPV vaccine for her younger sister. The objective was to examine the roles of identification with characters and narrative involvement (made up of three dimensions: involvement, perceived relevance, and immersion) on perceived response efficacy, perceived severity, and perceived susceptibility to HPV and behavior (discussing the HPV vaccine with a health care provider). A random sample of 450 European American, Mexican American, and African American women between the ages of 25 and 45 years, living in the Los Angeles area, was surveyed by phone before, 2 weeks after, and 6 months after viewing the film. The more relevant women found the narrative to their own lives at 2 weeks, the higher they perceived the severity of the virus and the perceived response efficacy of the vaccine to be. Also at 2 weeks, identifying with characters was positively associated with perceived susceptibility to HPV but negatively associated with perceived severity. At 6 months, identification with specific characters was significantly associated with perceived threat and behavior. These findings suggest that different aspects of narrative health messages should be manipulated depending on the specific beliefs and behaviors being targeted. Implications for narrative message design are discussed.

This study explores the role of interpersonal discussion and social norms in a public health campaign, the BBC Condom Normalization Campaign, designed to promote conversation and change the public perception of condom use in India. Drawing upon the integrative model of behavioral prediction, attitudes, self-efficacy, subjective norms, and descriptive norms were predicted to relate to behavioral intentions to use condoms. It is important to note that the valence of discussion was hypothesized to relate to each of these more proximal predictors. The authors used structural equation modeling to test the model on 3 separate samples of Indian men between the ages of 15 and 49 years: (a) high-risk men who had sex with nonspouses; (b) low-risk, sexually inactive, unmarried men; and (c) low-risk, monogamous, married men. Results were similar for low- and high-risk audiences, with valence of discussion about condoms predicting condom-related attitudes, self-efficacy, and subjective and descriptive social norms with respect to condom use, which, in turn, predicted behavioral intent to use condoms. These findings underscore the need to take not only the frequency but also the valence of interpersonal discussion into account when assessing the effect of health campaigns. Implications for theory and design of future public communication campaigns are explored.