Program-stimulated change in network composition and behavior related to family planning in Ghana

1. Program-stimulated change in network composition and behavior related to family planning in Ghana Nepal Marc Boulay Dynamics of Networks and Behavior Symposium XXIV International Social Network Conference Portoroz, Slovenia May 11, 2004

2. Social Networks and FP • Widely believed that social networks exert a strong influence on contraceptive behavior • This influence can be positive or negative • Favorable networks consistently associated with contraceptive adoption • Survey and anecdotal evidence has linked non-use to negative information women learn from peers

3. FP communication programs • Often promote discussions about FP as one mechanism for behavior change • Evaluations consistently show an association between exposure and FP discussion • Unclear whether these program-stimulated discussions result in a network favorable to contraceptive use

4. Other factors that may also influence composition of FP discussion network • Proximity • Likelihood of interaction • Ethnic Homophily • Similarity in language • Contraceptive use status • Information from expert sources • Confirmation/Dissonance reduction

5. Research Questions • What factors influence the selection of FP discussion partners within the study villages? • Ethnic homophily, contraceptive use • Does program exposure influence selection, particularly of contraceptive users? • Is a positive change in network composition associated with contraceptive adoption?

6. Nepal Radio Communication Project (RCP) • USAID-funded project to promote FP among couples in Nepal • Weekly radio drama • Residents of fictional village modeled interpersonal communication regarding FP • Broadcast between 1995-2000

7. Study Design • Site: 3 villages in Dang District, Nepal • Sample: Nearly all CMWRA (15-49 years) in November 1997 & March 1999 • Wave 1: n = 350 (response rate = 98.6%) • Wave 2: n = 337 (response rate = 83.0%) • Present in both surveys: n = 281 • Collected sociometric data • Women living in your village with whom you have discussed FP during the past six months

8. Description of the study villages

9. Analysis plan for change in network composition • Description of change in networks • Bivariate examination of change using binomial test • Multivariate analysis using SIENA

10. Change in FP discussion networks

11. Odds ratios for addition of a FP discussion partner to network Source: 1997 and 1999 Nepal Social Network Surveys *p<0.05 Adjusted for age, education, parity, village of residence, and ethnic group H-W standard errors accounting for within-village correlation

12. Observed and expected addition of Tharus to network, by ethnicity of ego

13. Observed and expected addition of contraceptive users to network, by contraceptive use of ego

14. Observed and expected addition of contraceptive users to network, by program exposure of ego

15. SIENA Analysis • Allowed for changing composition of networks • Assumed a constant rate function • Stepwise addition of variables into objective function • Final models confirmed using an independent run (initial parameter estimates = 0)

16. Variables in SIENA Analysis • Network effects • Ethnic similarity • Dichotomous variable (Tharu, non-Tharu) • Contraceptive Use in 1997 • Ego use, alter use, similarity • Program Exposure in 1997 • Ego exposure, alter exposure, • Ego Exposure X Alter FP Use Interaction • Dyadic covariate (= 1 if i exposed and j using FP, otherwise = 0)

17. Final SIENA Models

18. Analysis plan for adoption of FP between 1997 and 1999 • Analysis restricted to 170 non-users in 1997 interviewed in both survey waves • Huber-White standard errors used to account for interdependence of observations • Interdependence based on shared membership in a weakly-connected component • 216 connected components identified

19. Percent of adopters by presence of a contraceptive user in discussion network Source: 1997 and 1999 Nepal Social Network Surveys

20. Adjusted coefficients from a logistic regression model predicting adoption of a FP method Source: 1997 and 1999 Nepal Social Network Surveys N=170 *p<0.05 Adjusted for age, education, parity, village of residence, and ethnic group H-W standard errors accounting for within-component correlation

21. Conclusions • Effect of contraceptive use and program exposure on network change varies • No evidence that program exposure directly promotes network composition favorable to FP • Addition of a FP user to network appears to facilitate contraceptive use

22. Limitations • Small number of networks limits ability to assess differences across networks • Underreporting of FP discussion partners • Time between measures was fairly long • With only 2 waves, it is still difficult to establish time order between addition of FP user to network and FP adoption

23. Next steps • Rerun analyses with Ghana data when available • lower prevalence of FP Use • greater number of networks (9) • Explore role of community group participation on network change