Social Capital and Health in the Developing World: Meaning, Mechanisms, and Measurement

Abstract

The overall goal of this dissertation is to contribute to the understanding of community-based development by exploring the relationship between social capital and health in the developing world. Distinct methodological approaches were applied to each chapter of this dissertation to examine (1) the association between social capital and physical health in the least developed countries, (2) the content validity of the measurement of social capital in Bangladesh, and (3) the relationship between different components of social capital and the utilization of maternal and child health services in India. The study described in Chapter 2 used a systematic literature review process to show that social capital is an important factor for improving health in resource-poor settings; however, more research is needed in order to elucidate the mechanisms through which social capital affects health in the developing world. Chapter 3 used expert reviews, focus group discussions, and cognitive interviews to create a newly adapted social capital survey instrument for use by health and development organizations in Bangladesh. This study highlighted the importance of using cognitive interviews to ensure respondents are able to comprehend key terms, recall important information, and identify appropriate responses about social capital. Chapter 4 used exploratory factor analysis and multilevel logistic regression models to demonstrate that social capital operates at the community level in association with the utilization of antenatal care, professional delivery care, and childhood immunizations in India. Specifically, components of social capital that led to heterogeneous bridging ties were positively associated with all three types of health services, whereas components of social capital that led to strong bonding ties were negatively associated with use of preventive care, but positively associated with professional delivery care. Taken together, these three studies emphasized the theoretical and operational complexity of the concept of social capital and the importance of distinguishing between different components of social capital in order to understand their differential association with health behaviors. Policy implications include the need to develop innovative ways to strengthen community-level aspects of social relationships (social capital), while also making contributions to social resources available to individuals within communities (human and economic capital).