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

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

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

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

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

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

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

Description of the study villages

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

Change in FP discussion networks

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

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

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

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

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

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

Final SIENA Models

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

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

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

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

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

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