Bantu Social Networks in the Context of Ugandan Behavioral Health
Summary
We know our relationships affect how healthy we are and that our communities give us strength to live good lives. The details of how we are affected, by whom, and under what conditions often remain unknown in local communities. In order for communities to be healthier, we suggest that understanding those local relationships, and we mean relationships with land, ancestors, spirits, and healers, for example, helps the whole community. Better shared knowledge of behaviors common in communities can help the whole community flourish. By collecting and sharing the local wisdom of these communities, we both preserve cherished cultural knowledge and enhance community health. Our study results provide ethnographic insight into health-seeking behaviours shaping communities by including a wider set of social relationships often neglected in field ethnography intended to inform healthcare practices. We explain how more expansive social networks, inclusive of the significance of land and a variety of other non-human actors, facilitates a dialogue between tradition and modernity, between community and individual, and between the tangible and the spiritual. By anchoring our findings in the rich tapestry of Ugandan society, we illuminate pathways that resonate globally, fostering health practices that both medically sound and culturally harmonious.
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Theme
One Health & Food
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Abstract
Target Theme: One Health & Food
Scientific Area: Social Science Health Information from Sub-Saharan Africa
Sub-Theme 1: Indigenous Knowledge and Traditional African Knowledge
Sub-Theme 2: Data Ownership and Governance in Health Research
Purpose and Objectives:
Our study presents qualitative and quantitative data about first-hand accounts of practices and substantive beliefs shaping the actions people take when they face health challenges so that communities can be healthier. For example, some health challenges are best addressed quickly, lest the community member suffer worse outcomes for their condition. How we seek help can thus impact health. If local communities know more about the ways their members seek help (navigate their relationships and engage in health/life-seeking behaviours), then better care can be provided. The objective of the session is to present the scientifically-gathered local information to ensure future clinical tools used in hospitals and by village health workers fit the communities studied in the regions of Buganda and Kigezi. Our semi-structured interview data analyses provide:
–Intercultural knowledge about common practices and substantive beliefs impacting health-seeking behavior in central and southwestern Uganda, inclusive of the significance of land and a variety of other non-human actors. –Greater transparency among Ugandans about their health symptoms, acknowledging when individual biological and psychophysiological processes are the primary source of illness while sharing broader socio-cultural networks influencing health and wellness.
–Awareness of African ancestral relationships shaping past, present, and future communal life.
–A shift in global medical paradigm to recognize the profound role of communal aspects like belonging, moving away from an isolated approach to medicine towards one that comprehends the human’s profound interconnectedness.
–The session material can create mutual understanding and respect could cultivate healthier societies, not just in Uganda and America but globally.
RESEARCH PROBLEM STATEMENT
The research is designed to inform the development of a clinical tool for monitoring and treating brain disease in the aforementioned contexts. The Bantu contexts require a new empirical and theoretical approach (see Mitchell, et. al., 2011 on the need for communicating about health via cell phones in Uganda). Unfortunately, existing efforts to address community members underutilizing health options tend to take a purely patho-physiological, western-style approach, explaining the biological roots of a disease, and the medical advantages of prompt care, but don’t address the socio-cultural and spiritual factors that contribute to disease stigmatization (le Roux-Kemp, 2012). For example, Bain et al. (2013) recommend that “The National Epilepsy Programme must insist on modes of transmission, treatment options and first aid measures during epileptic seizures.” Yet it is no simple thing to “insist on modes of transmission” when speaking to an audience with a fundamentally different understanding of personhood, pathological causality, health and wellness. Consequently, there is a pressing need to study the socio-cultural and spiritual factors that underlie health-seeking behaviors in Africa (see Mulumba, et. al., 2021). This study, therefore, presents first-hand accounts of practices and substantive beliefs shaping what actions people take when they face health challenges in order to (1) create healthier communities, and (2) use the scientifically-gathered local information to ensure future clinical tools used in hospitals and by village health workers fit the communities studied in the regions of Buganda and Kigezi.
Hypothesis
The major hypothesis governing our choice of study design is that, although Ugandan communities are rich tapestries of complex relationships, maintained across generations with significant spiritual influences, the social network shaping how people go about seeking help for health challenges both helps and hinders community health. The variations in health-seeking behaviour are nevertheless understudied and subject to change over time. In order to know present practices and substantive beliefs shaping health-seeking behaviours, we must learn from community members. The semi-structured interview process is a field-tested social scientific method for gathering information with rigor from community members, information that can also be systematically analysed. Our study design thus arises from the principle that local information must first be gathered about what community members do, and what they believe about what they are doing, when they face health challenges, in order that future community health interventions are built on sound scientific data. Additionally, the semi-structured interviews allow for mixed-methods research since the qualitative content gathered in the interviews can also be analyzed using quantitative methods, thereby yielding a more scientifically robust account of what is learned within the interviews. Finally, the mixed-methods research further protects the community members interviewed by anonymizing and de-identifying data as it is analyzed, visualized, and presented.
Since we are using the mixed-methods (qualitative + quantitative) research model of the semi-structured interview, then, our major objective for choosing this method is for its utility in gathering local knowledge with rigor and systematic data-gathering practices so that communities can better understand themselves through their health-seeking behaviours and thereby better assist one another when facing health challenges. Our research shall provide a snapshot in time of what community members here and now are doing and believing so that future health interventions designed for these Bantu communities can take into consideration the varied social networks of their population. We know from the scientific research and publications of our lab partners in the USA that clarity about these social networks can improve care and health outcomes. However, the social networks in Uganda are different and our data from the regions of Buganda and Kigezi will advance cultural and scientific knowledge for present practitioners and future generations.
Uganda Personal Data Protection and Privacy Act (2019) In accordance with the Personal Data Protection and Privacy Act (2019), the “data controllers” are the designated hospital personnel within Uganda. This means that the data is owned, protected, and shared by Ugandan institutions.Uganda Personal Data Protection and Privacy Act (2019) In accordance with best practices for Uganda Data Protection laws, the data generated from the interviews is owned, operated, and protected by the Ugandan hospitals conducting the research. The research is funded by the Templeton World Charity Foundation (#20714) and granted to Brigham and Women’s Hospital, Boston, Massachusetts, the partner institution for the presented research.
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Expected outcomes
The scientific results we present from our international collaboration best match “Good Health and Well-Being” (SDG 3), “Sustainable Cities and Communities” (SDG 11), and “Partnerships for the Goals” (SDG 17). The results are part of a longer research study from a stroke health research lab in the Department of Neurology at the Brigham and Women’s Hospital and Harvard Medical School: the Dhand Lab and its subsidiary, The Human Network Initiative. At the Dhand Lab, we “aim to expand the view of a patient from a solitary person to an individual embedded in a social network. Our group quantitatively maps patients’ social networks, meaning the connections to family, friends, and acquaintances. We think deeply about the effects of illness on this network and the network effects on illness trajectories. Our findings suggest that social networks are an under-recognized factor in clinical studies and interventions, and may be harnessed to improve patients’ lives. We study social networks in various illnesses including stroke, heart attacks, multiple sclerosis, concussions, and normal aging” (https://www.dhandlab.com/).
Additionally, The Human Network Initiative we “use the tools of the humanities, medicine and the sciences to explore human interconnectedness, and advocate for a more communal, less individualistic understanding of the human person. We believe that humans are, as Aristotle puts it, the political animal, at home in the dense, complicated social web of the polis (the city) and ill-equipped to thrive in isolation. We are inescapably interdependent and vulnerable – we need each other, and this need is not a defect or a failing. It is a central genius and beauty of our species” (https://www.humannetworkinitiative.com/).
Background:
Accordingly, our team has experience with community health in the regions of Buganda and Kigezi as well as in the USA in Boston, Massachusetts. The research study originates in Uganda and shares the work with health professionals and professors at the Brigham and Women’s Hospital in Massachusetts. The specialists in the USA are research experts in stroke health, particularly the ways that social networks impact stroke health patients. We received funding from the international granting agency called the Templeton World Charity Foundation (TWCF) which funds (generally speaking) research in science and religion. We partner with four hospitals in Uganda to understand the fullest cultural set of influences on community health in Uganda, respecting and listening to especially the religious and spiritual traditions that are deeply embedded in Ugandan life. We thus bring science and religion together by learning from community members (1) who they are, (2) to whom they belong, and (3) how those ways of belonging to one another are navigated, i.e. what practices and substantive beliefs shape our behaviors. We must also emphasize that the Bantu social networks we are studying pay very close attention to the fully-expansive network common to Ugandans, including, though not exclusive to, life-giving relationships in how people relate to animals, ancestors, clan, family, God, healers, land, plants, spirits, and a supreme being/creator. The research presented here is also the first installment, the first prong, in a larger research project funded by the Templeton World Charity Foundation (TWCF) called “Buffering, Porosity and Brain Health in Uganda” (#20714). The final intention of that project is to create a clinical tool for stroke patients. The clinical tool will be a Bantu survey instrument for mapping the social networks of patients so that families and healthcare professionals can know better how influential relationships impact health-seeking behaviors as well as recovery practices. The study proposed here is foundational to the creation of that tool so that the survey is sufficiently sensitive to the Bantu communities to be served. Context of Global Stroke Health: Delayed arrival to the hospital (in stroke, for example) is a major unsolved problem in public health that leads to stark and persistent racial and socioeconomic disparities in health outcomes. Sub-Saharan Africa is experiencing an increase in diseases such as stroke, epilepsy, meningitis, and chronic headaches; the yearly age-adjusted rates of stroke in the 15-64 age group is four times the rate common in developed countries. The Dhand Lab specializes in stroke care and social network analytics. The present protocol is an extension of that Lab’s expertise into East Africa. The most common reason for delay in care-seeking is the time spent by the patient (and witnesses) who decide together to watch and wait or go to the hospital or clinic. Therefore, we propose that social connectedness is a major determinant of the delay phenomenon. Our team has demonstrated that the social network structure around a specific patient determines the flow of information that leads to decisions to act rapidly or slowly. Patients who arrived early had large and loosely connected networks, while those who arrived late had small and close-knit networks. What remains lacking, however, is knowledge of the extent of the social network effect in a more diverse population. This understanding is critical to establishing rigor and premise for future social network interventions to reduce disparities in health outcomes. Our long-term goal is to design network-based interventions that reduce delay during the stroke and ensure equitable access to therapies. Therefore, in this project, we use a dual empirical and social simulation approach to characterize and model social network effects in a diverse patient populations in Uganda.
Specific Aims and Objectives Aim
1 – Hypothesis: A complex social network of ties (i.e. relationships), inclusive of the significance of land and a variety of other non-human actors, significantly shapes health-seeking decisions in Buganda and Kigezi communities.
1. Hypothesis 1A: Kinship relations, including ancestral and spiritual actors, strongly influence health-seeking behavior.
2. Hypothesis 1B: Expressed willingness to seek healthcare assistance will be attenuated among those with large, porous social networks, compared to those with small, less porous social networks.
Objective:
Present the diversity of community perspectives on expansive social networks (encompassing the significance of land and a variety of other non-human actors) to inform the future design of a clinical tool for future use with stroke health patients within Buganda and Kigezi communities.
We welcome interdisciplinary collaboration. Key words Health, Partnership, Community, Behavior, Hospitals, Medicine, Beliefs, Subsidiarity