Effects of social network diversity in the disablement process: a comparison of causal inference methods and an outcome-wide approach to the Indonesian Family Life Surveys, 2007–2015

Abstract

Background: Social networks (SN) have been proven to be instrumental for healthy aging and function as important safety nets, particular for older adults in low and middle-income countries (LMICs). Despite the importance of interpreting health outcomes in terms of SN, in many LMICsincluding Indonesiaepidemiological studies and policy responses on the health effects of SN for aging populations are still uncommon. Using outcome-wide multi-method approaches to longitudinal panel data, this study aims to outline more clearly the role of SN diversity in the aging process in Indonesia. We explore whether and to what degree there is an association of SN diversity with adult health outcomes and investigate potential gender differences, heterogeneous treatment effects, and effect gradients along disablement processes. Methods: Data came from the fourth and fifth waves of the Indonesian Family Life Survey fielded in 2007-08 and 2014-15. The analytic sample consisted of 3060 adults aged 50+ years. The primary exposure variable was the diversity of respondents' SN at baseline. This was measured through a social network index (SNI), conjoining information about household size together with a range of social ties with whom respondents had active contact across six different types of role relationships. Guided by the disablement process model, a battery of 19 outcomes (8 pathologies, 5 impairments, 4 functional limitations, 2 disabilities) were included into analyses. Evidence for causal effects of SN diversity on health was evaluated using outcomewide multivariable regression adjustment (RA), propensity score matching (PSM), and instrumental variable (IV) analyses. Results: At baseline, 60% of respondents had a low SNI. Results from the RA and PSM models showed greatest concordance and that among women a diverse SN was positively associated with pulmonary outcomes and upper and lower body functions. Both men and women with a high SNI reported less limitations in performing activities of daily living (ADL) and instrumental ADL (IADL) tasks. A high SNI was negatively associated with C-reactive protein levels in women. The IV analyses yielded positive associations with cognitive functions for both men and women.

‘The Devil’s Company’: A Grounded Theory Study on Aging, Loneliness and Social Change Among ‘Older Adult Children’ in Rural Indonesia

“…To the best of our knowledge, our study is one of the first to incorporate how precarity and loneliness interrelate in the lifeworld of OACs in a transitioning LMIC context. The pathways through which social networks may exacerbate precarious aging trajectories and negatively impact health and wellbeing among aging Indonesian populations have been explored in our previous work on the health effects of social network diversity ( Schröders et al, 2020 ) and the role of network dynamics on healthcare utilization outcomes ( Schröders et al, 2021 ).…”

“…For selecting study areas below regional level, we used socioeconomic development together with the concepts of rurality/ urbanity. Based on the notion that in LMICs in general (Perkins et al, 2015) and in Indonesia in particular (Schröders et al, 2020) the presence or absence of social networks make a pronounced difference to the ultimate consequences of poverty on people's lives, we decided to purposively sample two regencies which vary significantly with regards to their poverty levels and human development indices (HDI): the Sleman regency ranking best within the region with a poverty rate of 8.21% and a HDI of 82.15; and the Gunung Kidul regency ranking last with 19.34% of its population being classified as poor and a HDI of 67.82 [Badan Pusat Statistik (BPS) D. I. Yogyakarta (Statistic Office of the Yogyakarta Special Region), 2018]. Many studies have shown that poverty in Indonesia is strongly related to the socio-cultural tendency of poor people to share their limited assets-a practice that makes people poorer as their social networks expand (Geertz, 1963;Alexander and Alexander, 1982).…”

“…Social networks are important social determinants of health influencing various health outcomes across the life course ( Berkman et al, 2000 ; Ertel et al, 2009 ; Holt-Lunstad et al, 2015 ; Kelly et al, 2017 ; Schröders et al, 2020 ), as well as an important resource when it comes to navigating health care systems ( Valtorta et al, 2018 ; Schröders et al, 2021 ). Particularly in low and middle-income countries (LMICs) with limited social welfare protection, social networks appear to be even more influential, oftentimes ensuring the only chances for health and wellbeing for many vulnerable populations ( Kelly et al, 2014 ; Perkins et al, 2015 ).…”

“…Though Indonesia launched an UHC scheme in 2014, many challenges for the provision for formal LTC and geriatric services remain, i.e., lack of LTC regulations, institutionalized programs, and integration of services, particularly in underserved rural areas ( Mboi, 2015 ; Pisani et al, 2017 ; Agustina et al, 2019 ). In the context of relatively weak formal networks of protection, our previous work has highlighted the importance of informal social networks for affecting both older adults’ health ( Schröders et al, 2020 ) and their healthcare utilization ( Schröders et al, 2021 ).…”

The Challenges in Implementing Mixed Economy of Care Practices in Child Welfare Network in Malaysia

“…Such 'fourth sector' service delivery [15] involves informal neighbouring and time giving on a one-to-one basis in recognition of an 'unmet need' at grassroots level, on the ground. These informal neighborhood community-based services and activities that rely upon localized networks are part of the fabric of rural community life [16], and include a diverse range of activities such as befriending and home visiting by members of church groups, social activities at village halls, informal gatherings and social contact that occurs while accessing services at village post offices or when visiting village pubs [14].…”