Social networks and their impact on access to health care: insights from older widows living alone in Kottayam, South India

Abstract

The feminisation of ageing observed across the world is a significant challenge in many societies. Women's greater longevity is associated with the increased likelihood of age-related disability and morbidity. Furthermore, gendered disadvantage and poverty can make access to health care increasingly problematic in later years. Among the Indian states, Kerala has the highest number of residents above the age of 60 and many are older widows. Given this context, this paper explores what promotes access to health care for older widows living alone in the south Indian state of Kerala. Thirty-two in-depth interviews, eight focus group discussions and eight units of participant observation were carried out among widows, health-care providers and key informants. Applying a reflexive inductive approach to our analysis, the main barriers to access that emerged were altered family structures and loneliness, whilst enablers included good social networks and access to neighbourhood clinics. Our participants’ social networks were drawn from three levels: family, neighbourhood and the wider community. The ability to form a personal community from their social networks and the quality of relationships within this community strongly predicted the capacity to access health care. Efforts to improve access to health care for older widows requires a response that is rooted in the socio-cultural context of the community. Comprehensive social protection policies that promote initiatives to engender social capital among the older population, decentralised primary health-care services, and the training and sensitisation of health service staff would be key to promote equitable access for older widows.

Does the presence of health insurance and health facilities improve access to healthcare for major morbidities among Indigenous communities and older widows in India? Evidence from India Human Development Surveys I and II

“…The social contexts of these communities differ considerably from those of other groups. If they are to be effective, interventions to improve access to treatment need to be sensitive to the macro-level determinants of these communities, such as social status, living conditions, literacy, and access to land and nutrition [ 50 , 51 , 57 ].…”

“…Among the Indigenous communities, the lack of culturally safe healthcare services and issues including power differentials between the community and the health system, and the barriers created by social determinants, were major impediments for the community in accessing healthcare services. Free healthcare provided at primary, secondary and tertiary levels was not, on its own, enough to overcome these barriers and ensure that the community members were able to access treatment when they needed it [ 50 , 51 ].…”

“…Among the older widows living by themselves in Kottayam district, the fieldwork was carried out between November 2018 and January 2019 and again between October 2019 and January 2020. Details regarding the methods, analysis and key findings from the qualitative arm have already been published [ 50 , 51 ].…”

“…This paper forms the quantitative component of a larger mixed methods study that looked at the issue of equitable access to healthcare from the perspective of two excluded communities, Indigenous and widows above the age of 60 (hereafter referred to in this paper as widows), in the south Indian state of Kerala. The qualitative results from this study have already been published and showed how social exclusion played an important role in creating barriers to equitable access for both communities despite the presence of financial protection schemes including health insurance coverage [ 50 , 51 ].…”

Child Marriage and Problems Accessing Healthcare in Adulthood: Evidence from India

“…As such, culturally acceptable community-based interventions to empower women and promoting supportive structures within families may be helpful in improving a child bride’s access to healthcare [ 72 ]. Social policies aimed at promoting social networks and engendering social capital within the community may help as well [ 73 , 74 ]. In addition, national-level policies to promote gender equality and structural interventions to create economic opportunities for women will facilitate child brides’ healthcare access in LMICs [ 75 ].…”