Social Capital and the Improvement in Functional Ability among Older People in Japan: A Multilevel Survival Analysis Using JAGES Data.
ABSTRACT: We investigated the contextual effects of community social capital on functional ability among older people with functional disability in Japan, and the cross-level interaction effects between community social capital and individual psychosocial characteristics. We used data from the Japan Gerontological Evaluation Study for 1936 men and 2207 women nested within 320 communities and followed for 46 months. We used objective data for functional ability trajectories derived from the national long-term care-insurance system, and a validated measure of health-related community social capital comprising three components: civic participation, social cohesion, and reciprocity. A multilevel survival analysis with a community-level random intercept showed that in communities with high civic participation, women who actively participated in any community group showed greater functional ability improvement than did women who did not participate (pinteraction = 0.05). In communities with high social cohesion, older men who perceived that their communities' social cohesion was high showed greater functional ability improvement than men who perceived it to be low (pinteraction = 0.02). Community social capital can thus affect functional ability improvements variously, depending on individual psychosocial characteristics and gender. Community interventions aiming to foster social capital should focus on people who are excluded from existing opportunities to participate.
Project description:OBJECTIVE:The present study examined the association between community social capital and the onset of functional disability among older Japanese people by using validated indicators of social capital and a prospective multilevel design. DESIGN:Prospective cohort study SETTING: We used data from the Japan Gerontological Evaluation Study, established from August 2010 to January 2012 in 323 districts. PARTICIPANTS:The target population was restricted to non-institutionalised people aged 65 years or older who were independent in activities of daily living. Participants included 73 021 people (34 051 men and 38 970 women) who were followed up over a 3-year period. PRIMARY OUTCOME MEASURE:The primary outcome measure was the onset of functional disability, defined as a new registration in public long-term care insurance system records with a care-needs level of two or above, analysed with multilevel Cox proportional hazards regression models by community social capital (civic participation, social cohesion and reciprocity). RESULTS:The mean age of participants was 73.3 years (SD=6.0) for men and 73.8 years (SD=6.2) for women. During the study period, the onset of functional disability occurred in 1465 (4.3%) men and 1519 (3.9%) women. Of three community social capital variables, social cohesion significantly reduced the risk of onset of functional disability (HR 0.910; 95% CI 0.830 to 0.998) among men, after adjusting for individual social and behavioural variables. There was no significant effect among women. CONCLUSIONS:Living in a community with rich social cohesion is associated with a lower incidence of onset of functional disability among older Japanese men.
Project description:BACKGROUND:This study aimed to examine the contextual effects of community-level social capital on the onset of depressive symptoms using a longitudinal study design. METHODS:We used questionnaire data from the 2010 and 2013 waves of the Japan Gerontological Evaluation Study that included 14,465 men and 14,600 women aged over 65 years from 295 communities. We also used data of a three-wave panel (2006-2010-2013) to test the robustness of the findings (n = 7,424). Using sex-stratified multilevel logistic regression, we investigated the lagged associations between three scales of baseline community social capital and the development of depressive symptoms. RESULTS:Community civic participation was inversely associated with the onset of depressive symptoms (men: adjusted odds ratio [AOR] 0.93; 95% confidence interval [CI], 0.88-0.99 and women: AOR 0.94; 95% CI, 0.88-0.997 per 1 standard deviation unit change in the score), while no such association was found in relation to the other two scales on social cohesion and reciprocity. This association was attenuated by the adjustment of individual responses to the civic participation component. Individual-level scores corresponding to all three community social capital components were significantly associated with lower risks for depressive symptoms. The results using the three-wave data set showed statistically less clear but similar associations. CONCLUSIONS:Promoting environment and services enhancing to community group participation might help mitigate the impact of late-life depression in an aging society.
Project description:Although studies have suggested that community social capital contributes to narrow income-based inequality in depression, the impacts may depend on its components. Our multilevel cross-sectional analysis of data from 42,208 men and 45,448 women aged 65 years or older living in 565 school districts in Japan found that higher community-level civic participation (i.e., average levels of group participation in the community) was positively associated with the prevalence of depressive symptoms among the low-income groups, independent of individual levels of group participation. Two other social capital components (cohesion and reciprocity) did not significantly alter the association between income and depressive symptoms.
Project description:We developed and validated an instrument to measure community-level social capital based on data derived from older community dwellers in Japan.We used cross-sectional data from the Japan Gerontological Evaluation Study, a nationwide survey involving 123,760 functionally independent older people nested within 702 communities (i.e., school districts). We conducted exploratory and confirmatory factor analyses on survey items to determine the items in a multi-dimensional scale to measure community social capital. Internal consistency was checked with Cronbach's alpha. Convergent construct validity was assessed via correlating the scale with health outcomes.From 53 candidate variables, 11 community-level variables were extracted: participation in volunteer groups, sports groups, hobby activities, study or cultural groups, and activities for teaching specific skills; trust, norms of reciprocity, and attachment to one's community; received emotional support; provided emotional support; and received instrumental support. Using factor analysis, these variables were determined to belong to three sub-scales: civic participation (eigenvalue = 3.317, ? = 0.797), social cohesion (eigenvalue = 2.633, ? = 0.853), and reciprocity (eigenvalue = 1.424, ? = 0.732). Confirmatory factor analysis indicated the goodness of fit of this model. Multilevel Poisson regression analysis revealed that civic participation score was robustly associated with individual subjective health (Self-Rated Health: prevalence ratio [PR] 0.96; 95% confidence interval [CI], 0.94-0.98; Geriatric Depression Scale [GDS]: PR 0.95; 95% CI, 0.93-0.97). Reciprocity score was also associated with individual GDS (PR 0.98; 95% CI, 0.96-1.00). Social cohesion score was not consistently associated with individual health indicators.Our scale for measuring social capital at the community level might be useful for future studies of older community dwellers.
Project description:It has been shown that community-level social capital may affect residents' health. The present mixed ecological study assesses the evidence for an association between the community-level social capital and the individual level of self-rated health. The Hakui City Health Interview Survey targeted 15,242 people aged 40 years and older from 11 communities. Among them, 6578 residents responded to the questionnaire (response rate, 43.2%). We examined whether the community-level social capital (general trust, norm, and civic participation) was associated with the individual level of self-rated health. Overall, 1919 (29.1%) answers of self-rated poor health were identified. Community-level civic participation was negatively associated with poor self-rated health after adjusting for individual demographic factors, individual social capitals, and community-level economic status, whereas community-level general trust, and norm were not significant. The findings suggest the importance of fostering communities with high civic participation to reduce the poor health status of residents.
Project description:Instrumental activities of daily living (IADL) represent the most relevant action capacity in older people with regard to independent living. Previous studies have reported that there are geographical disparities in IADL decline. This study examined the associations between each element of community-level social capital (SC) and IADL disability. This prospective cohort study conducted between 2010 and 2013 by the Japan Gerontological Evaluation Study (JAGES) surveyed 30,587 people aged 65 years or older without long-term care requirements in 380 communities throughout Japan. Multilevel logistic-regression analyses were used to determine whether association exists between community-level SC (i.e., civic participation, social cohesion, and reciprocity) and IADL disability, with adjustment for individual-level SC and covariates such as demographic variables, socioeconomic status, health status, and behavior. At three-year follow-up, 2886 respondents (9.4%) had suffered IADL disability. Residents in a community with higher civic participation showed significantly lower IADL disability (odds ratio: 0.90 per 1 standard deviation increase in civic participation score, 95% confidence interval: 0.84⁻0.96) after adjustment for covariates. Two other community-level SC elements showed no significant associations with IADL disability. Our findings suggest that community-based interventions to promote community-level civic participation could help prevent or reduce IADL disability in older people.
Project description:The National Health Policy (2017) of India advocates Universal Health Coverage through inclusive growth, decentralization, and rebuilding a cohesive community through a participatory process. To achieve this goal, understanding social organization, and community relationships - defined as social capital - is critical. This study aimed to explore the influence of individual and community-level social capital on a critical health system performance indicator, three-doses of diphtheria-pertussis-tetanus (DPT3) immunization among 12-59 month children, in rural Uttar Pradesh (UP), India. The analysis is based on a cross-sectional survey from two districts of UP, which included 2239 children 12-59 months of age (level 1) from 1749 households (level 2) nested within 346 communities (level 3). We used multilevel confirmatory factor analysis to generate standardized factor scores of social capital constructs (Organizational Participation, Social Support, Trust and Social Cohesion) of the household heads and mothers both at individual and community level, which were then used in the multilevel logistic regressions to explore the independent and contextual effect of social capital on a child's DPT3 immunization status. The result showed only community-level Social Cohesion of the mothers was associated with a child's DPT3 immunization status (Adjusted odds ratio = 1.25, 95% confidence interval = 1.12-1.54; p = 0.04). Beyond its independent effect on utilization of immunization service, the collective Social Cohesion of the mothers significantly modified the relationship of child age, mother's knowledge of immunization, community wealth, and communities' contact with frontline workers with immunization status of the child. With a strong theoretical underpinning, the result substantially contributes to understanding the individual and contextual predictors of immunization service utilization and further advancing the literature of social capital in India. This study can serve as a starting point to catalyze social capital within the health interventions for achieving wellbeing and the collective development of society.
Project description:OBJECTIVE:Having the world's second-largest tobacco-consuming population, tobacco control is a priority agenda of the Indian Government. Yet, there is no evidence of how peer influence and nature of social relationships-defined as social capital-affect tobacco use. This study aimed to explore the role of social capital and peer influence on tobacco consumption among household heads in rural Uttar Pradesh (UP), India. DESIGN AND SETTING:This study was embedded within the baseline evaluation of Project Samuday. A cross-sectional multistage cluster survey was implemented in six census blocks of Hardoi and Sitapur districts of UP from June to August 2017. Self-reported tobacco consumption status of randomly selected 6218 household heads (?18 years; men vs women=5312 vs 906) was assessed from 346 rural communities. Peer influence of tobacco use was measured by the non-self cluster proportion of tobacco consumption among respondents. Community engagement, social support, trust and social cohesion were separately measured as unique facets of social capital both at individual and community levels using the Shortened Adapted Social Capital Assessment Tool in India (SASCAT-I). The explanatory power of covariates was assessed using gender-stratified generalised estimating equations (GEE) with robust-variance estimator. RESULT:Tobacco consumption patterns were starkly different for men and women (71% vs 14%). The peer influence only affected men (adjusted odds ratio (AOR)=1.10, 95% CI: 1.05 to 1.16, p<0.01), whereas women were more likely to consume tobacco if they were more engaged with community organisations (AOR=1.33, 95% CI=1.07 to 1.66, p<0.01). CONCLUSION:Gender alters the way social engagement affects tobacco use in rural India. Countering peer influence on Indian men should be prioritised as a tobacco control strategy. Moreover, as gender mainstreaming is a critical egalitarian agenda in India, further research is needed to understand how social engagement affects tobacco consumption behaviours among women.
Project description:Social capital is defined as the nature of the social relationship between individuals or groups and the embedded resources available through their social network. It is considered as a critical determinant of health and well-being. Thus, it is essential to assess the performance of any tool when meaningfully comparing social capital between specific groups. Using measurement invariance (MI) analysis, this paper explored the factor structure of the social capital of men and women measured by a modified Shortened Adapted Social Capital Assessment Tool (SASCAT-I) in rural Uttar Pradesh (UP), India. The study sample comprised 5,287 men (18-101 years) and 7,186 women (15-45 years) from 6,218 randomly selected households who responded to SASCAT-I during a community-level cross-sectional survey. Social capital factor structure was examined by both exploratory and confirmatory factor analysis (CFA), and MI across genders was investigated using multigroup CFA. While disregarding gender, four unique factors (Organizational Participation, Social Support, Trust, and Social Cohesion) represented the structure of social capital. The MI analysis presented a partial metric-invariance indicating factor loadings for Organizational Participation and Social Support were the same across genders. The gender-stratified analysis demonstrated that a four-factor solution was best fitted for both men and women. Men and women of rural UP interpreted social capital differently as the perception of Trust and Social Cohesion varied across genders. For any future applications of SASCAT-I, we recommend gender-stratified factor analysis to quantify social capital's measure, acknowledging its multidimensionality.
Project description:Despite global health improvements, substantial challenges in social determinants of health and poverty remain in rural communities in low-income countries. Public health theorists suggest that communities with high social capital are less vulnerable to such challenges and more likely to participate in community development. This research examines levels of social capital amongst rural communities in southern Malawi through data gathered as part of a participatory needs assessment for a Healthy Settings project, and discusses the potential benefits of having access to such data before project implementation. Social capital data was collected during 108 focus group discussions in 18 communities (split by gender, age, status) by adapting an existing mixed methods measurement tool, the Schutte tool. Five indicators were measured: sense of belonging, friendship, reliance, ability to work together and influence. Mean results showed all 18 communities had medium-high levels of social capital. Means from each group in the 18 communities highlighted the lowest social capital among the youth groups and the highest with the leaders. A more detailed breakdown highlighted that all groups had a strong sense of belonging to the community, while youth and women had lower social capital levels in terms of influence over local decisions and ability to rely on other community members. Incorporating social capital tools into community health needs assessments in low-income settings provides a valuable overview of community dynamics before project implementation, and Monitoring & Evaluation indicators which allow changes in social capital to be measured at different stages of the project.