# Kin Network Experiences, Mortality Perceptions, and Health Behaviors in Malawi

> **NIH NIH R03** · UNIVERSITY OF SOUTHERN CALIFORNIA · 2023 · $82,500

## Abstract

Project Summary
Child mortality rates have declined dramatically over the past 40 years, especially in African countries like
Malawi. Yet, research shows that many individuals in the communities experiencing this swift change do not
perceive it but think instead that mortality levels are far higher than empirically true or even increasing. We lack
a comprehensive assessment of the social experiences that encourage these distorted perceptions of community
mortality conditions. Additionally, key but untested hypotheses hold that mortality perceptions may be entwined
with schemas of healthcare; if elevated mortality perceptions correspond with lower trust in and use of formal
healthcare, they could feed a cycle of stalled population health improvements. Given mortality perceptions are a
causal lynchpin in theories of demographic change and may be a harbinger of skepticism about formal
healthcare, identifying the social factors that inform such perceptions is of critical importance. Grounded in life
course theory and social learning theory, the proposed study will leverage detailed kin history data to offer the
first empirical analysis of whether kin network mortality experiences are principal determinants of mortality
perceptions in adulthood. The project will also offer the first empirical assessment of whether mortality
perceptions are intimately entwined with schemas of formal healthcare and use of health services. The project
will rely on data from Tsogolo la Thanzi, a study of women in Balaka, Malawi (2009-2019), which features full
kin history data; subjective probabilities elicited with an interactive technique; comprehensive information on
women’s healthcare use; and rich measures of women’s recent network mortality, sociodemographic factors,
personality traits, health, and additional subjective perceptions. The study will offer a comprehensive, life course
overview of experiences of kin loss, including the type, intensity, and timing of deaths from before one’s birth
through young adulthood (Aim 1). With multiple indicators of kin loss generated through the completion of Aim
1, the study will identify which experiences of kin loss pattern women’s subjective perceptions of community
mortality conditions (Aim 2). The study will then establish how both kin mortality and mortality perceptions relate
to perceptions and use of formal healthcare (Aim 3). Together, the results from this research will address a
longstanding puzzle in demography by clarifying whether kin network experiences can complicate the potential
for individuals to readily perceive and react to mortality decline and will clarify the broader relevance of this for
population health. Given evidence that adults’ perceptions are modifiable, the proposed research will offer critical
knowledge for the implementation of effective interventions in Malawi.

## Key facts

- **NIH application ID:** 10612907
- **Project number:** 5R03HD105834-02
- **Recipient organization:** UNIVERSITY OF SOUTHERN CALIFORNIA
- **Principal Investigator:** Emily Smith-Greenaway
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $82,500
- **Award type:** 5
- **Project period:** 2022-05-01 → 2025-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10612907

## Citation

> US National Institutes of Health, RePORTER application 10612907, Kin Network Experiences, Mortality Perceptions, and Health Behaviors in Malawi (5R03HD105834-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10612907. Licensed CC0.

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