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Health Econ Policy Law. 2019 Apr;14(2):231-248. doi: 10.1017/S1744133118000130. Epub 2018 May 22.

Family networks and healthy behaviour: evidence from Nepal.

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1Centre for Global Health Economics,University College London,London,UK.
2Department of Economics,University Ca' Foscari of Venice,Venezia,Italy.
3Department of Economics,University College London,London,UK.
4Institute of Education,University College London,London,UK.
5Centre for Global Health Economics,University College London,London,UK.
6Maternal and Infant Research Activity (MIRA),Kathmandu, Nepal.
7University College London, Institute for Global Health,London, UK.


Models of household decision-making commonly focus on nuclear family members as primary decision-makers. If extended families shape the objectives and constraints of households, then neglecting the role of this network may lead to an incomplete understanding of health-seeking behaviour. Understanding the decision-making processes behind care-seeking may improve behaviour change interventions, better intervention targeting and support health-related development goals. This paper uses data from a cluster randomised trial of a participatory learning and action cycle (PLA) through women's groups, to assess the role of extended family networks as a determinant of gains in health knowledge and health practice. We estimate three models along a continuum of health-seeking behaviour: one that explores access to PLA groups as a conduit of knowledge, another measuring whether women's health knowledge improves after exposure to the PLA groups and a third exploring the determinants of their ability to act on knowledge gained. We find that, in this context, a larger network of family is not associated with women's likelihood of attending groups or acquiring new knowledge, but a larger network of husband's family is negatively associated with the ability to act on that knowledge during pregnancy and the postpartum period.


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