Exploring how structural and cognitive social capital influence preventive health behavior: Evidence from a Bottom of the Pyramid (BoP) population

Abstract

Purpose: People living on poverty-level incomes in developing nations face unique health challenges as compared to those in developed nations. New insights emerge from a bottom of the pyramid context (India) where culture-based health notions, preventive orientation and health resources differ from developed western health orientations and resources. The purpose of this paper is to explore how structural and cognitive social capital indirectly influence preventive health behavior (PHB) through perceived health value.

Design/methodology/approach: The participants for this study include rural people from Tamil Nadu, a state of India who are classified as those living below poverty level based on a per capita/per day consumption expenditure of Rupees 22.50 (an equivalent of US$0.40 a per capita/per day) (Planning Commission, Government of India, 2012). The study included a total number of 635 participants (312 males and 323 females). Relatively a high response rate (79 percent) was achieved through personal contacts and telephone solicitation, cash incentive and multiple follow-ups. Participants completed a questionnaire assessing structural and cognitive social capital, preventative health behavior, perceived health value, and health locus of control (HLC).

Findings: The results show that perceived health value mediates the relationship between cognitive social capital and PHB. Specifically, cognitive social capital influences BoP people’s assessment of benefits of engaging in PHB, that, in turn, influences PHB. In addition, the findings showed that HLC moderates the effect of social capital on PHB. Social capital positively related to enhanced PHB only among those who believe that health outcomes are controllable.

Originality/value: The authors findings indicate that cognitive social capital has enormous potential in promoting health intervention and the health of poor communities, a sentiment shared by prior researchers (Glenane-Antoniadis et al., 2003; Fisher et al., 2004; Martin et al., 2004; Weitzman and Kawachi, 2000). Overall, from a theoretical, empirical and methodological perspective, the current study offers a unique contribution to the social capital and PHB literature. First, drawing from the HBM and HLC, the findings provide a more nuanced explanation of how distinct aspects of social capital predict PHB. Specifically, the relationship between social capital and PHB is qualified by the extent one perceives personal control over her health. In addition, the cognitive component of social capital influences PHB through perceptions of health value.