UCSF

Social capital is features embedded in social networks, such as social norms and trust. This dissertation aimed to deepen understanding of the effect of social capital on health outcomes among people living with HIV (PLWH) in the context of global health.

Chapter two scrutinized the complexity of the concept of social capital to find out which aspects of the concepts play a major role in relation to better health outcomes. Then chapter three reviewed application of the concept in clinical practice; a meta-analysis examining efficacy of mobile phone reminders on improving HIV patients’ return to care. Chapter four applied social capital theoretical framework for PLWH in a resource limited, clinical setting and to inform future studies.

Chapter two identified the importance of social connections over other aspects of social capital such as community participation, trust, and feeling of safety. The findings suggest that social networks to promote health related quality of life among PLWH needed to be strengthened. Also, this study found a mediating effect of engagement with health care providers between social capital and health related quality of life.

Chapter three included nine studies into the systematic meta-analysis and found that PLWH who received mobile phone reminders for their follow-up appointments were two times more likely to return to the care than those who did not received the reminders; however, this estimate was not statistically significant (pooled odd ratio (OR)=2.04, 95% confidence interval (CI): 0.97-4.27). Sensitivity analysis drew stronger evidence of the efficacy of mobile phone reminders on retention in care based on five randomized controlled studies (OR=2.04, 95% CI: 1.11-3.74).

Chapter four found that social capital was an independent predictor of higher quality of life based on a cross-sectional study of 163 PLWH in Dar es Salaam, Tanzania. Women were more likely to have less social capital and report lower quality of life compared to men.

This dissertation contributed to socio-behavioral and nursing research by elucidating the importance of social capital and suggesting clinical implications of social capital to improve health outcomes among PLWH in a global perspective.